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Panayiotis N. Varelas - One of the best experts on this subject based on the ideXlab platform.

  • The Appointment of Neurointensivists Is Financially Beneficial to the Employer
    Neurocritical care, 2010
    Co-Authors: Panayiotis N. Varelas, Tamer Abdelhak, Jody Wellwood, Donald Benczarski, Stanton B. Elias, Mark L. Rosenblum
    Abstract:

    Background Although the impact of a Neurointensivist (NI) on patient outcomes has been examined in the past, the financial impact has not been estimated before.

  • How I treat status epilepticus in the Neuro-ICU.
    Neurocritical care, 2008
    Co-Authors: Panayiotis N. Varelas
    Abstract:

    Status epilepticus still remains a formidable adversary to Neurointensivists. Although the majority of cases admitted to the Neuro-ICU are easily controlled with one or two antiepileptic drug defense lines, several cases become refractory and end up receiving general anesthetics for days or weeks with significant morbidity. Treatment algorithms have been published and should be followed, but in many cases they are inadequate because, especially in the distal branches of the treatment tree, are based on anecdotal data or small series of patients. In addition, a double-blind, randomized-controlled study in status has not been done for many years and solid data are lacking for the newer antiepileptics. Therefore, in the moderately to severely refractory cases, status treatment is based on personal previous experience and becomes an art more than a science. In this review of a difficult case, we discuss some fine details of the treatment provided and emphasize the multidisciplinary approach that should be followed including involvement of Neurointensivists, epileptologists, electroencephalographers, and neurosurgeons.

  • Neurointensivists. Author's reply
    Journal of Neurosurgery, 2007
    Co-Authors: Hiren Patel, Andrew King, Fiona Lecky, Panayiotis N. Varelas
    Abstract:

    Object. The aim of this study was to evaluate the impact of a newly appointed Neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). Methods. The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a Neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the Neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the same period (p < 0.0001). The unadjusted mean mortality rate in the NICU decreased from 13.4 to 12.9% (relative mortality rate reduction 4%) and the mean NICU LOS increased from 3.1 to 3.6 days (relative NICU LOS increase 16%), both nonsignificantly. A 51% reduction in the NICU-associated mortality rate (p = 0.01), a 12% shorter hospital LOS (p = 0.026), and 57% greater odds of being discharged to home or to rehabilitation (p = 0.009) were found in the after period in multivariate models after controlling for baseline differences between the two time periods. Better documentation of the GCS score by the NICU team was also found in the after period (from 60.4 to 82%, p = 0.02). Conclusions. The institution of a Neurointensivist-led team model had an independent, positive impact on patient outcomes, including a lower NICU-associated mortality rate and hospital LOS, improved disposition, and better chart documentation.

  • Impact of a Neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit
    Journal of neurosurgery, 2006
    Co-Authors: Panayiotis N. Varelas, Marianna V. Spanaki, Lotfi Hacein Bey, Daniel Eastwood, Hyun J. Yun, Christos Kessaris, Thomas A. Gennarelli
    Abstract:

    Object The aim of this study was to evaluate the impact of a newly appointed Neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). Methods The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a Neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the Neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the ...

  • Documentation in medical records improves after a Neurointensivist's appointment.
    Neurocritical care, 2005
    Co-Authors: Panayiotis N. Varelas, Marianna V. Spanaki, Lotfi Hacein-bey
    Abstract:

    Introduction: Medical documentation is important for communication among health care professionals, research, legal defense, and reimbursement. Previous studies have indicated insufficient documentation by health care providers and resistance among physicians to comply with the new guidelines. Data in the intensive care unit (ICU) subpopulation are scarce. We examined the hypothesis that a newly appointed Neurointensivist may alter documentation practices in a university hospital setting.

Eelco F. M. Wijdicks - One of the best experts on this subject based on the ideXlab platform.

  • On Aneurysmal Rupture and Rerupture
    Neurocritical Care, 2018
    Co-Authors: Eelco F. M. Wijdicks
    Abstract:

    A warning leak is a curious phenomenon attributed to cerebral aneurysms. Once the leak occurs, it has been postulated it could lead to a more catastrophic rebleeding. The designation “warning leak” trickled into neurosurgery vocabulary as early as the 1950s. The phenomenon has been poorly understood and characterized, but its presence spurs emergency physicians and Neurointensivists to take action to secure the aneurysm. Rapid treatment of a recently discovered aneurysm is now commonplace, but it has not always been so. Antifibrinolytic agents spawned particular interest in the late 1970s, when many neurosurgeons postponed surgery after a recent hemorrhage. This historical vignette reviews the early views on aneurysmal rupture, rerupture, and the role of fibrinolysis.

  • The history of neurocritical care.
    Handbook of clinical neurology, 2017
    Co-Authors: Eelco F. M. Wijdicks
    Abstract:

    Critical care medicine came into sharp focus in the second part of the 20th century. The care of acutely ill neurologic patients in the USA may have originated in postoperative neurosurgical units, but for many years patients with neurocritical illness were admitted to intensive care units next to patients with general medical or surgical conditions. Neurologists may have had their first exposure to the complexity of neurocritical care during the poliomyelitis epidemics, but few were interested. Much later, the development of neurocritical care as a legitimate subspecialty was possible as a result of a new cadre of neurologists, with support by departments of neurosurgery and anesthesia, who appreciated their added knowledge and expertise in care of acute neurologic illness. Fellowship programs have matured in the US and training programs in certain European countries. Certification in the USA is possible through the American Academy of Neurology United Council of Neurologic Specialties. Most Neurointensivists had a formal neurology training. This chapter is a brief analysis of the development of the specialty critical care neurology and how it gained strength, what it is to be a Neurointensivist, what the future of care of these patients may hold, and what it takes for Neurointensivists to stay exemplary. This chapter revisits some of the earlier known and previously unknown landmarks in the history of neurocritical care.

  • famous first papers for the Neurointensivist
    2012
    Co-Authors: Eelco F. M. Wijdicks
    Abstract:

    Preface Acknowledgments Chapter 1: First and Famous: criteria and qualifiers Chapter 2: First intensive care units Chapter 3: First descriptions of clinical signs Chapter 4: First descriptions of clinical syndromes Chapter 5: First descriptions of initial management Chapter 6: First clinical studies and trials Chapter 7: First outcome studies Chapter 8: First bioethics studies Index

  • Angioedema After tPA: What Neurointensivists Should Know
    Neurocritical Care, 2012
    Co-Authors: Jennifer E. Fugate, Ejaaz A. Kalimullah, Eelco F. M. Wijdicks
    Abstract:

    Background Angioedema is an underappreciated and potentially life-threatening complication of intravenous (IV) recombinant tissue plasminogen activator (rt-PA). Patients taking angiotensin converting enzyme (ACE) inhibitors are at increased risk of this rare complication. Methods Case report. Results A 74 year-old woman taking lisinopril for hypertension was treated with IV rt-PA for right hemispheric acute ischemic stroke. Shortly after completion of the rt-PA infusion, she developed asymmetric angioedema involving the tongue and left lower lip. No emergent airway intervention was needed. Following treatment with epinephrine, antihistamines, and corticosteroids, the edema resolved within 24 h. The patient made an excellent recovery from the ischemic stroke. Conclusions Orolingual angioedema can complicate rt-PA treatment of acute stroke and is often ipsilateral to the side of hemiparesis. Neurointensivists should be aware of this possibility, which is increased in patients taking ACE inhibitors. Epinephrine can be given safely in this scenario. Identification of high risk features may help guide decisions regarding early definitive airway management.

  • The First Neurointensive Care Units
    Famous First Papers for the Neurointensivist, 2012
    Co-Authors: Eelco F. M. Wijdicks
    Abstract:

    This chapter reviews the beginnings of intensive care units and the history of neurosciences intensive care units. The physical presence of a Neurointensivist in a neurosciences intensive care unit has been a landmark development, and neurocritical care as a specialty has now finally been established.

Jeong Am Ryu - One of the best experts on this subject based on the ideXlab platform.

  • severe pain related adverse events of percutaneous dilatational tracheostomy performed by a Neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients
    BMC Neurology, 2020
    Co-Authors: Yong Oh Kim, Gee Young Suh, Chi Ryang Chung, Chimin Park, Jeong Am Ryu
    Abstract:

    We evaluated severe pain-related adverse events (SAE) during the percutaneous dilatational tracheostomy (PDT) procedure performed by a Neurointensivist and compared the outcomes with that of conventional surgical tracheostomy in neurocritically ill patients. This was a retrospective and observational study of adult patients who were admitted to the neurosurgical intensive care unit between January 2014 and March 2018 and underwent tracheostomy. In this study, primary endpoints were incidence of SAE: cardiac arrest, arrhythmias, hypertension, hypotension, desaturation, bradypnea, or ventilatory distress. The secondary endpoint was procedure-induced complications. A total of 156 patients underwent tracheostomy during the study. Elective surgery of brain tumors (34.0%) and intracranial hemorrhage (20.5%) were the most common reasons for admission. The most common reasons for tracheostomy were difficult ventilator weaning or prolonged intubation (42.9%) and sedative reduction (23.7%). Tachycardia (30.1%) and hypertension (30.1%) were the most common SAE. Incidence of SAE was more common in conventional tracheostomy compared to PDT (67.1% vs. 42.3%, P = 0.002). The total duration of SAE (19.8 ± 23.0 min vs. 3.4 ± 5.3 min, P < 0.001) and procedural time (42.2 ± 21.8 min vs. 17.7 ± 9.2 min, P < 0.001) were longer in conventional tracheostomy compared to PDT. Multivariable adjustment revealed that only PDT by a Neurointensivist significantly reduced the incidence of SAE by one third (adjusted odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.187–0.691). In addition, PDT by a Neurointensivist deceased the duration of SAE by 8.64 min (β: -8.64, 95% CI: − 15.070 – -2.205, P = 0.009) and prolonging the procedure time by every one minute significantly increased the duration of SAE by 6.38 min (β: 6.38, 95% CI: 0.166–0.470, P < 0.001). Procedure-induced complications were more common in conventional tracheostomy compared to PDT (23.5% vs. 11.3%, P = 0.047). This retrospective and exploratory study of our single-center limited cohort of tracheostomy patients revealed that decreased SAE may be associated with short procedural time during the PDT procedure performed by a Neurointensivist. It is proposed that PDT by a Neurointensivist may be safe and feasible in neurocritically ill patients.

  • safety and feasibility of ultrasound guided placement of peripherally inserted central catheter performed by Neurointensivist in neurosurgery intensive care unit
    PLOS ONE, 2019
    Co-Authors: Yong Oh Kim, Chi Ryang Chung, Gee Young Suh, Chimin Park, Eunmi Gil, Jeong Am Ryu
    Abstract:

    We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a Neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a Neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.

  • Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit.
    Journal of Korean medical science, 2017
    Co-Authors: Jeong Am Ryu, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh, Seung Chyul Hong
    Abstract:

    Limited data are available on improved outcomes after initiation of Neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed Neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after Neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of Neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of Neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after Neurointensivist co-management, initiation of a strategy of routine involvement of a Neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients.

Thomas A. Gennarelli - One of the best experts on this subject based on the ideXlab platform.

  • Impact of a Neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit
    Journal of neurosurgery, 2006
    Co-Authors: Panayiotis N. Varelas, Marianna V. Spanaki, Lotfi Hacein Bey, Daniel Eastwood, Hyun J. Yun, Christos Kessaris, Thomas A. Gennarelli
    Abstract:

    Object The aim of this study was to evaluate the impact of a newly appointed Neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). Methods The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a Neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the Neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the ...

  • The impact of a Neurointensivist-led team on a semiclosed neurosciences intensive care unit*
    Critical care medicine, 2004
    Co-Authors: Panayiotis N. Varelas, Mary Conti, Marianna V. Spanaki, Eric Potts, Deborah Bradford, Cindy Sunstrom, Wende N. Fedder, Lotfi Hacein Bey, Safwan Jaradeh, Thomas A. Gennarelli
    Abstract:

    Objective:To evaluate the impact of a newly appointed Neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables.Design:Observational cohort with historical controls.Setting:Ten-bed neurointensive care unit in tertiary university hospital.Patients:Mor

Raminder Nirula - One of the best experts on this subject based on the ideXlab platform.