Pilotażowy test interwencji świadomej medytacji w redukcji stresu u młodszych pacjentów z udarem mózgu

Introduction. The population of younger people having strokes is growing. Persons who are younger and have a stroke have specific stressors after a stroke that those over 60 may not experience (e.g., ability to earn an income, provide for a family, returning to work, etc.).Aim. In order to address some of these age-specific stressors, new and novel approaches to stress mediation are needed. In order to address this gap in the literature this study piloted a mindfulness meditation with younger in hospital stroke survivors.Material and Methods. Prospective non-randomized pilot study of in-hospital stroke patients < 60 years of age. Baseline assessment included the Perceived Stress Scale (PSS), heart rate (HR), blood pressure (BP), and respiratory rate (RR). Patients received a 10-minute mindfulness training session with instructions for home use. PSS, HR, BP, and RR were collected immediately after training and telephone assessments of PSS were collected 30-day post discharge.Results. The mean age of the 21 patients included in the final analysis was 47.4 years. Paired t-test showed statistically significant differences in heart rate (p < 0.001) and respiratory rate (p < 0.001) before and after the intervention, but no statistically significant differences in pre and post training blood pressure (p = 0.480). There was no statistically significant difference in PSS scores before and after the training.Conclusions. The findings of this study suggest that the mindfulness intervention is feasible for in-hospital stroke patients and shows promise for reducing stress, as indicated by physiologic changes such as lowering heart and blood pressure rates. (JNNN 2019;8(2):48–53)Wstęp. Wzrasta populacja młodych ludzi zapadających na udary mózgu. Osoby młodsze w wyniku udaru odczuwają określone czynniki stresogenne, których osoby powyżej 60. roku życia mogą nie doświadczyć (np. zdolność do zarabiania pieniędzy, utrzymanie rodziny, powrót do pracy itp.).Cel. Aby odnieść się do niektórych z tych specyficznych dla danego wieku czynników stresogennych, potrzebne są nowe i nowatorskie podejścia do mediacji w zakresie stresu. W celu zajęcia się tą luką w literaturze, w badaniu tym przeprowadzono pilotażową świadomą medytację w szpitalu z młodszymi osobami, które przeżyły udar mózgu.Materiał i metody. Prospektywne, nierandomizowane badanie pilotażowe u pacjentów po udarze mózgu w wieku poniżej 60 lat przeprowadzono w warunkach szpitalnych. Ocena stanu wyjściowego obejmowała skalę postrzeganego stresu (PSS), częstość akcji serca (HR), ciśnienie krwi (BP) i częstość oddechową (RR). Pacjenci otrzymali 10-minutowy trening świadomego myślenia oraz instrukcje wykonywania w warunkach domowych. PSS, HR, BP i RR zebrano natychmiast po przeszkoleniu, a oceny telefoniczne PSS zebrano 30 dni po wypisie ze szpitala.Wyniki. Średni wiek 21 pacjentów objętych finalną analizą wynosił 47,4 lat. Analiza t-testem wykazała istotne statystycznie różnice w częstości akcji serca (p < 0,001) i częstości oddechu (p < 0,001) przed i po interwencji, jednakże nie wykazano istotnych statystycznie różnic w ciśnieniu krwi przed i po instruktażu (p = 0,480). Nie odnotowano statystycznie istotnej różnicy w wynikach PSS przed i po szkoleniu.Wnioski. Wyniki tego badania sugerują, że interwencja w zakresie świadomego myślenia jest wykonalna dla pacjentów po udarze mózgu w warunkach szpitalnych i wskazuje na obiecujące możliwości zmniejszenia stresu, na co wskazują zmiany fizjologiczne, takie jak obniżenie częstości akcji serca i ciśnienia krwi. (PNN 2019;8(2):48–53

Rola zarejestrowanej objętości wyrzutu płynu mózgowo-rdzeniowego w przewidywaniu wyniku w zmodyfikowanej skali Rankina przy wypisie ze szpitala u pacjentów z krwawieniami podpajęczynówkowymi (DROPSS)

Introduction. External ventricular drain (EVD) placement is common among aneurysmal subarachnoid hemorrhage (aSAH). Draining cerebrospinal fluid (CSF) from the EVD is also common, yet little is known about how much to drain, the length of time to drain, or how drainage impacts patient outcomes. Aim. The purpose of this study is to correlate amount of CSF drainage to patient outcomes, via modified Rankin Score (mRS). Material and Methods. This retrospective review of data located in a local hospital-based registry and electronic medical record. A linear mixed effects model was constructed to examine CSF drainage volume as a predictor of mRS at discharge. Results. Data from 82 patients was included in this analysis. There was no statistically significant relationship between CSF totals and mRS at hospital discharge (p = 0.3614, r² = 0.01). After controlling for age, Hunt and Hess score, and subject as random effect, there was still no significant relationship between CSF drained and mRS score at hospital discharge (p = .9042). Conclusions. There is no correlation between the total volume of CSF drained and mRS at discharge. Future research should explore CSF drainage documentation practices. (JNNN 2022;11(2):43–48) Key Words: acute care, aneurysmal subarachnoid hemorrhage, cerebrospinal fluid, external ventricular drain, patient outcomesWstęp. Założenie drenu komorowego zewnętrznego (EVD) jest powszechne w przypadku tętniakowatego krwotoku podpajęczynówkowego (aSAH). Drenaż płynu mózgowo-rdzeniowego (cerebrospinal fluid, CSF) z EVD jest również powszechny, jednak niewiele wiadomo na temat ilości płynu, czasu trwania drenażu i wpływu drenażu na wyniki leczenia. Cel. Celem tego badania jest korelacja ilości drenażu płynu mózgowo-rdzeniowego z wynikami leczenia pacjentów w zmodyfikowanej skali Rankina (modified Rankin Score, mRS). Materiał i metody. Retrospektywny przegląd danych znajdujących się w lokalnym rejestrze szpitalnym i elektronicznej dokumentacji medycznej. W celu zbadania objętości drenażu płynu mózgowo-rdzeniowego jako predyktora mRS przy wypisie ze szpitala skonstruowano liniowy model efektów mieszanych. Wyniki. Do analizy włączono dane od 82 pacjentów. Nie stwierdzono istotnej statystycznie zależności między całkowitą objętością płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala (p = 0,3614, r² = 0,01). Po uwzględnieniu wieku, punktacji w skali Hunta i Hessa oraz podmiotu jako efektu losowego, nadal nie było istotnej zależności między odsączonym płynem mózgowo-rdzeniowym a wynikiem mRS przy wypisie ze szpitala (p = .9042). Wnioski. Nie ma korelacji między całkowitą objętością zdrenowanego płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala. W przyszłych badaniach należy przeanalizować sposób prowadzenia dokumentacji drenażu płynu mózgowo-rdzeniowego. (PNN 2022;11(2):43–48)

Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study

BackgroundAsymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better understanding of quantitative pupil characteristics would be a non–invasive, safe, and cost-effective way to improve identification of life-threatening mass effect and resource utilization of emergent radiographic imaging. We aimed to better characterize the association between midline shift at various anatomic levels and quantitative pupil characteristics.MethodsWe conducted a multicenter retrospective study of brain CT images within 75 min of a quantitative pupil observation from patients admitted to Neuro-ICUs between 2016 and 2020 with large (>1/3 of the middle cerebral artery territory) acute supratentorial ischemic stroke or primary IPH > 30 mm3. For each image, we measured midline shift at the septum pellucidum (MLS-SP), pineal gland shift (PGS), the ratio of the ipsilateral to contralateral midbrain width (IMW/CMW), and other exploratory markers of radiographic shift/compression. Pupil reactivity was measured using an automated infrared pupillometer (NeurOptics®, Inc.), specifically the proprietary algorithm for Neurological Pupil Index® (NPi). We used rank-normalization and linear mixed-effects models, stratified by diagnosis and hemorrhagic conversion, to test associations of radiographic markers of shift and asymmetric pupil reactivity (Diff NPi), adjusting for age, lesion volume, Glasgow Coma Scale, and osmotic medications.ResultsOf 53 patients with 74 CT images, 26 (49.1%) were female, and median age was 67 years. MLS-SP and PGS were greater in patients with IPH, compared to patients with ischemic stroke (6.2 v. 4.0 mm, 5.6 v. 3.4 mm, respectively). We found no significant associations between pupil reactivity and the radiographic markers of shift when adjusting for confounders. However, we found potentially relevant relationships between MLS-SP and Diff NPi in our IPH cohort (β = 0.11, SE 0.04, P = 0.01), and PGS and Diff NPi in the ischemic stroke cohort (β = 0.16, SE 0.09, P = 0.07).ConclusionWe found the relationship between midline shift and asymmetric pupil reactivity may differ between IPH and ischemic stroke. Our study may serve as necessary preliminary data to guide further prospective investigation into how clinical manifestations of radiographic midline shift differ by diagnosis and proximity to the midbrain

Admission Glasgow Coma Scale Score as a Predictor of Outcome in Patients Without Traumatic Brain Injury.

BACKGROUND: The Glasgow Coma Scale was developed in 1974 as an injury severity score to assess and predict outcome after traumatic brain injury. The tool is now used to score depth of impaired consciousness in patients with and without traumatic brain injury. However, evidence supporting the use of the Glasgow Coma Scale in the latter group is limited. OBJECTIVE: To assess Glasgow Coma Scale score on hospital admission as a predictor of outcome in patients without traumatic brain injury. METHODS: This was a secondary analysis of prospectively collected data from 3507 patients admitted to 4 hospitals between October 2015 and October 2019. Patients with a primary diagnosis of traumatic brain injury were excluded from this study. RESULTS: The mean age of the 3507 participants in the study was 57 years. Participants were primarily female (52%), White (77%), and non-Hispanic (89%). On admission, 90% of patients had a modified Rankin Scale score of 0 to 3 and 72% had a Glasgow Coma Scale score of 13 to 15 (mild injury). Generalized estimating equation modeling indicated that admission Glasgow Coma Scale score did not predict modified Rankin Scale score at discharge in patients not diagnosed with traumatic brain injury (Glasgow Coma Scale score= -7.89, P \u3c .001; Glasgow Coma Scale score 8-12: z = -4.17, P \u3c .001). CONCLUSIONS: The Glasgow Coma Scale is not recommended for use in patients without traumatic brain injury; clinicians should use a more appropriate and validated clinical assessment instrument for this patient population

Correlation of noninvasive blood pressure and invasive intra-arterial blood pressure in patients treated with vasoactive medications in a neurocritical care unit

BACKGROUND: The correlation between noninvasive (oscillometric) blood pressure (NBP) and intra-arterial blood pressure (IAP) in critically ill patients receiving vasoactive medications in a Neurocritical Care Unit has not been systematically studied. The purpose of this study is to examine the relationship between simultaneously measured NBP and IAP recordings in these patients. METHODS: Prospective observational study of patients (N = 70) admitted to a neurocritical care unit receiving continuous vasopressor or antihypertensive infusions. Paired NBP/IAP observations along with covariate and demographic data were abstracted via chart audit. Analysis was performed using SAS v9.4. RESULTS: A total of 2177 paired NBP/IAP observations from 70 subjects (49% male, 63% white, mean age 59 years) receiving vasopressors (n = 21) or antihypertensive agents (n = 49) were collected. Paired t test analysis showed significant differences between NBP versus IAP readings: ([systolic blood pressure (SBP): mean = 136 vs. 140 mmHg; p \u3c 0.0001], [diastolic blood pressure (DBP): mean = 70 vs. 68 mmHg, p \u3c 0.0001], [mean arterial blood pressure (MAP): mean = 86 vs. 90 mmHg, p \u3c 0.0001]). Bland-Altman plots for MAP, SBP, and DBP demonstrate good inter-method agreement between paired measures (excluding outliers) and demonstrate NBP-IAP SBP differences at extremes of blood pressures. Pearson correlation coefficients show strong positive correlations for paired MAP (r = 0.82), SBP (r = 0.84), and DBP (r = 0.73) recordings. An absolute NBP-IAP SBP difference of \u3e 20 mmHg was seen in ~ 20% of observations of nicardipine, ~ 25% of observations of norepinephrine, and ~ 35% of observations of phenylephrine. For MAP, the corresponding numbers were ~ 10, 15, and 25% for nicardipine, norepinephrine, and phenylephrine, respectively. CONCLUSION: Despite overall strong positive correlations between paired NBP and IAP readings of MAP and SBP, clinically relevant differences in blood pressure are frequent. When treating with vasoactive infusions targeted to a specific BP goal, it is important to keep in mind that NBP and IAP values are not interchangeable

Distributions and Reference Ranges for Automated Pupillometer Values in Neurocritical Care Patients.

BACKGROUND: Automated pupillometry is becoming widely accepted as an objective measure of pupillary function, especially in neurocritical care units. Normative reference values and thresholds to denote a significant change are necessary for integrating automated pupillometry into practice. OBJECTIVE: Providing point estimates of normal ranges for pupillometry data will help clinicians intuit meaning from these data that will drive clinical interventions. METHODS: This study used a planned descriptive analysis using data from a multicenter registry including automated pupillometry assessments in 2140 subjects from 3 US hospitals collected during a 3-year period. RESULTS: We provide a comprehensive list of admission pupillometry data. Our data demonstrate significant differences in pupillary values for Neurological Pupil Index, latency, and constriction velocity when stratified by age, sex, or severity of illness defined by the Glasgow Coma Scale score. CONCLUSION: This study provides a greater understanding of expected distributions for automated pupillometry values in a wide range of neurocritical care populations