Hemodynamic and neuro-monitoring for neurocritically ill patients: An international survey of intensivists

Sanjeev Sivakumar, Fabio S. Taccone, Mohammed Rehman, Holly Hinson, Neeraj Naval, Christos Lazaridis

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among “neurointensivists” (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). Methods Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. Results Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P = .007) and SAH (38% vs 21%, P < .001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P = .019), and ultrasound (37.5% vs 28%, P = .023); NI use more PbtO2 (28% vs 10%, P < .001). In the case scenario of raised ICP/low PbtO2, most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P = .014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P < .001), and fluid responsiveness (62.5% vs 53%, P = .03). Also, NI use more angiography (57% vs 43.5%, P = .004), TCD (56.5% vs 38%, P < .001), CTP (32% vs16%, P < .001), and PbtO2 (18% vs 7.5%, P = .001). Conclusions Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters.

Original languageEnglish (US)
Pages (from-to)40-47
Number of pages8
JournalJournal of Critical Care
Volume39
DOIs
StatePublished - Jun 1 2017

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Brain Injuries
Hemodynamics
Cytidine Triphosphate
Analgesia
Angiography
Physicians
Pressure
Brain
Surveys and Questionnaires
3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid

Keywords

  • Brain injuries
  • Hemodynamics
  • Monitoring, neuromonitoring
  • Physiologic
  • Survey

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hemodynamic and neuro-monitoring for neurocritically ill patients : An international survey of intensivists. / Sivakumar, Sanjeev; Taccone, Fabio S.; Rehman, Mohammed; Hinson, Holly; Naval, Neeraj; Lazaridis, Christos.

In: Journal of Critical Care, Vol. 39, 01.06.2017, p. 40-47.

Research output: Contribution to journalArticle

Sivakumar, Sanjeev ; Taccone, Fabio S. ; Rehman, Mohammed ; Hinson, Holly ; Naval, Neeraj ; Lazaridis, Christos. / Hemodynamic and neuro-monitoring for neurocritically ill patients : An international survey of intensivists. In: Journal of Critical Care. 2017 ; Vol. 39. pp. 40-47.
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AU - Taccone, Fabio S.

AU - Rehman, Mohammed

AU - Hinson, Holly

AU - Naval, Neeraj

AU - Lazaridis, Christos

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N2 - Purpose To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among “neurointensivists” (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). Methods Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. Results Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P = .007) and SAH (38% vs 21%, P < .001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P = .019), and ultrasound (37.5% vs 28%, P = .023); NI use more PbtO2 (28% vs 10%, P < .001). In the case scenario of raised ICP/low PbtO2, most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P = .014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P < .001), and fluid responsiveness (62.5% vs 53%, P = .03). Also, NI use more angiography (57% vs 43.5%, P = .004), TCD (56.5% vs 38%, P < .001), CTP (32% vs16%, P < .001), and PbtO2 (18% vs 7.5%, P = .001). Conclusions Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters.

AB - Purpose To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among “neurointensivists” (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). Methods Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. Results Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P = .007) and SAH (38% vs 21%, P < .001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P = .019), and ultrasound (37.5% vs 28%, P = .023); NI use more PbtO2 (28% vs 10%, P < .001). In the case scenario of raised ICP/low PbtO2, most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P = .014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P < .001), and fluid responsiveness (62.5% vs 53%, P = .03). Also, NI use more angiography (57% vs 43.5%, P = .004), TCD (56.5% vs 38%, P < .001), CTP (32% vs16%, P < .001), and PbtO2 (18% vs 7.5%, P = .001). Conclusions Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters.

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