The Impact of Head-of-Bed Positioning and Transducer Location on Cerebral Perfusion Pressure Measurement.

Introduction: Head-of-bed (HOB) elevation is the standard of care for patients with intracranial pressure monitoring at risk for intracranial hypertension. Measurement of cerebral perfusion pressure (CPP) based on HOB elevation and arterial transducer position has not been adequately studied.

Methods: This is a planned secondary analysis of prospectively collected data in which paired, serial arterial blood pressure (ABP), intracranial pressure, and CPP measures were obtained once per day for 3 days, with measures leveled at the tragus (Tg) and the phlebostatic axis (PA).

A National Trial on Differences in Cerebral Perfusion Pressure Values by Measurement Location.

Background: Cerebral perfusion pressure (CPP) is a key parameter in management of brain injury with suspected impaired cerebral autoregulation. CPP is calculated by subtracting intracranial pressure (ICP) from mean arterial pressure (MAP). Despite consensus on importance of CPP monitoring, substantial variations exist on anatomical reference points used to measure arterial MAP when calculating CPP.

Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine.

Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals.

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine.

End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions.

Status Epilepticus in Adults: A Review of Diagnosis and Treatment.

Status epilepticus is a medical emergency that requires rapid diagnosis and treatment. Nonconvulsive status epilepticus is frequently underdiagnosed and therefore undertreated, which can lead to permanent neuronal damage resulting in disability or death. Despite the frequent occurrence and morbidity associated with status epilepticus, this topic has received little attention within the literature.

Neuroradiology of the Brain.

A variety of imaging modalities are currently used to evaluate the brain. Prior to the 1970s, neurologic imaging involved radiographs, invasive procedures for spinal and carotid artery air and contrast injection, and painful patient manipulation. The brain was considered inaccessible to imaging and referred to as "the dark continent.

Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management : A Position Statement for Healthcare Professionals from the Neurocritical Care Society.

Devastating brain injuries (DBIs) profoundly damage cerebral function and frequently cause death. DBI survivors admitted to critical care will suffer both intracranial and extracranial effects from their brain injury. The indicators of quality care in DBI are not completely defined, and despite best efforts many patients will not survive, although others may have better outcomes than originally anticipated.

Acute nontraumatic weakness: overview of central nervous system differential diagnosis.

Depending on the causative agent, the differential diagnosis for acute nontraumatic weakness presentation can range from life threatening to trivial. Practitioners' comfort and experience with the rapid identification and evaluation of presenting neurological deficits vary widely. Given this fact and the reality that neurological presentation of weakness is common, the potential for missed diagnosis increases.

Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index.

Background: Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment.

Detraumatizing nurse practitioner orientation.

Health care reform and legislation of restricted resident work hours lead to the evaluation and the changes in health care delivery. In the early 1990s, the Acute Care Nurse Practitioner role evolved to fill the care gaps created by these changes. As the numbers and opportunities for nurse practitioners (NPs) in tertiary settings continue to increase, how to successfully integrate these providers into the health care setting becomes more of a challenge with limited published assimilation models to provide guidance.

The neuroscience acute care nurse practitioner: role development, implementation, and improvement.

As the number and opportunities for acute care nurse practitioners (ACNPs) continue to increase, the successful integration of these providers into the health care setting becomes more of a challenge. This article outlines strategies for role development, implementation, and evaluation to optimize the performance of the neuroscience ACNP role. The concepts presented are applicable across all acute-care specialties that use ACNPs.

Ventriculostomy for treatment of persistent cervical cerebral spinal fluid leak after excision of cervical schwannoma: a case study.

Intradural spinal cord tumors present many challenges to patients and the healthcare professionals providing treatment. Given the tumor's attachment to dural tissue, cerebrospinal fluid (CSF) leaks are an anticipated challenge. If present, CSF leaks can lead to infection and increased length of stay.

Interdisciplinary collaboration: the heart and soul of health care.

In a health care system in which patient complexity, outcome indicators, and informed families are representative of current reality, an interdisciplinary approach to care is crucial to successful navigation of a patient's experience in the ICU. To guide practitioners toward favorable patient progression, a thorough understanding of interdisciplinary collaboration is necessary. This article focuses on definitions of, benefits of, and barriers to interdisciplinary collaboration and provides practical solutions for implementation.

Use of personal digital assistants with acute care nurse practitioner students.

Personal digital assistants (PDAs) are attaining increased functionality by acute care nurse practitioners (ACNPs). Supplemented by recently developed medical software, these devices assist nurse practitioners in having information available at the point of care. This article reviews the introductory use of PDAs throughout ACNP graduate training with an emphasis on clinical and classroom application.