Collaborative Integration of Palliative Care in Critically Ill Stroke Patients in the Neurocritical Care Unit: A Single Center Pilot Study.

INTRODUCTION: Patients admitted to the Neurocritical Care Unit (NCCU) with moderate-to-severe acute strokes, along with their surrogate decision makers, have the potential for unrecognized or unmet emotional and psychological needs. Our primary objective was to determine if early integration of palliative care consultations within this cohort was feasible and would impact understanding, decision-making and emotional support to patients and their surrogate decision makers. Our secondary objective was to evaluate the long-term impact of early palliative care assessment on the development of post-traumatic stress disorder (PTSD). METHODS: This was a single center prospective pilot study. Patients with moderate-to-severe ischemic and hemorrhagic strokes were randomized into two arms. The control arm received standard intensive care and the intervention arm received an additional early palliative care consultation within 72 hours of hospitalization. Study assessments with the participants were obtained on day 1-3, and day 5-7 of care with comparisons of total scores on the Questionnaire on Communication (QOC), Decisional Conflict Scale (DCS), and Hospital Anxiety and Depression Scale (HADS). Furthermore, comparisons of HADS and PTSD DSM-5 (PCL- 5) scores were completed at 3 months. Linear mixed effects models were conducted to examine the association between intervention and participant's scores. RESULTS: A total of 22 participants were enrolled between February 2019 and April 2020. Statistically significant improvement in scores was seen in the total HADS score (p=0.043) and PCL5 score (p=0.033) at 3 months following intervention. CONCLUSION: Collaboration between the intensive care and palliative care team with early palliative assessment may be beneficial in lowering anxiety, depression and PTSD symptoms in critically ill stroke patients and their caregivers. Further research is needed to validate these findings.

Negative pressure wound therapy overlay technique with collagen dressings for nonhealing wounds.

BACKGROUND: Our clinical experience suggests that the effectiveness of negative pressure wound therapy is enhanced by adding collagen alginate to the dressing regimen, applying foam over areas that are undermined or tunneled, and approximating and securing wound edges prior to applying foam. CASES: The use of this combined technique is described in 4 cases, including 2 patients with spinal cord injury and category IV pressure ulcers and 2 patients with extensive postsurgical wounds. CONCLUSION: Our outcomes demonstrate the feasibility of this technique and suggest that patients with significant wound size benefit from adding collagen alginate to negative pressure wound therapy and by applying foam over areas that are undermined or tunneled and/or approximating and securing wound edges prior to applying foam.