Neuromonitoring and Assessment
Preface Neuromonitoring in the In t e ns i ve C a r e U ni t
Catherine Harris, PhD, MBA, AGACNP, ANP, FNP-BC Editor
This issue of Critical Care Nursing Clinics of North America is focused on neuromonitoring in the intensive care unit (ICU). Neuromonitoring is a broad umbrella term that elicits different concepts depending on a person’s role in the ICU. For instance, a trauma nurse may associate neuromonitoring with intracranial bolts, whereas an ultrasound technician may immediately think of transcranial Dopplers. A neuro ICU nurse may have visions of going to multiple scans or working with external ventricular drains. The term neuromonitoring includes all these concepts as well as more, which are discussed within this dedicated issue of Critical Care Nursing Clinics of North America. In designing this issue, we created three overriding themes of neuromonitoring that remained fairly broad. First, we thought of traditional methods of neuromonitoring that a nurse would expect to see in this issue. Robinson goes into depth on treating refractory increased intracranial pressures, while Heck discusses different modalities that are available for using invasive neuromonitoring for patients. Irick and Feil provide an extremely helpful overview of neuromonitoring in the operating room. Many ICU nurses are not familiar with neuromonitoring in the operating room, and the literature is resource-poor in this area. Therefore, the collaborative approach from Irick and Feil not only provides a better understanding of neuromonitoring but also gives nurses a glimpse into the role of the nurse anesthetist. The second approach we took on neuromonitoring was to explore novel concepts and products. Hylkema provides a look at one of the newest concepts of using optic sheath ultrasound as a method for assessing intracranial pressures noninvasively. The use of ultrasound has grown exponentially over the years due to its ease of use, low cost, and accessibility. Hylkema provides an overview of how it is being used for neurologic patients. Few centers have microdialysis, but the road on how to use it is being mapped by Kumar and Young in this issue. Even if your hospital setting does not use microdialysis, there is tremendous value in understanding brain metabolism. Wilson and Della Penna present evidenced-based research on the value of Crit Care Nurs Clin N Am 28 (2016) xiii–xiv http://dx.doi.org/10.1016/j.cnc.2015.12.001 0899-5885/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
ccnursing.theclinics.com
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Preface
thermoregulation in the neurologically impaired patients and treatment options. Olson and Fishel provide an astounding wealth of information on the value of pupillometry and how it can be used in the ICU. We took some liberty in expanding the concept of neuromonitoring to encompass a nontraditional approach to the topic. Livesay highlights the fact that the nurse is indeed the most important part of the neuromonitoring armamentarium that we have. McNett reinforces that concept with the challenges nurses have with blood pressures in neuro patients. Why do we use mean arterial pressures? Haymore delves into his own research on delirium to show that nurses are the most important piece of the picture as their astuteness in evaluating changes, however subtle in patients, is essential. Finally, Yeager provides the most comprehensive review of neuroradiology that will likely remain as a resource for nurses for years to come! We hope this issue of Critical Care Nursing Clinics of North America serves as a resource for ICU nurses who are seeking to better understand how to care for complex patients with a neurologic issue. The most important concept we want to convey in this issue is that no matter how much neurotechnology exists, the most critical neuromonitoring process we have is the nurse. The nurse is the ultimate tool in neuromonitoring. The nurse is the one who needs to understand, interpret, and troubleshoot the equipment. Without the knowledge and resourcefulness of the nurse, the technology can only provide output. The nurse’s passion to improve care and outcomes in patients with neurologic injury is pivotal, since no device can replace the care and protective vigilance nursing brings to the table. Therefore, this special issue of Neuromonitoring is dedicated to the nurse in the ICU who is committed to working with patients with neurologic injuries and to improving his or her knowledge of what technology is out there. Catherine Harris, PhD, MBA, AGACNP, ANP, FNP-BC Adult Gerontology Acute Care Nurse Practitioner Program Jefferson College of Nursing Neurocritical Care, Jefferson Hospital for Neuroscience 901 Walnut Street, Suite 823 Philadelphia, PA 19107, USA E-mail address: [email protected]
Preface Neuromonitoring in the In t e ns i ve C a r e U ni t
Catherine Harris, PhD, MBA, AGACNP, ANP, FNP-BC Editor
This issue of Critical Care Nursing Clinics of North America is focused on neuromonitoring in the intensive care unit (ICU). Neuromonitoring is a broad umbrella term that elicits different concepts depending on a person’s role in the ICU. For instance, a trauma nurse may associate neuromonitoring with intracranial bolts, whereas an ultrasound technician may immediately think of transcranial Dopplers. A neuro ICU nurse may have visions of going to multiple scans or working with external ventricular drains. The term neuromonitoring includes all these concepts as well as more, which are discussed within this dedicated issue of Critical Care Nursing Clinics of North America. In designing this issue, we created three overriding themes of neuromonitoring that remained fairly broad. First, we thought of traditional methods of neuromonitoring that a nurse would expect to see in this issue. Robinson goes into depth on treating refractory increased intracranial pressures, while Heck discusses different modalities that are available for using invasive neuromonitoring for patients. Irick and Feil provide an extremely helpful overview of neuromonitoring in the operating room. Many ICU nurses are not familiar with neuromonitoring in the operating room, and the literature is resource-poor in this area. Therefore, the collaborative approach from Irick and Feil not only provides a better understanding of neuromonitoring but also gives nurses a glimpse into the role of the nurse anesthetist. The second approach we took on neuromonitoring was to explore novel concepts and products. Hylkema provides a look at one of the newest concepts of using optic sheath ultrasound as a method for assessing intracranial pressures noninvasively. The use of ultrasound has grown exponentially over the years due to its ease of use, low cost, and accessibility. Hylkema provides an overview of how it is being used for neurologic patients. Few centers have microdialysis, but the road on how to use it is being mapped by Kumar and Young in this issue. Even if your hospital setting does not use microdialysis, there is tremendous value in understanding brain metabolism. Wilson and Della Penna present evidenced-based research on the value of Crit Care Nurs Clin N Am 28 (2016) xiii–xiv http://dx.doi.org/10.1016/j.cnc.2015.12.001 0899-5885/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
ccnursing.theclinics.com
xiv
Preface
thermoregulation in the neurologically impaired patients and treatment options. Olson and Fishel provide an astounding wealth of information on the value of pupillometry and how it can be used in the ICU. We took some liberty in expanding the concept of neuromonitoring to encompass a nontraditional approach to the topic. Livesay highlights the fact that the nurse is indeed the most important part of the neuromonitoring armamentarium that we have. McNett reinforces that concept with the challenges nurses have with blood pressures in neuro patients. Why do we use mean arterial pressures? Haymore delves into his own research on delirium to show that nurses are the most important piece of the picture as their astuteness in evaluating changes, however subtle in patients, is essential. Finally, Yeager provides the most comprehensive review of neuroradiology that will likely remain as a resource for nurses for years to come! We hope this issue of Critical Care Nursing Clinics of North America serves as a resource for ICU nurses who are seeking to better understand how to care for complex patients with a neurologic issue. The most important concept we want to convey in this issue is that no matter how much neurotechnology exists, the most critical neuromonitoring process we have is the nurse. The nurse is the ultimate tool in neuromonitoring. The nurse is the one who needs to understand, interpret, and troubleshoot the equipment. Without the knowledge and resourcefulness of the nurse, the technology can only provide output. The nurse’s passion to improve care and outcomes in patients with neurologic injury is pivotal, since no device can replace the care and protective vigilance nursing brings to the table. Therefore, this special issue of Neuromonitoring is dedicated to the nurse in the ICU who is committed to working with patients with neurologic injuries and to improving his or her knowledge of what technology is out there. Catherine Harris, PhD, MBA, AGACNP, ANP, FNP-BC Adult Gerontology Acute Care Nurse Practitioner Program Jefferson College of Nursing Neurocritical Care, Jefferson Hospital for Neuroscience 901 Walnut Street, Suite 823 Philadelphia, PA 19107, USA E-mail address: [email protected]
