Encuesta nacional de atención del paciente neurocrítico

Pedro Grille; Lucas Martínez; Leandro Moraes; Luis Nuñez; Ana Canale

doi:10.29193/10.29193/RMU.39.1.4

Authors

Pedro Grille Sociedad Uruguaya de Medicina Intensiva, Comisión de Neurocríticos
Lucas Martínez Administración de los Servicios de Salud del Estado (ASSE), Hospital Maciel, Unidad de Cuidados Intensivos (UCI), Médico residente
Leandro Moraes Sociedad Uruguaya de Medicina Intensiva, Comisión de Neurocríticos
Luis Nuñez Sociedad Uruguaya de Medicina Intensiva, Comisión de Neurocríticos
Ana Canale Sociedad Uruguaya de Medicina Intensiva, Comisión de Neurocríticos

DOI:

https://doi.org/10.29193/10.29193/RMU.39.1.4

Keywords:

SURVEYS, CLINICAL PRACTICE, NEUROCRITICAL PATIENT

Abstract

Background: neurocritical care patients constitute a special subgroup in intensive care medicine. Recent international studies have shown variability in their monitoring and therapeutic handling.
Objective. to learn about the handling and care characteristics of neurocritical patients in Uruguay.
Method: prospective, descriptive study. A telephone survey was conducted based on a structure and processes questionnaire on neurocritical patients’ care. It was designed by the Neurocritical Patients Comittee of the Uruguayan Society of Intensive Medicine (SUMI). Chiefs or coordinators of each intensive care units were interviewed, their participation being voluntary an anonymous.
Results: 52 ICU in the country were interviewed, 67% were located in the provinces and 65% belonged to the private sector. 96% of intensive care units received neurocritical care patients. Routine neurosurgery was available in 46% of cases. Computerized technology was the most widely available imaging study (81%). The following procedures were conducted: intracranial pressure monitoring in 65% of patients, jugular venous oximetry in 27%, non-invasive neuromonitoring in 58%, ultrasound being the most frequently used. The most commonly used strategies to treat intracranial hypertension are: osmotherapy (hypertonic saline in 100%), propofol (85%), muscular blockade (78%) and decompressive craniectomy (75%). Reperfusion in cerebrovascular attack, thrombolisis (88%) and mechanical thrombectomy (44%). The most widely used antiepileptic drugs are: midazolam (100%), levetiracetam y phenytoin (96%). Cerebral aneurysm was treated with surgical clipping (98%) and endovascular treatment (66%). Protocols were followed in 96% and case conferences were organized in 61%.
Conclusions: the study presents the first research conducted on this topic in our country and it found variability in terms of monitorization and availability of neuro-imagining and neurointerventionist special strategies. The study represents an opportunity for effectiveness comparative research.

References

1) Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ, et al. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002; 30(8):1870-6. doi: 10.1097/00003246-200208000-00033.
2) Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MA, Chico-Fernández M, et al. Encuesta de atención al paciente neurocrítico en España. Parte 1: Traumatismos del sistema nervioso central. Med Intensiva 2021; 45(4):250-2. doi: 10.1016/j.medin.2019.09.001.
3) Rehman T, Rehman AU, Rehman A, Bashir HH, Ali R, Bhimani SA, et al. A US-based survey on ventriculostomy practices. Clin Neurol Neurosurg 2012; 114(6):651-4. doi: 10.1016/j.clineuro.2011.12.040.
4) Enblad P, Nilsson P, Chambers I, Citerio G, Fiddes H, Howells T, et al. R3-survey of traumatic brain injury management in European brain IT centres year 2001. Intensive Care Med 2004; 30(6):1058-65. doi: 10.1007/s00134-004-2206-8.
5) Alali AS, Fowler RA, Mainprize TG, Scales DC, Kiss A, de Mestral C, et al. Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program. J Neurotrauma 2013; 30(20):1737-46. doi: 10.1089/neu.2012.2802.
6) Maas AI, Menon DK, Lingsma HF, Pineda JA, Sandel ME, Manley GT. Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research. J Neurotrauma 2012; 29(1):32-46. doi: 10.1089/neu.2010.1599.
7) Olson DM, Batjer HH, Abdulkadir K, Hall CE. Measuring and monitoring ICP in Neurocritical Care: results from a national practice survey. Neurocrit Care 2014; 20(1):15-20. doi: 10.1007/s12028-013-9847-9.
8) Cnossen MC, Huijben JA, van der Jagt M, Volovici V, van Essen T, Polinder S, et al. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: a survey in 66 neurotrauma centers participating in the CENTER-TBI study. Crit Care 2017; 21(1):233. doi: 10.1186/s13054-017-1816-9.
9) Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MÁ, Chico-Fernández M, et al. Encuesta de atención al paciente neurocrítico en España. Parte 2: Patología cerebrovascular. Med Intensiva 2021; 45(7):e1-e3. doi: 10.1016/j.medin.2019.11.004.
10) Teasdale G, Jennet B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2(7872):81-4. doi: 10.1016/s0140-6736(74)91639-0.
11) Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma 1998; 15(8):587-97. doi: 10.1089/neu.1998.15.587.
12) Grille P, Puppo C, Biestro A. Traumatismo encefalocraneano en la UCI. En: Juambeltz C, Machado F, Trostchansky J, eds. Trauma: la enfermedad del nuevo milenio. Montevideo: ARENA, 2005:777-802.
13) Cnossen MC, Polinder S, Lingsma HF, Maas AI, Menon D, Steyerberg EW; CENTER-TBI Investigators and Participants. Variation in structure and process of care in traumatic brain injury: provider profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study. PLoS One 2016; 11(8):e0161367. doi: 10.1371/journal.pone.0161367. eCollection 2016.
14) Lagares A, Munarriz PM, Ibáñez J, Arikán F, Sarabia R, Morera J, et al. [Variability in the management of aneurysmal subarachnoid haemorrhage in Spain: analysis of the prospective multicenter database from the Working Group on Neurovascular Diseases of the Spanish Society of Neurosurgery]. Neurocirugia (Astur) 2015; 26(4):167-79. doi: 10.1016/j.neucir.2014.11.005.
15) Godoy DA, Carrizosa J, Aguilera S, Videtta W, Jibaja M; Latin America Brain Injury Consortium (LABIC) Members. Current practices for intracranial pressure and cerebral oxygenation monitoring in severe traumatic brain injury: a Latin American survey. Neurocrit Care 2022. doi: 10.1007/s12028-022-01605-0.
16) Suarez JI, Zaidat OO, Suri MF, Feen ES, Lynch G, Hickman J, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 2004; 32:2311-7. doi: 10.1097/01.ccm.0000146132.29042.4c.
17) Kramer AH, Zygun DA. Do neurocritical care units save lives? Measuring the impact of specialized ICUs. Neurocrit Care 2011; 14:329-33. doi: 10.1007/s12028-011-9530-y.
18) Le Roux P. Evolution of neurocritical care. Curr Opin Crit Care 2020; 26(2):83-6. doi: 10.1097/MCC.0000000000000712.
19) Kalantar JS, Talley NJ. The effects of lottery incentive and length of questionnaire on health survey response rates: a randomized study. J Clin Epidemiol 1999; 52(11):1117-22. doi: 10.1016/s0895-4356(99)00051-7.