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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.
Subject(s)
Humans , Male , Female , Adult , Patients/classification , World Health Organization , Cerebral Hemorrhage/pathology , Drug Interactions , Intensive Care Units/classification , Pharmaceutical Preparations/analysis , Cross-Sectional Studies/methods , Hospitalization , Anticoagulants/adverse effectsABSTRACT
Based on clinical training and practice experience of the authors in recent years, the training practice of critical ultrasonography in standardized training of neurosurgical specialists were summarized in the study. The study also discussed the appropriate training mode and training requirements of critical ultrasonography in standardized training of neurosurgical specialists, from the aspects of basic theory training, clinical application training of critical ultrasonography and special training of craniocerebral ultrasound, training precautions and training assessment, so as to provide comprehensive evaluation and treatment strategies for neurological intensive patients.
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Objective:To explore the establishment of a cluster intervention strategy by multi-criteria decision analysis (MCDA) to provide a basis for the early removal of indwelling catheters in severe neurological patients.Methods:Through literature retrieval and MCDA, the catheter cluster intervention strategy was constructed, and the expert consultation was adopted to finally form 7 item cluster intervention strategies. The convenience sampling method was used to select 122 patients with severe neurological diseases as the research objects. A total of 61 patients with indwelling catheters from November 2018 to April 2019 were selected as the control group, and routine nursing care was performed according to indwelling catheters. A total of 61 patients with indwelling catheters from May 2019 to October 2019 were selected as the intervention group to compare the success rate of removing catheters, the number of days of indent catheters and the incidence of catheter-associated urinary tract infection ( CAUTI) in the two groups, as well as to analyze the indicators related to indent catheters in the intervention group with different diagnoses. Results:CAUTI incidence, successful catheter removal rate, indwelling days of catheter in the intervention group were 39.3% (24/61), 32.79% (20/61), 17 (14,22) days, which were significantly higher than 59.0% (36/61), 8.19% (5/61), 21 (15, 27) days in the control group, and the difference was statistically significant (χ 2 values were 4.723, 11.775, Z value was -9.211, P<0.05 or 0.01); In the intervention group, stroke patients′ indwelling time of catheter were 7-20 days, and the highest success rate of removing urinary catheters 36.6% (15/41), compared with other diseases, the difference was statistically significant ( Z values were -2.448, -2.109, P<0.05). Conclusion:MCDA construction of early catheter removal strategy can significantly shorten the indwelling time of the catheter in patients with severe neurological diseases, improve the success rate of early catheter extubation, reduce the CAUTI rate, to provide evidence-based basis for clinical nursing.
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Objective To explore the application value of percutaneous dilational tracheostomy in the neurological intensive patients. Methods The clinical data of 298 neurological intensive patients treated with percutaneous dilational tracheotomy were analyzed retrospectively from June 2010 to July 2016. Results Percutaneous dilational tracheostomy was successfully performed in all of the 298 cases. The mean operation duration was (6.8 ± 2.2) minutes with a rang of 2 to 15 min. There were 1 case with tracheal tube placement difficulties, 1 case in whom the trachea spatium was strayed into, 1 case with arrhythmia, 10 cases with mild bleeding and 5 cases with moderate bleeding. No severe bleeding, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and other complications caused by the operation were found. And no death case was found. Conclusions Percutaneous dilational tracheostomy is a rapid and minimally invasive technique, which is a better choice for patients with severe neurological diseases.
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Objective To investigate the level and influence factors of sleep quality in caregivers to neurological intensive care unit (NICU) survivors. Methods The Pittsburgh Sleep Quality Index (PQSI) and the sleep quality influence factor scale were administered on 167 family caregivers to NICU survivors. Results The score of PQSI was 8.81 ± 3.25,and 55.68%(98/167) of caregivers reported poor sleep quality. Logistic regression analysis showed that medical insurance(OR=2.025, P<0.01), hospital stay (OR==2.235, P<0.01), whether caregivers in service (OR=0.583, P<0.05), resisdence(OR=2.341, P<0.01), and tracheal tubes/ventricular drainage (OR=5.857, P<0.01) were influencing factors of sleep quality. Conclusions It proved that our intervention should focus on family caregivers to NICU survivors social and psychological characteristics may help to enhance their sleep quality and quality of life.
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Objective To investigate the clinical validity of the Chinese version of John Hopkins Adapted Cognitive Exam (ACE) for in-patients in neurological intensive care unit (NICU). Methods From May, 2014 to June, 2015, 94 inpatients in NICU and 52 healthy persons were assessed with the Chinese version of ACE and Mini-Mental State Examination (MMSE). Results The total score of ACE correlated with the total score of MMSE (r=0.805, P2.458, P<0.05). The area under the receiver operating curve was not different between ACE and MMSE (Z=0.707, P=0.480). Conclusion The Chinese version of ACE can be the tool for assessment of cognition for pa-tients in NICU.
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Objective To explore safety evaluation of the approaches of the percutaneous eilational tracheostomy(PDT)ane traeitional tracheotomy in the treatment of neurological patients. Methods The stuey eesign was a multicenter,prospective,raneomizee clinical trial. One huneree ane seventy-six cases with acute nerve trachea incision from Feb. 2010 to Feb. 2013 of 3 hospitals were selectee as our subject. They were raneomly eivieee into the traeitional group ane PDT group. The information inclueing operation time,the incieence of pneumothorax,subcutaneous emphysema,tracheal fistula,esophageal,trachea ane lung injury from complications such as infection were recoreee. Results The complication rate in traeitional group was 19. 51%(16 / 82),higher than that of PDT group(8. 51%(8 / 94),P = 0. 021). The surgery perioe in PDT group was(7. 5 ± 2. 3)min,shortee than that in traeitional group((41. 6 ± 5. 8)min,P = 0. 000). Conclusion The approach of percutaneous tracheostomy can quickly buile airway of neurological patients with character of simple, safe,ane it also can reeuce the incieence of respiratory complications.
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Objective To Explored the relative factors which caused the extubation failure in neurological intensive care unit (NICU).Methods It was a retrospective study.40 cases of patients who met the criteria,were brought into statistical analysis.They were admitted in NICU in Nan Fang Hospital from December 2008 to February 2011.The name,sex,age,diagnosis,respiratory parameters,24 hours discrepancy quantity,sputum,and Glasgow Coma Scale,Full Outline of UnResponsiveness Scale were recorded.SPSS 13.0 was used as statistic software.P ＜ 0.05 was considered statistically significant.Results Both in extubation successful and failure groups,GCS and Four were significantly different (all P ＜ 0.05).Howerer,there were no statistically significant in the other factors.There were significantly differences between GCS and Four in predicting extubation results (P =0.012).Logistic multiple regression showed that Four and GCS grade were predictive factor of extubation failure (P =0.041).Conclusions The result suggests that it is statistically significant to use GCS and Four as factors to predict extubation results.It can be widely used to help medical personnels monitoring the changes of patients'clinical conditions,judging prognosis,and making treatment plan in NICU.Wether other factors would effect the extubation results,more prospective,randomized controlled studies were needed.
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The authors give an account of the historical development of neurological intensive care and its current status in China and put forward the view that establishment of neurological intensive care units can improve the level of neurological departments in delivering emergency treatments and give impetus to the improvement of expertise in diagnosing and treating acute neurological diseases. It will also play a key role in clinically conducting encephalic resuscitation and hibernation therapy, finely monitoring changes of intracranial physiologic indexes by electro physiological methods, further clarifying organ failure resulting from cerebral and neural failure, and promoting the study of nerve grafting and regeneration. Neurological intensive care units can serve as both the teaching base for training professional staff and the research base for advancing neurological emergency medicine.
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Objective To investigate the risk factors of death in patients with acute stroke in the neurological intensive care unit(NICU). Methods The clinical data of 137 patients with acute stroke in the NICU were induced. The risk factors were analysed by univariate and multi-variate Logistic regression analysis.Results There were 13 risk factors including age, coma, hyperpyrexia, pulmonary disease, atrial fibrilation/cardiac dilatation, stroke history, mechanical ventilation, brain midline shift, initial serum glucose, APACHEⅡscores, feeding tube, urethral catheter and concurrent pulmonary infection which had statistical significance between the death group and survive group,by univariate analysis(P