TY - JOUR
T1 - Hemodynamic and neuro-monitoring for neurocritically ill patients
T2 - An international survey of intensivists
AU - Sivakumar, Sanjeev
AU - Taccone, Fabio S.
AU - Rehman, Mohammed
AU - Hinson, Holly
AU - Naval, Neeraj
AU - Lazaridis, Christos
PY - 2017/6/1
Y1 - 2017/6/1
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.
KW - Brain injuries
KW - Hemodynamics
KW - Monitoring, neuromonitoring
KW - Physiologic
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85017625644&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017625644&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2017.01.005
DO - 10.1016/j.jcrc.2017.01.005
M3 - Article
C2 - 28171804
AN - SCOPUS:85017625644
SN - 0883-9441
VL - 39
SP - 40
EP - 47
JO - Seminars in Anesthesia
JF - Seminars in Anesthesia
ER -