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To explore and describe the experience of decision-making for patients with disorders of consciousness (DOC) from the perspectives of family surrogate decision-makers. A total of 21 face-to-face interviews with family surrogate decision-makers from a tertiary hospital in Shanghai, China were conducted from January 2021 to February 2021. Thematic analysis was used for data analysis. Four main themes were identified and were included in this study: (1) a tough choice between life and dignity, (2) a major responsibility for patient's voice, (3) complex considerations between ethics and morals, and (4) the importance of realistic basis. The surrogate decision-making of DOC patients in China has been affected by the Chinese cultural context and several practical roots. And the family surrogate decision-makers shared their experiences of trade-offs during the decision-making process. Moreover, family surrogate decision-makers realized their serious responsibility to make a decision that would be in the best interest of DOC patients. [ABSTRACT FROM AUTHOR]

Purpose of review: The purpose of this review is to summarize the latest evidence regarding family presence at the bedside in the neuro-ICU. Benefits, drawbacks, and recommendations are provided to support family members of persons receiving neurocritical care. Recent findings: Family presence at the bedside can support positive outcomes for patients, family members, and health care staff. Recent findings suggest better satisfaction with care, reduced negative symptoms, and increased self-efficacy in families engaging in family-centered ICU care. The perceptions of health care staff regarding increased family presence at bedside is mixed and warrants further discussion and research. Summary: Family presence at the bedside in neurocritical care is a new and somewhat controversial concept in current literature. Studies outlined in this article have proven benefit for patients and family; however, future research must be done on how to protect family and prepare care staff in family-centered neuro-ICU care. Special consideration must be made in future research on how to integrate family into neuro-ICU care and minimize impediment of neuro-ICU workflow and standards. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the advantages and disadvantages,complication and mortality rates of percutaneous and surgical tracheostomy procedures performed in patients in neuro-intensive care unit (neuro-ICU). Materials and Methods: The study was carried out retrospectively in neuro-ICU. Patients' demographic characteristics, comorbidities, reasons for hospitalization, ICU scores at admission [Acute Physiology and Chronic Health Evluation 2 (APACHE 2) score and Sequential Organ Failure Assessment (SOFA) score], intubation period (days), length of stay in ICU, procedural complications, mortality rates, modified Rankin scale (mRS) scores at discharge and 3rd month were evaluated. Surgical and percutaneous tracheostomy results were compared. Laryngeal mask airway (LMA), bronchoscopy, and tube withdrawal procedures used in percutaneous tracheostomy were compared as well. Results: Fifty five patients were included in the study. Of the patients, 60.0% were male. Mean age was 71.4+-11.8 years. The APACHE 2 score was 25.4+-4.8 and SOFA score was 8.1+-2.7 at admission to ICU. Mean number of intubation days of the patients was 20.7+-11.8, and mean length of stay in ICU was 33.1+-13.0 days. Tracheostomy procedure was successful in 53 (96.4%) patients, complications were encountered in 5 (9.1%) patients among all (succesful and unsuccessful) intervention groups. Mortality was seen in 23 (41.8%) patients. Three-month mRS was 5 in 32 (%58.2) patients. Duration of stay in ICU, intubation period (days), and time between intensive care hospitalization and tracheostomy (days) in surgery group were significantly longer compared to percutaneous tracheostomy group. No statistically significant difference was observed in comparison of different groups such as LMA, tube withdrawal, bronchoscopy in patients undergoing percutaneous tracheostomy. Conclusion: In the study in which we compared the surgical and percutaneous tracheostomy results, no statistically significant difference was found in the complication rates and mRS score at discharge of the two groups. In-hospital mortality rate, which was defined as mRS 6, was observed to be higher in patients who underwent surgical tracheostomy. Because of the rapid application of the procedure at the bedside in patients for whom percutaneous tracheostomy was preferred, it was observed that the length of stay in the neuro-ICU and the number of days followed up with intubation were reduced.

Objective: Status epilepticus (SE) is one of the severe neurological emergencies with significant morbidity and mortality. Most of the time these patients require admission to intensive care units. There is little information about health-economy related burden of SE and potential factors affecting cost except for developed Western countries, especially from the perspective of non-convulsive SE (NCSE). Materials and Methods: We included all consecutive patients diagnosed as having NCSE with continuous electroencephalogram (EEG) in our neurological intensive care unit (NICU) between 2009 and 2019. Demographic and clinical features were collected from patient files. Total cost during NICU care was obtained from hospital financial records. The results were compared with other NICU patients (control group) followed during the same period for the same length of stay. We also investigated the potential impact of several parameters on cost. Results: Thirty two patients with NCSE and 32 controls were included. Mean cost per patient was 11,831 US dollars (USD) in the study and 11,240 USD in the control group (p=0.386). Increased length of stay (p

Our aim of this study was to identify risk factors and develop a prediction model for unplanned neurological intensive care unit (NICU) events after elective infratentorial brain tumor resection in order to propose an individualized admission to the NICU tailored to patient needs. Patients admitted to our NICU between September 2018 and May 2021 after elective infratentorial brain tumor resection were reviewed. Prolonged NICU stays and unplanned NICU admissions were defined as unplanned NICU events. The prognostic model of unplanned NICU events was developed using a forward stepwise logistic regression analysis, and external validation was evaluated. The C-statistic was used to assess discrimination, and a smooth, nonparametric calibration line was used to assess calibration graphically in the model. Of the 1,710 patients in the development cohort, unplanned NICU events occurred in 162 (9.5%). Based on the lesion type, a Karnofsky Performance Status score <70 at admission, longer duration of surgery, bleeding in the operative area evident on postoperative computed tomography, higher fibrinogen and blood glucose levels at admission, and more intraoperative blood loss were independently associated with unplanned NICU events. The external validation test showed good discrimination (C-statistic = 0.811) and calibration (Hosmer-Lemeshow P = 0.141) for unplanned NICU events. Several patient and operative characteristics are associated with a greater likelihood of the occurrence of unplanned NICU events. In the future, we may be able to provide better help for the resource allocation of NICUs according to these risk factors and prediction models. [ABSTRACT FROM AUTHOR]

Abstract Our aim was to determine the prevalence of potential drug-drug interactions (pDDIs) and to identify relevant factors associated with the occurrence of the most dangerous or contraindicated pDDIs (pCDDIs) in hospitalized patients with spontaneous intracerebral hemorrhage (sICH). A retrospective cross-sectional study was performed enrolling all consecutive patients with sICH treated at the Neurological Intensive Care Unit, Clinical Center in Kragujevac, Serbia, during the three-year period (2012-2014). The inclusion criteria encompassed patients aged 18 years and over, those diagnosed with ICH, and those prescribed at least two drugs during hospitalization, while we did not include patients whose hospitalization lasted less than 7 days, those who were diagnosed with other neurological diseases and patients with incomplete medical files. For each day of hospitalization, the online checker Micromedex® software was used to identify pDDIs and classify them according to severity. A total of 110 participants were analysed. A high prevalence of pDDIs (98.2%) was observed. The median number of pDDIs regardless of severity, was 8.00 (IQR 4.75-13.00;1-30). The pairs of drugs involving cardiovascular medicines were the most commonly identified pDDIs. Twenty percent of the total number of participants was exposed to pCDDIs. The use of multiple drugs from different pharmacological-chemical subgroups and the prescribing of anticoagulant therapy significantly increase the chance of pCDDI (aOR with 95% CI 1.19 (1.05-1.35) and 7.40 (1.13-48.96), respectively). This study indicates a high prevalence of pDDIs and pCDDIs in patients with sICH. The use of anticoagulant therapy appears to be the only modifiable clinically relevant predictor of pCDDIs.

Objective: We aimed to evaluate the neurology and intensive care training of neurology specialists who have started and/or completed intensive care subspecialty training and their views on neurological intensive care organizations. Materials and Methods: All neurology specialists who have started and/or completed intensive care subspecialty training were invited to contribute a 30 question survey via e-mail or text message from mobile phone, which contained a link to the online questionnaire form. Results: There are 29 neurology specialists in Turkey who have started and/or completed intensive care subspecialty training, and all of these specialists completed the survey. Of the neurologists, 12 reported that they completed the intensive care subspecialty training, 12 continued their intensive care subspecialty training, and 5 left the training process. Of the neurologists, 86.2% stated that they wanted to work in neurological intensive care units, 79.3% stated that neurological and neurosurgical intensive care units should be combined, 75.9% stated that they could work in these common intensive care units. However, it was determined that none of the 12 neurology-based intensive care specialists could work in the neurological intensive care units. Conclusion: Studies have shown that providing neurocritical care services, neurological intensive care units and neurointensivists could improve clinical outcomes in patients with neurocritical illnesses. In our study, neurology-based intensive care specialists reported that they could not work in neurological intensive care units. Worldwide neurointensivists cared for only a fifth of patients in neurological intensive care units. Neurointensivists need to manage neurological intensive care units to improve patient outcomes both in the world and in Turkey.

Objective: The aim of the study is to evaluate the advantages and disadvantages,complication and mortality rates of percutaneous and surgical tracheostomy procedures performed in patients in neuro-intensive care unit (neuro-ICU). Materials and Methods: The study was carried out retrospectively in neuro-ICU. Patients' demographic characteristics, comorbidities, reasons for hospitalization, ICU scores at admission [Acute Physiology and Chronic Health Evluation 2 (APACHE 2) score and Sequential Organ Failure Assessment (SOFA) score], intubation period (days), length of stay in ICU, procedural complications, mortality rates, modified Rankin scale (mRS) scores at discharge and 3rd month were evaluated. Surgical and percutaneous tracheostomy results were compared. Laryngeal mask airway (LMA), bronchoscopy, and tube withdrawal procedures used in percutaneous tracheostomy were compared as well. Results: Fifty five patients were included in the study. Of the patients, 60.0% were male. Mean age was 71.4±11.8 years. The APACHE 2 score was 25.4±4.8 and SOFA score was 8.1±2.7 at admission to ICU. Mean number of intubation days of the patients was 20.7±11.8, and mean length of stay in ICU was 33.1±13.0 days. Tracheostomy procedure was successful in 53 (96.4%) patients, complications were encountered in 5 (9.1%) patients among all (succesful and unsuccessful) intervention groups. Mortality was seen in 23 (41.8%) patients. Three-month mRS was 5 in 32 (%58.2) patients. Duration of stay in ICU, intubation period (days), and time between intensive care hospitalization and tracheostomy (days) in surgery group were significantly longer compared to percutaneous tracheostomy group. No statistically significant difference was observed in comparison of different groups such as LMA, tube withdrawal, bronchoscopy in patients undergoing percutaneous tracheostomy. Conclusion: In the study in which we compared the surgical and percutaneous tracheostomy results, no statistically significant difference was found in the complication rates and mRS score at discharge of the two groups. In-hospital mortality rate, which was defined as mRS 6, was observed to be higher in patients who underwent surgical tracheostomy. Because of the rapid application of the procedure at the bedside in patients for whom percutaneous tracheostomy was preferred, it was observed that the length of stay in the neuro-ICU and the number of days followed up with intubation were reduced. [ABSTRACT FROM AUTHOR]

Objective: Status epilepticus (SE) is one of the severe neurological emergencies with significant morbidity and mortality. Most of the time these patients require admission to intensive care units. There is little information about health-economy related burden of SE and potential factors affecting cost except for developed Western countries, especially from the perspective of non-convulsive SE (NCSE). Materials and Methods: We included all consecutive patients diagnosed as having NCSE with continuous electroencephalogram (EEG) in our neurological intensive care unit (NICU) between 2009 and 2019. Demographic and clinical features were collected from patient files. Total cost during NICU care was obtained from hospital financial records. The results were compared with other NICU patients (control group) followed during the same period for the same length of stay. We also investigated the potential impact of several parameters on cost. Results: Thirty two patients with NCSE and 32 controls were included. Mean cost per patient was 11,831 US dollars (USD) in the study and 11,240 USD in the control group (p=0.386). Increased length of stay (p<0.001), lower Glasgow Coma scale score at admission (p=0.003), and new diagnosis of NCSE after admission to NICU (p=0.018) were significantly associated with higher cost in study group. SE related direct costs (anti-seizure medicines, anesthetics and continuous EEG) comprised only 3% of total NICU care expenditures. Conclusion: Management for NCSE in NICU leads to significant intensive care related cost. The similarity of the cost level to other NICU patients indicates that most of the expenditures are related to intensive care, rather than management of seizures. We found that a few patient-related parameters could significantly affect the cost, but they were all non-modifiable. [ABSTRACT FROM AUTHOR]

Background: Cerebral autoregulation plays an important role in safeguarding adequate cerebral perfusion and reducing the risk of secondary brain injury, which is highly important for patients in the neurological intensive care unit (neuro-ICU). Although the consensus white paper suggests that a minimum of 5 min of data are needed for assessing dynamic cerebral autoregulation with transfer function analysis (TFA), it remains unknown if the length of these data is valid for patients in the neuro-ICU, of whom are notably different than the general populations. We aimed to investigate the effect of data length using transcranial Doppler ultrasound combined with invasive blood pressure measurement for the assessment of dynamic cerebral autoregulation in patients in the neuro-ICU. Methods: Twenty patients with various clinical conditions (severe acute encephalitis, ischemic stroke, subarachnoid hemorrhage, brain injury, cerebrovascular intervention operation, cerebral hemorrhage, intracranial space-occupying lesion, and toxic encephalopathy) were recruited for this study. Continuous invasive blood pressure, with a pressure catheter placed at the radial artery, and bilateral continuous cerebral blood flow velocity with transcranial Doppler ultrasound were simultaneously recorded for a length of 10 min for each patient. TFA was applied to derive phase shift, gain, and coherence function at all frequency bands from the first 2, 3, 4, 5, 6, 7, 8, 9, and 10 min of the 10-min recordings in each patient on both hemispheres. The variability in the autoregulatory parameters in each hemisphere was investigated by repeated measures analysis of variance. Results: Forty-one recordings (82 hemispheres) were included in the study. According to the critical values of coherence provided by the Cerebral Autoregulation Research Network white paper, acceptable rates for the data were 100% with a length ≥ 7 min. The final analysis included 68 hemispheres. The effects of data length on trends in phase shift in the very low frequency (VLF) band (F1.801,120.669 = 6.321, P = 0.003), in the LF band (F1.274,85.343 = 4.290, P = 0.032), and in the HF band (F1.391,93.189 = 3.868, P = 0.039) were significant for 3–7 min, for 4–7 min, and for 5–8 min, respectively. Effects were also significant on the gain in the VLF band (F1.927,129.134 = 3.215, P = 0.045) for 2–8 min and on the coherence function in all frequency bands (VLF F2.846,190.671 = 90.247, P < 0.001, LF F2.515,168.492 = 55.770, P < 0.001, HF F2.411, 161.542 = 33.833, P < 0.001) for 2–10 min. Conclusions: Considering the acceptable rates for the data and the variation in the TFA variables (phase shift and gain), we recommend recording data for a minimum length of 7 min for TFA in patients in the neuro-ICU. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients who are hospitalized in a neurological intensive care unit (NICU) are largely susceptible to nutrition risk. However, only a limited number of studies have investigated the applicable assessment tool in NICUs. Methods: This was a prospective observational study conducted at a single‐center NICU. A total of 140 adult patients who were hospitalized for >24 hours were enrolled. The Nutritional Risk Screening 2002, Nutrition Risk in the Critically ill (NUTRIC), and modified NUTRIC (mNUTRIC) scores were applied for the assessment of nutrition risk. Analyses of multivariable logistic regression were performed by considering a 28‐day mortality as the outcome of interest. Results: Nutrition risk was commonly identified in NICU patients. Multivariate analysis revealed that age ≥60 years, hospital infection, mechanical ventilation, and high nutrition risk (mNUTRIC score ≥ 5) independently increased 28‐day mortality in NICU patients. For subgroups of patients with a prolonged length of stay, high nutrition risk (mNUTRIC score ≥ 5) has always been an independent risk factor of 28‐day mortality. Both NUTRIC and mNUTRIC scores were able to predict 28‐day mortality, with area under the receiver operating characteristic curves of 0.857 (95% CI, 0.786–0.928) and 0.856 (95% CI, 0.786–0.927), respectively. Conclusion: The mNUTRIC scoring system is not only a useful tool for nutrition risk assessment but also, and more importantly, it is independently related to the risk of 28‐day mortality in NICU patients. Therefore, mNUTRIC scoring is an appropriate tool for nutrition risk assessment and prognosis prediction of NICU patients. [ABSTRACT FROM AUTHOR]

Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.

Objective: To describe the causes of intubation in patients who have been diagnosed with middle cerebral artery (MCA) infarction requiring mechanical ventilation (MV) by evaluating the clinical and radiologic features in the neurological intensive care unit (NICU). Materials and Methods: The patients with MCA infarction who required MV in the NICU were evaluated retrospectively. All patients’ age, sex, risk factors of stroke, lesion topography, etiology and treatment of stroke, cause of intubation, percentage of extubation, death/discharge status were recorded. Results: It is found that between June 1st, 2009, and December 31st, 2015, 91 patients with stroke with MCA infarction were mechanically ventilated in the NICU. Fifty patients were intubated with neurologic causes and 40 patients needed intubation due to cardiopulmonary problems. One patient was treated in the NICU after surgery for a diaphragmatic hernia. Conclusion: The patients with MCA infarction who are followed up on a mechanical ventilator have poor prognosis. This group of patients constitutes elderly individuals who are at risk for vascular and organ failure. Their follow-up must be conducted in NICUs.

Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and sinus venous thrombosis (SVT) examined in the intensive care unit (ICU). Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures occurred in 48 out of 199 patients who were followed up with AIS, ICH, and SVT in the neurology ICU within the specified time period. The frequency of having early seizures was found to be higher in patients with left hemisphere lesions, cortical lesions, and those with AIS with hemorrhagic transformation. Lesion volume was found to be higher in patients with AIS who had early seizures compared with those who had AIS without seizures. Early seizures were observed in all patients with SVT who were followed up in the ICU. Conclusion: Early seizures are a common complication in patients with stroke followed up in neurology ICUs. Determination of effective factors in early seizures is important for its early diagnosis and treatment

What is known and objective: Thrombocytopenia is a common laboratory abnormality among critically ill patients under neurological intensive care unit (NCU) care. Valproic acid (VPA), a widely used antiepileptic drug, is one of the common causes of drug‐induced thrombocytopenia. The purpose of this study was to estimate the incidence and risk factors of thrombocytopenia after intravenous VPA therapy among the patients admitted to NCU. Methods: We retrospectively reviewed the medical records of patients who were treated with intravenous VPA during their NCU stay between January 2014 and December 2018. We studied the frequency of thrombocytopenia and further evaluated the risk of thrombocytopenia in these patients. Results: Among the 283 patients (181 male [64.0%], mean age: [61.0 ± 14.9] years) who were treated with intravenous VPA, thrombocytopenia was observed in 104 patients (36.7%). Thrombocytopenia was associated with several risk factors, including lower baseline platelet counts (<200 × 109/L); aetiologies other than intracranial or subarachnoid haemorrhage; longer use of VPA (more than 3 days); higher daily dose of VPA (more than 1000 mg/d); concurrent use of VPA with other antiepileptic drugs; infection; and the use of mechanical ventilation. Multivariate analysis found several independent risk factors of thrombocytopenia with intravenous VPA therapy, including lower baseline platelet counts, aetiologies other than intracranial or subarachnoid haemorrhage, use of VPA for more than 3 days and infection. What is new and conclusion: Thrombocytopenia is common in NCU patients. Because several clinical and laboratory factors are associated with thrombocytopenia, careful use of VPA should be considered in patients with these risk factors. [ABSTRACT FROM AUTHOR]

Objective: Nosocomial infections (NI) are serious threats for patients, especially those treated in intensive care units (ICU), which have high risk. Therefore, determining the infectious agents in this area and treating the infections are crucial for both the prognosis of primary disease and the time of stay in hospital. In this study, we aimed to perform an active infection surveillance in the neurological ICU (NICU). Materials and Methods: Two hundred ninety-one patients who stayed in NICU over a twelve-month period were included in the study. Data obtained by infection control committee of our faculty according to “Centres for Disease Control and Prevention” diagnostic criteria were used for the diagnosis of NI. Isolated microorganisms and their systemic involvement were examined. Results: The infections in NICU constituted 6.39% of all NI in the hospital. These were skin and soft tissue infections (3.13%), bloodstream infections (9.38%), pneumonia not associated with mechanical ventilator (9.38%), pneumonia associated with mechanical ventilator (6.25%), and urinary tract infections (UTI) (71.88%). Fourteen different microorganisms were determined in the unit over the twelve months. Conclusion: Caution is advised regarding urinary catheter insertion and care because catheters are the most common cause of infection, UTI, in the ICU. Also, diagnosis of NI and determining the antibiotic sensitivity of the causal microorganisms are very important for the determination of empiric treatment and reducing mortality and morbidity

Objective: To study the effects of infection on severe stroke patients in the neurological intensive care unit and to find the related risk factors for mortality of severe stroke patients. Methods: We conducted a retrospective study including 343 patients with ischaemic or haemorrhagic stroke and staying for more than 2 patient-days in the neurological intensive care unit at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyse the infection features of patients with severe stroke in the neurological intensive care unit. All analyses were conducted using SPSS 18.0. Results: The mortality rate, hospital staying time and hospital costs between infected and uninfected stroke patients were higher in the infected patients than in the uninfected patients, P < 0.05, and except for the hospital staying time, the mortality rate and hospital costs were both significantly higher in the infected patients. Respiratory tract infection was the most common infection type at all time periods, P < 0.05. However, urinary tract infection increased at 72 h after stroke compared with infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stroke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P < 0.05. Conclusion: Infection can significantly influence the mortality rate and hospital costs of stroke patients, and is an independent risk factor for mortality of stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To describe the causes of intubation in patients who have been diagnosed with middle cerebral artery (MCA) infarction requiring mechanical ventilation (MV) by evaluating the clinical and radiologic features in the neurological intensive care unit (NICU). Materials and Methods: The patients with MCA infarction who required MV in the NICU were evaluated retrospectively. All patients' age, sex, risk factors of stroke, lesion topography, etiology and treatment of stroke, cause of intubation, percentage of extubation, death/discharge status were recorded. Results: It is found that between June 1st, 2009, and December 31st, 2015, 91 patients with stroke with MCA infarction were mechanically ventilated in the NICU. Fifty patients were intubated with neurologic causes and 40 patients needed intubation due to cardiopulmonary problems. One patient was treated in the NICU after surgery for a diaphragmatic hernia. Conclusion: The patients with MCA infarction who are followed up on a mechanical ventilator have poor prognosis. This group of patients constitutes elderly individuals who are at risk for vascular and organ failure. Their follow-up must be conducted in NICUs. [ABSTRACT FROM AUTHOR]

Background: To investigate the prognostic value of acute thyroid function in patients with severe encephalitis. Methods: We retrospectively analyzed information from patients with severe encephalitis from June 2012 to June 2017. Using multivariate logistic regression analysis, we examined predictors of poor outcomes in these patients after 6 months. Results: A total of 94 patients with severe encephalitis were included in the study. Univariate analysis showed that patients with good or poor outcomes had significantly different total thyroxine (TT4) (P = 0.012) and free triiodothyronine (FT3) (P = 0.049) levels, mechanical ventilation requirements (P < 0.001), pulmonary infection complications (P = 0.001), lengths of neurological intensive care unit (P = 0.003) and total hospital (P = 0.012) stay, and Acute Physiology and Chronic Health Evaluation (APACHE II) (P = 0.005) and Glasgow Coma Scale (GCS) (P = 0) scores. The results of multivariate analysis suggested the following factors to be associated with a poor outcome: a low TT4 level (OR 0.303, 95% CI 0.100-0.923) and a low GCS score (OR 0.683, 95% CI 0.506-0.923). Conclusions: Low TT4 has a predictive value for the adverse outcomes of severe encephalitis; further study is needed for verification. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and sinus venous thrombosis (SVT) examined in the intensive care unit (ICU). Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures occurred in 48 out of 199 patients who were followed up with AIS, ICH, and SVT in the neurology ICU within the specified time period. The frequency of having early seizures was found to be higher in patients with left hemisphere lesions, cortical lesions, and those with AIS with hemorrhagic transformation. Lesion volume was found to be higher in patients with AIS who had early seizures compared with those who had AIS without seizures. Early seizures were observed in all patients with SVT who were followed up in the ICU. Conclusion: Early seizures are a common complication in patients with stroke followed up in neurology ICUs. Determination of effective factors in early seizures is important for its early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: Nosocomial infections (NI) are serious threats for patients, especially those treated in intensive care units (ICU), which have high risk. Therefore, determining the infectious agents in this area and treating the infections are crucial for both the prognosis of primary disease and the time of stay in hospital. In this study, we aimed to perform an active infection surveillance in the neurological ICU (NICU). Materials and Methods: Two hundred ninety-one patients who stayed in NICU over a twelve-month period were included in the study. Data obtained by infection control committee of our faculty according to "Centres for Disease Control and Prevention" diagnostic criteria were used for the diagnosis of NI. Isolated microorganisms and their systemic involvement were examined. Results: The infections in NICU constituted 6.39% of all NI in the hospital. These were skin and soft tissue infections (3.13%), bloodstream infections (9.38%), pneumonia not associated with mechanical ventilator (9.38%), pneumonia associated with mechanical ventilator (6.25%), and urinary tract infections (UTI) (71.88%). Fourteen different microorganisms were determined in the unit over the twelve months. Conclusion: Caution is advised regarding urinary catheter insertion and care because catheters are the most common cause of infection, UTI, in the ICU. Also, diagnosis of NI and determining the antibiotic sensitivity of the causal microorganisms are very important for the determination of empiric treatment and reducing mortality and morbidity. [ABSTRACT FROM AUTHOR]

Since the last 20 years, entry of neurointensive care units (NICU) has provided a significant increase of survival rate and quality of post-ICU life of the patients with life-threatening neurological and neurosurgical catastrophies. Therefore, NICU has become a fundamental part of contemporary third-level hospitals or reference centers. Because extensiveness of specific examination, monitoring and treatment techniques and methods unique to neurology makes impossible to manage critical neurological patients in “General” ICUs instead of NICUs, the number of proponent stating that national health authorities “should” not only establish more and improve NICUs in all reference hospitals, but also (re)organize a transport and referral system to get the patients in need of NICU care to these hospitals is progressively increasing. As mandated by modern critical care paradigm, the proposed plan and strategy can be suggested as a “sine aqua non” for avoiding ethicolegal problems.

Objectives . The frequency and types of complications in patients with nonconvulsive status epilepticus (NCSE) who are followed up in the intensive care unit (ICU), and the impact of these complications on outcome are not well-known. We investigated the complications and their effects on prognosis in NCSE patients. Methods . After reviewing the video-EEG monitoring (VEEGM) reports of all the consecutive patients who were followed up in our ICU between 2009 and 2019, we identified two groups of patients: 1-patients with NCSE (study group) and 2-patients who underwent VEEGM for possible NCSE but did not have ictal recordings (no-NCSE group). Electronic health records were reviewed to identify demographic and clinical data, duration of ICU care, medical and surgical complications, pharmacologic treatment, and outcome. These parameters were compared statistically between the groups. We also investigated the parameters affecting prognosis at discharge. Results . Thirty-two patients with NCSE comprised the study group. Infection developed in 84%. More than half were intubated, had tracheostomy or percutaneous endoscopic gastrostomy application. Refractory NCSE was associated with significantly more frequent complications and worse outcome. There was a higher tendency of infections in the study group ( P  = .059). Higher organ failure scores and prolonged stay in ICU predicted worse outcome ( P  < .05). Conclusion . The frequency of complications in patients with NCSE who are cared for in the ICU is considerable. Most of the complications are similar to the other patients in ICU, except for the higher frequency of infections. Increased physician awareness about modifiable parameters and timely interventions might help improve prognosis.

Background: Postoperative intracranial hypotension-associated venous congestion (PIHV) is an uncommon cause of clinical deterioration after a neurosurgical procedure that is often unrecognized until late in its course. Functional outcomes range from remarkable neurological recovery to death. Little is understood about the reason for deterioration in certain patients compared with improvement in others. A 68-year-old man with a progressive cervical myelopathy underwent an uncomplicated cervical decompression and alignment restoration at our hospital and suffered violent generalized tonic-clonic seizures intraoperatively and postoperatively. A postoperative head CT showed a right parietal hematoma, but no other cranial findings. A subsequent MRI demonstrated what we describe as early PIHV with symmetric T2 signal changes in the bilateral deep gray structures. No diffusion restriction corresponded to these areas. A CT myelogram revealed a considerable CSF collection within the operative bed. Upon returning to the operating room to localize the source of the leak, a large dural tear was identified off of midline with a bone chip alongside the defect. The defect was repaired, and the patient remained comatose for over a week postoperatively. He made a remarkable gradual recovery, and after a month in the hospital and rehabilitation, he returned home with relatively minimal neurological deficits.Conclusions: We postulate that if caught early and treated aggressively, neurologic injury resulting from PIHV may be reversible despite initially ominous imaging. Neurosurgeons and neurointensivists should therefore be compelled to search for dural defects and return to the operating room for immediate repair. [ABSTRACT FROM AUTHOR]

The goal of this performance improvement study was to evaluate the effect of a targeted intervention to decrease catheter-associated urinary tract infections (CAUTIs) and urinary catheter utilization by implementing quality improvement initiatives. Monthly patient data were abstracted including total CAUTI, urinary catheter utilization, urinary catheter days, CAUTI rate, and limited demographics for those with CAUTI, including age, sex, and diagnoses pre- and post-interven- tion. The effect of CUSP on catheter utilization and CAUTI was determined using independent samples, t-tests and Mann-Whitney U tests. Implementing CUSP resulted in decreased catheter utilization from 89% to 75% (p = 0.001) and clini- cal reduction rate of CAUTI rate by 19% (from 7.9 to 7.2). Inappropriate urinary catheters can be avoided by daily assessment of catheter need and catheter removal. It is also important to establish catheter care guidelines and assure this care is being properly carried out. These management strategies can decrease catheter utilization and preventable complications, such as CAUTI. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the clinical and procedural risk factors associated with the unplanned neurosurgical intensive care unit (NICU) readmission of patients after elective supratentorial brain tumor resection and serves as an exploratory analysis toward the development of a risk stratification tool that may be prospectively applied to this patient population., Methods: This was a retrospective observational cohort study. The electronic medical records of patients admitted to an institutional NICU between September 2018 and November 2021 after elective supratentorial brain tumor resection were reviewed. Demographic and perioperative clinical factors were recorded. A prognostic model was derived from the data of 4892 patients recruited between September 2018 and May 2021 (development cohort). A nomogram was created to display these predictor variables and their corresponding points and risks of readmission. External validation was evaluated using a series of 1118 patients recruited between June 2021 and November 2021 (validation cohort). Finally, a decision curve analysis was performed to determine the clinical usefulness of the prognostic model., Results: Of the 4892 patients in the development cohort, 220 (4.5%) had an unplanned NICU readmission. Older age, lesion type, Karnofsky Performance Status (KPS) < 70 at admission, longer duration of surgery, retention of endotracheal intubation on NICU entry, and longer NICU length of stay (LOS) after surgery were independently associated with an unplanned NICU readmission. A total of 1118 patients recruited between June 2021 and November 2021 were included for external validation, and the model's discrimination remained acceptable (C-statistic = 0.744, 95% CI 0.675-0.814). The decision curve analysis for the prognostic model in the development and validation cohorts showed that at a threshold probability between 0.05 and 0.8, the prognostic model showed a positive net benefit., Conclusions: A predictive model that included age, lesion type, KPS < 70 at admission, duration of surgery, retention of endotracheal intubation on NICU entry, and NICU LOS after surgery had an acceptable ability to identify elective supratentorial brain tumor resection patients at high risk for an unplanned NICU readmission. These risk factors and this prediction model may facilitate better resource allocation in the NICU and improve patient outcomes.