Jefferson Physicians

JHN Journal - Winter 2017

jhn-journal-winter-2017

A special neurocritical issue of the JHN Journal, the highlighted articles (and their accompanying conclusions) included: 

  • Phenotype Variant Brugada Pattern: An Early Sign of Propofol Infusion Syndrome- Recognition of PRIS is crucial to preventing bad outcomes. The goal should be to make fewer autopsy diagnosis of PRIS by discontinuing the propofol early. 

  • Decompressive Hemicraniectomy in Acute Neurological Diseases: DHC done alone or combined with hematoma evacuation appears to be safe. The earlier the DHC is performed, the greater the potential benefit. 

  • Early Ambulation in Patients with External Ventricular Drains: Result of a Quality Improvement Project- The observational study suggests that PT is feasible in patients with EVDs and can be safely tolerated. Further research in a larger patient population conducted prospectively warranted to assess potential benefit of early mobility. 

  • Management of Severe TBI: A Review of Recent Literature- A multi-modal monitoring approach is a likely direction for future research into the management of patients with severe TBI. 

  • Tele-ICU Development and Application- The future of teleneuro and telestroke is promising as the application and promises of telemedicine in the neurocritical-ICU increases as a whole. 

  • Unity of Biomarkers in the Evaluation of Fever in the Intensive Care Unit After Brain Injury- The development of fever in critically ill patients needs immediate attention and action to rule out infection. PCT may be a more sensitive and specific test that can help differentiate between infectious and central fever. 

  • Declaring Brain Death on ECMO- The study demonstrated the variability of practice patterns in the declaration of brain death for patients on ECMO over time and the lack of understanding of the C02 physiology on ECMO. Additional studies are needed to devise a national standardized protocol to declare brain death on ECMO. 

  • Paroxysmal Sympathetic Hyperactivity- Management of PSH involves both non-pharmacologic and pharmacologic treatment. Managing the symptoms is important in preventing second brain injury. 

  • Incidence and Prevalence of Deep Vein Thrombosis Among Neurocritical Intensive Care Unit Patients- Patients admitted to a neuro ICU are at high risk for having DVT present on admission and for acquiring DVT during their hospitalization. Further research is needed to understand the risk of patients with acute neurological injury.