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Mechanically ventilated (MV) patients in the intensive care unit (ICU) often experience disturbed sleep and profound inactivity.

The aim of this study was to report 5 consecutive days' descriptive analyses on sleep efficiency (SE), total sleep time (TST), daytime activity ratio (DAR), and hourly activity counts among critically ill MV adults from 9 ICUs across 2 hospitals.

A secondary analysis was undertaken from our parent National Institutes of Health-funded randomized controlled trial (NIH R01 NR016702). Subjects included 31 critically ill patients from multiple ICUs. Wrist actigraphy estimated SE and TST. Mean DAR, an indicator of altered sleep-wake cycles, was calculated. Continuous 24-hour activity counts over 5 consecutive days were summarized. Descriptive analyses were used.

A total of 31 subjects with complete actigraphy data were included. Mean age was 59.6 (SD, 17.3) years; 41.9% were male; 83.9% were White, and 67.7% were Hispanic/Latino; and the mean APACHE III (Acute Physiology and Chronic Health Evaluation III) severity of illness score was 74.5 (SD, 25.5). The mean nighttime SE and TST over the 5-day ICU period were 83.1% (SD, 16.14%) and 6.6 (SD, 1.3) hours, respectively. The mean DAR over the 5-day ICU period was 66.5% (SD, 19.2%). The DAR surpassed 80% on only 17.5% of subject days. The majority of subjects' activity level was low, falling below 1000 activity counts per hour.

Our study revealed poor rest-activity cycle consolidation among critically ill MV patients during the early ICU period. Future interventional studies should promote quality sleep at nighttime and promote mobilization during the daytime.

Our study revealed poor rest-activity cycle consolidation among critically ill MV patients during the early ICU period. Future interventional studies should promote quality sleep at nighttime and promote mobilization during the daytime.

Hospital antimicrobial stewardship (AS) interventions have been shown to reduce the overuse and misuse of antimicrobials and rates of resistant organisms. https://www.selleckchem.com/products/midostaurin-pkc412.html To date, nurses have had limited involvement in AS. Improving nursing AS knowledge and sense of empowerment may improve their engagement in AS.

The purpose of this study was to evaluate the impact of an educational intervention on AS knowledge and sense of empowerment among bedside registered nurses (RNs) in a surgical intensive care unit in an academic medical center.

This was a quasi-experimental pre-post study.

Forty-four RNs (85%) participated. There was a statistically significant (P < .01) increase in both AS knowledge and empowerment level of staff RNs. Registered nurses identified participation in patient care rounds and use of antibiotic timeouts as strategies for increasing their AS engagement. Perceived barriers included lack of physician/other team member support and knowledge deficits.

The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.

The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.Several nursing practices are related to oral, enteral, or parenteral feeding on the intensive care unit. Nurses are the group of health care professionals who provide 24-hour care for patients. Therefore, they play a key role in not only identifying nutritional problems but also in ensuring the success of nutritional therapy by implementing evidence-based feeding protocols and ongoing care for (par)enteral access devices. Having an up-to-date evidence-based knowledge about nutritional support can increase safety and quality of care and can contribute to better outcomes. In this narrative review, the most recent European intensive care unit nutrition guidelines and related research are highlighted, and where appropriate, specific applications for nursing practice are described.

Patients with isolated left ventricular failure may have positive outcomes after being implanted with a left ventricular assist device. Unfortunately, almost half of patients with heart failure and reduced ejection fraction also have evidence of right ventricular dysfunction. For a subset of this population with severe biventricular failure, or those who develop right ventricular dysfunction after left ventricular assist device implantation, patients may necessitate biventricular assist devices or the total artificial heart.

This overview of mechanical circulatory support devices will enhance nurses' ability to differentiate criteria for implantation, current practice, and outcomes with a focus on durable ventricular assist devices and the total artificial heart.

A review of the literature involved searching CINAHL and PubMed databases using keywords biventricular assist devices, total artificial heart, and durable mechanical circulatory support. Results were narrowed to articles based on adults, 18 years or older. Seventy-eight relevant articles were identified, and 8 articles compared the durable biventricular assist devices.

Similar patient outcomes were found when comparing the use of left ventricular assist devices as biventricular support versus the total artificial heart.

The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.

The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.The common mechanisms and injury patterns of accidental trauma in infants differ from those of older children and adults, with falls representing the most common etiology. While the evaluation of traumatic injury in infants should follow an algorithm similar to that used for adults, the unique pediatric physiologic response to trauma must be taken into consideration. In addition, the utility of certain imaging studies in these patients is highly case specific, particularly with minor head injuries. This supplement reviews the evaluation and management of infants with accidental traumatic injury, including the most common circumstances and pathophysiology of injury, the differential diagnosis of the infant trauma victim, and the workup and management of accidental injuries in this patient population.The manuscript is devoted to world experience of carotid endarterectomy and carotid artery stenting in advanced age patients. Some authors report the advantages of endovascular surgery in elderly patients while the others prefer carotid endarterectomy. Senile patients (75-80 years old) with asymptomatic internal carotid artery stenosis is one of the most difficult group for the management. This is due to a more complex assessment of perioperative surgical risk, high incidence of complicated atherosclerotic plaques in carotid arteries and dubious benefits of surgery considering short life expectancy and severe comorbidities. Accumulation of experience in the management of advanced age patients should be valuable for either optimizing or individualizing surgical strategy.In recent years, the effect of critical conditions on intestine and the role of such changes in maintenance and progression of systemic disorders are of particular attention. This issue is relevant in critically ill neurosurgical patients too. Intestine morphology and microbiome changes in these patients represent a wide field for researches in intensive care and prevention of secondary damage to other organs and systems. This review ensures a current approach to the problem of intestine morphology and microbiome changes in critically ill neurosurgical patients. We reviewed the data from clinical studies and experiments reproducing a critical condition in animals. Most publications are indexed in the PubMed, e-library, Google Scholar databases. We also analyzed the data from NEJM, JAMA, Lancet, Critical Care and other issues. The manuscript contains an overview of 44 foreign and 13 domestic references; over 50% of researches were published within the past 5 years. Searching depth was over 50 years.The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.Chondrosarcoma is a rare malignancy composed of transformed cells of cartilage. This cancer is characterized by slow growth. Almost 75% of intracranial chondrosarcomas are observed on the skull base and grow from bone synchondrosis. Other rarer localizations of tumor are cerebral falx, tentorium cerebelli, vascular plexuses of the ventricles, fourth ventricle, convexital surface of the brain, etc. In this manuscript, we report treatment of patient with falcine chondrosarcoma.

The analyze the neuro-ophthalmic outcomes in patients with pineal and suprasellar germinoma after complex treatment.

There were 125 patients (88 males, 37 females) with primary CNS germinoma for the period 2008-2017. All patients were divided into 3 groups depending on the tumor localization pineal area - 62 patients, suprasellar neoplasm - 38 patients, bifocal germinoma - 25 patients. Treatment was performed in accordance with the «Germinoma-2008» protocol. Tumors were histologically patients (partial - 32 cases, subtotal - 16 cases). Surgery was followed by postoperative chemotherapy and stereotactic radiotherapy. The results were evaluated by neuro-ophthalmological examination at all stages of complex treatment.

Pineal germinoma resulted oculomotor and pupillary disorders (58 patients - 94%) and papilledema. The last one completely regressed under the treatment. Partial reduction of oculomotor and pupillary abnormalities occurred throughout chemotherapy (6 patients - 10%). More than half of patients rapy (12 patients - 86%). Bifocal germinoma was followed by various combinations of oculomotor, pupillary and/or visual impairments. We observed regression of only mild visual disorders. Stereotactic radiotherapy did not ensure any changes in neuro-ophthalmic symptoms in all groups.Background. Hyperthermia is a common symptom in ICU patients with brain injury.

To study the effect of hyperthermia on intracranial pressure (ICP) and cerebral autoregulation (Prx).

There were 8 patients with acute brain injury, signs of brain edema and intracranial hypertension. Cerebral autoregulation was assessed by using of PRx. ICP, CPP, BP, PRx were measured before and during hyperthermia. We have analyzed 33 episodes of cerebral hyperthermia over 38.30 C. Statistica 10.0 (StatSoft) was used for statistical analysis.

Only ICP was significantly increased by 6 [3; 11] mm Hg (

<0.01). In patients with initially normal ICP, hyperthermia resulted increase of ICP in 48% of cases (median 24 [22; 28] mm Hg). In patients with baseline intracranial hypertension, progression of hypertension was noted in 100% cases (median 31 [27; 32] mm Hg) (

<0.01). Hyperthermia resulted intracranial hypertension regardless brain autoregulation status.

Cerebral hyperthermia in patients with initially normal ICP results intracranial hypertension in 48% of cases.