Background: We aimed to provide a systematic description of our 2-year experience using a standardized bedside, single burr hole approach to intracranial multimodality monitoring (MMM) in patients with severe traumatic brain injury (sTBI), focusing on safety and probe reliability.
Methods: We performed this observational cohort study at a university-affiliated, Level I trauma center with dedicated 20-bed neuroscience intensive care unit. We included 43 consecutive sTBI patients who required MMM to guide clinical care based on institutional protocol and had a four-lumen bolt placed to measure intracranial pressure, brain tissue oxygen, regional cerebral blood flow, brain temperature, and intracranial electroencephalography.
Results: sTBI patients were aged 41.6 ± 17.5 years (mean ± SD) and 84% were men. MMM devices were placed at a median of 12.5 h (interquartile range [IQR] 9.0-21.4 h) after injury and in non-dominant frontal lobe in 72.1% of cases. Monitoring was conducted for a median of 97.1 h (IQR 46.9-124.6 h) per patient. While minor hemorrhage, pneumocephalus, or small bone chips were common, only one (2.4%) patient experienced significant hemorrhage related to device placement. Radiographically, device malpositioning was noted in 13.9% of patients. Inadvertent device discontinuation occurred for at least one device in 58% of patients and was significantly associated with the frequency of travel for procedures or imaging. Devices remained in place for > 80% of the total monitoring period and generated usable data > 50% of that time.
Conclusions: A standardized, bedside single burr hole approach to MMM was safe. Despite some probe-specific recording limitations, MMM provided real-time measurements of intracranial pressure, oxygenation, regional cerebral blood flow, brain temperature, and function.
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http://dx.doi.org/10.1007/s12028-018-0551-7 | DOI Listing |
J Ultrasound
January 2025
Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
Hepatic gas gangrene (HGG) is a rare but life-threatening condition typically caused by anaerobic bacteria such as Clostridium perfringens, though Gram-negative bacteria like Escherichia coli and Klebsiella species have also been implicated. Traditionally diagnosed via computed tomography (CT), point-of-care ultrasound (POCUS) has emerged as a valuable tool in critical care settings for its non-invasive, bedside utility. We report the case of a 51-year-old female with choledochal syndrome secondary to cholangiocarcinoma who developed HGG following left extended hepatectomy and biliary reconstruction.
View Article and Find Full Text PDFJ Clin Med
January 2025
Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
To compare the outcomes of tracheostomised COVID-19 patients with non-COVID-19 tracheostomised patients to identify factors influencing severity and mortality. A retrospective, single-centre cohort study was conducted on COVID-19 tracheostomised patients admitted from May 2020 to February 2022, compared with a cohort of non-COVID-19 tracheostomised patients. COVID-19 tracheostomised patients had a higher mortality rate (50% vs.
View Article and Find Full Text PDFBMC Med Educ
January 2025
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Background: There exists no standardized longitudinal curriculum for teaching bedside ultrasonography (US) in Pulmonary and Critical Care Medicine (PCCM) fellowship programs. Given the importance of mastering bedside US in clinical practice, we developed an integrated year-long US curriculum for first-year PCCM fellows.
Methods: 11 first-year PCCM fellows completed the entire seven-step Blended Learning Curriculum.
Eur J Pediatr
January 2025
School of Nursing, College of Nursing, Taipei Medical University, Xinyi Dist, No. 250, Wuxing St, Taipei, 110, Taiwan.
Unlabelled: This study has the objective to translate the Cornell Assessment of Pediatric Delirium (CAPD) into Indonesian and evaluate the psychometric properties and diagnostic accuracy of the Indonesian version of the CAPD (I-CAPD) in identifying delirium in critically ill children. This prospective methodological study was conducted between January and April 2024 in a 6-bed pediatric intensive care unit (PICU). In total, 90 children aged 0-18 years hospitalized in the PICU were included.
View Article and Find Full Text PDFNurs Rep
December 2024
Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health, La Jolla, CA 92093, USA.
Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.
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