Tools for neurological monitoring
This section provides a summary of the proposed instruments, aimed to monitor the critically ill patients’ neurology. The main purpose of our work is to make an on-line support available to all the ICUs to help the daily neurological evaluation, thus sharing instruments that we consider extremely valuable and essentials to perform our job.
These instruments are freely available and there is no limit to their divulgation, upon proper reference. We would like for them to become commonly used, spreading them through both the institutional ways (hospital guidelines, ward’s protocol) as well as via communication between everyday users (physicians and nurses).
A useful instrument makes the work simpler and the patients’ outcome better. Based on last years’ experience and on an extensive literature review, we are intimately convinced that both these conditions are likely to occur using our instruments.
Moreover, starting from your own personal experience we believe you will have smart and interesting suggestions to improve our instruments. We would highly appreciate any prompt communication allowing us to make a continuous sources update available to all ICUs.
We understand that we are proposing new, innovative and unfamiliar instruments that will have to face a harsh critical phase before being accepted by all the operators. We invite you not to give up because of these normal, hardly predictable and frustrating initial difficulties.
It will surely take some efforts to ride over these difficulties. Nevertheless, the consciousness of instruments’ potential, the improvement of daily job quality and the positive patients’ outcome will help you going ahead with this. We believe that that last sceptics will be finally convinced once the instruments will penetrate the medical market and become a reference standard.
To measure pain, sedation/agitation and delirium, methods that are clear and understandable to ICUs team members should be used.
An instrument can be considered to be validated once two different operators, when observing the same patient in the same conditions, agree on the same conclusion (almost always!).
This simple concept is not easily applicable to high risk critically ill patients, namely:
- Does “Patient 3” still feel pain?
- Is “Patient 6” still sedated in continuous? Could we reduce infusion?
- Is “Patient 2” freaking out or it is just his usual attitude?
To answer these questions see Validated Scales.
To stay focused on the objective, no matter how far it is!
Every therapeutic choice in ICU implies the consideration of numberless details and a precise order of priorities. In such background it is easy to get lost and put off therapeutic achievements that could be quickly reached during the treatment of high risk patients. In the following three diagrams we tried to summarize the meaning of sedaICU.it
These are the hardest changes to accept, based on current ICU average habits and culture:
- The sedation level to be achieved as soon as possible corresponds to RASS = 0 (alert and calm);
- A neurologic evaluation with validated methods should be performed at least once for every nurse shift;
- First reassure the patient and improve patient-ventilator interaction, then assess and treat pain, and lastly recur to sedation;
- It is important to preserve physiological sleep, far more refreshing than a drug-induced one;
To get a better view on the matter we suggest you to print the three PDFs you’ll find below, and use them daily and thoroughly at the bedside. Current habits can be changed: before becoming part of common sense, every innovation must be tried out and felt as a new rule.
In order to make it easier to understand we’ve made some videoclips that can help you out in:
- Grasping the technical aspects of neurologic monitoring
- Becoming aware of the importance of this subject on high risk patients’ outcome
- Making an example of how should neurological monitoring be made, both in simple and complex situations
If you have your own videos to submit, send them to us: we’ll be more than happy to see them and eventually add them in this section. If you want to use this video in your own presentations or at conferences, send us an e-mail and we’ll send you a HD version.
Un reparto di Terapia Intensiva è un unico organismo… Non si può curare gli ammalati senza prendersi cura anche degli operatori.
Gestire il doloreFlowchart dolore
Gestire la sedazioneFlowchart sedaz/agitaz
Gestire il deliriumFlowchart Delirium
Scheda di lavoro CAM-ICU
Questo sito è stato realizzato grazie al contributo di:
Finanziamento per la Ricerca Indipendente
(Decreto DGS 13456 del 22 dicembre 2010)