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  1. Article: Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge.

    Barra, Megan E / Iracheta, Christine / Tolland, Joseph / Jehle, Johnathan / Minova, Ljubica / Li, Karen / Amatangelo, Mary / Krause, Patricia / Batra, Ayush / Vaitkevicius, Henrikas

    The Neurohospitalist

    2023  Volume 13, Issue 4, Page(s) 351–360

    Abstract: Background and purpose: Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with ... ...

    Abstract Background and purpose: Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU).
    Methods: We performed a single-center prospective cohort study with adult patients admitted to a neuroscience ICU between March and June 2016-2018 who required MV for greater than 48 hours. Patients were included from three separate phases of the study: Phase I - historical controls (2016); Phase II - analgesia-first pathway (2017); Phase III - early mobility protocol (2018). Primary outcomes included propofol requirements during MV, total rehabilitation therapy provided, and functional mobility during ICU admission.
    Results: 156 patients were included in the analysis. Decreasing propofol exposure was observed during Phase I, II, and III (median 2243.7 mg/day vs 2065.6 mg/day vs 1360.8 mg/day, respectively; P = .04 between Phase I and III). Early mobility was provided in 59.7%, 40%, and 81.6% of patients while admitted to the ICU in Phase I, II, and III, respectively (P < .01). An increased proportion of patients in Phase III were walking or ambulating at ICU discharge (26.7%; 8/30) compared to Phase I (7.9%, 3/38, P = .05).
    Conclusions: An interdisciplinary approach with an analgesia-first sedation pathway with early mobility protocol was associated with less sedative use, increased rehabilitation therapy, and improved functional mobility status at ICU discharge.
    Language English
    Publishing date 2023-06-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2629083-2
    ISSN 1941-8752 ; 1941-8744
    ISSN (online) 1941-8752
    ISSN 1941-8744
    DOI 10.1177/19418744231182897
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19: A Rehabilitation-Based Prone Team.

    Ng, Jillian A / Miccile, Lauren A / Iracheta, Christine / Berndt, Carolyn / Detwiller, Meredith / Yuse, Carolyn / Tolland, Joseph

    Physical therapy

    2020  Volume 100, Issue 10, Page(s) 1737–1745

    Abstract: Objective: Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive ... ...

    Abstract Objective: Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive care unit staff at Brigham and Women's Hospital.
    Methods: A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety.
    Results: The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. The volume of requests to the rehabilitation-based prone team generally increased to week 4 and has, since then, declined. Key points for successful implementation included identification of rehabilitation therapists with intensive care unit experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process.
    Conclusion: The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation.
    Impact: This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to coronavirus disease 2019 and will help guide other institutions.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/therapy ; Critical Care ; Humans ; Pandemics ; Patient Positioning ; Pneumonia, Viral/complications ; Pneumonia, Viral/therapy ; Prone Position ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; Respiratory Distress Syndrome/virology ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-07-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 415886-6
    ISSN 1538-6724 ; 0031-9023
    ISSN (online) 1538-6724
    ISSN 0031-9023
    DOI 10.1093/ptj/pzaa124
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19: A Rehabilitation-Based Prone Team

    Ng, Jillian A / Miccile, Lauren A / Iracheta, Christine / Berndt, Carolyn / Detwiller, Meredith / Yuse, Carolyn / Tolland, Joseph

    Phys Ther

    Abstract: OBJECTIVE: Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive ... ...

    Abstract OBJECTIVE: Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive care unit staff at Brigham and Women's Hospital. METHODS: A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety. RESULTS: The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. The volume of requests to the rehabilitation-based prone team generally increased to week 4 and has, since then, declined. Key points for successful implementation included identification of rehabilitation therapists with intensive care unit experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process. CONCLUSION: The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation. IMPACT: This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to coronavirus disease 2019 and will help guide other institutions.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #657155
    Database COVID19

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  4. Article ; Online: Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19

    Ng, Jillian A / Miccile, Lauren A / Iracheta, Christine / Berndt, Carolyn / Detwiller, Meredith / Yuse, Carolyn / Tolland, Joseph

    Physical Therapy

    A Rehabilitation-Based Prone Team

    2020  Volume 100, Issue 10, Page(s) 1737–1745

    Abstract: Abstract Objective Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the ... ...

    Abstract Abstract Objective Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive care unit staff at Brigham and Women’s Hospital. Methods A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety. Results The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. The volume of requests to the rehabilitation-based prone team generally increased to week 4 and has, since then, declined. Key points for successful implementation included identification of rehabilitation therapists with intensive care unit experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process. Conclusion The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation. Impact This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to coronavirus disease 2019 and will help guide other institutions.
    Keywords Physical Therapy, Sports Therapy and Rehabilitation ; covid19
    Language English
    Publisher Oxford University Press (OUP)
    Publishing country uk
    Document type Article ; Online
    ZDB-ID 415886-6
    ISSN 0031-9023
    ISSN 0031-9023
    DOI 10.1093/ptj/pzaa124
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Quantitative evaluation of changes in gait after extended cerebrospinal fluid drainage for normal pressure hydrocephalus.

    Yang, Felix / Hickman, Thu-Trang / Tinl, Megan / Iracheta, Christine / Chen, Grace / Flynn, Patricia / Shuman, Matthew E / Johnson, Tatyana A / Rice, Rebecca R / Rice, Isaac M / Wiemann, Robert / Johnson, Mark D

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

    2016  Volume 28, Page(s) 31–37

    Abstract: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability, urinary incontinence and cognitive dysfunction. These symptoms can be relieved by cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements ...

    Abstract Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability, urinary incontinence and cognitive dysfunction. These symptoms can be relieved by cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements are poorly characterized. Attempts to prospectively identify iNPH patients responsive to CSF drainage by evaluating presenting gait quality or via extended lumbar cerebrospinal fluid drainage (eLCD) trials are common, but the reliability of such approaches is unclear. Here we combine eLCD trials with computerized quantitative gait measurements to predict shunt responsiveness in patients undergoing evaluation for possible iNPH. In this prospective cohort study, 50 patients presenting with enlarged cerebral ventricles and gait, urinary, and/or cognitive difficulties were evaluated for iNPH using a computerized gait analysis system during a 3day trial of eLCD. Gait speed, stride length, cadence, and the Timed Up and Go test were quantified before and during eLCD. Qualitative assessments of incontinence and cognition were obtained throughout the eLCD trial. Patients who improved after eLCD underwent ventriculoperitoneal shunt placement, and symptoms were reassessed serially over the next 3 to 15months. There was no significant difference in presenting gait characteristics between patients who improved after drainage and those who did not. Gait improvement was not observed until 2 or more days of continuous drainage in most cases. Symptoms improved after eLCD in 60% of patients, and all patients who improved after eLCD also improved after shunt placement. The degree of improvement after eLCD correlated closely with that observed after shunt placement.
    MeSH term(s) Aged ; Aged, 80 and over ; Female ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/surgery ; Humans ; Hydrocephalus, Normal Pressure/complications ; Hydrocephalus, Normal Pressure/surgery ; Male ; Outcome Assessment (Health Care)/methods ; Ventriculoperitoneal Shunt/methods
    Language English
    Publishing date 2016-06
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 1193674-5
    ISSN 1532-2653 ; 0967-5868
    ISSN (online) 1532-2653
    ISSN 0967-5868
    DOI 10.1016/j.jocn.2015.11.013
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  6. Article ; Online: Association between shunt-responsive idiopathic normal pressure hydrocephalus and alcohol.

    Hickman, Thu-Trang / Shuman, Matthew E / Johnson, Tatyana A / Yang, Felix / Rice, Rebecca R / Rice, Isaac M / Chung, Esther H / Wiemann, Robert / Tinl, Megan / Iracheta, Christine / Chen, Grace / Flynn, Patricia / Mondello, Mary Beth / Thompson, Jillian / Meadows, Mary-Ellen / Carroll, Rona S / Yang, Hong Wei / Xing, Hongyan / Pilgrim, David /
    Chiocca, E Antonio / Dunn, Ian F / Golby, Alexandra J / Johnson, Mark D

    Journal of neurosurgery

    2016  Volume 127, Issue 2, Page(s) 240–248

    Abstract: OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventriculomegaly, gait difficulty, incontinence, and dementia. The symptoms can be ameliorated by CSF drainage. The object of this study was to identify factors associated with ...

    Abstract OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventriculomegaly, gait difficulty, incontinence, and dementia. The symptoms can be ameliorated by CSF drainage. The object of this study was to identify factors associated with shunt-responsive iNPH. METHODS The authors reviewed the medical records of 529 patients who underwent shunt placement for iNPH at their institution between July 2001 and March 2015. Variables associated with shunt-responsive iNPH were identified using bivariate and multivariate analyses. Detailed alcohol consumption information was obtained for 328 patients and was used to examine the relationship between alcohol and shunt-responsive iNPH. A computerized patient registry from 2 academic medical centers was queried to determine the prevalence of alcohol abuse among 1665 iNPH patients. RESULTS Bivariate analysis identified associations between shunt-responsive iNPH and gait difficulty (OR 4.59, 95% CI 2.32-9.09; p < 0.0001), dementia (OR 1.79, 95% CI 1.14-2.80; p = 0.01), incontinence (OR 1.77, 95% CI 1.13-2.76; p = 0.01), and alcohol use (OR 1.98, 95% CI 1.23-3.16; p = 0.03). Borderline significance was observed for hyperlipidemia (OR 1.56, 95% CI 0.99-2.45; p = 0.054), a family history of hyperlipidemia (OR 3.09, 95% CI 0.93-10.26, p = 0.054), and diabetes (OR 1.83, 95% CI 0.96-3.51; p = 0.064). Multivariate analysis identified associations with gait difficulty (OR 3.98, 95% CI 1.81-8.77; p = 0.0006) and alcohol (OR 1.94, 95% CI 1.10-3.39; p = 0.04). Increased alcohol intake correlated with greater improvement after CSF drainage. Alcohol abuse was 2.5 times more prevalent among iNPH patients than matched controls. CONCLUSIONS Alcohol consumption is associated with the development of shunt-responsive iNPH.
    MeSH term(s) Aged ; Alcoholism/complications ; Female ; Humans ; Hydrocephalus, Normal Pressure/complications ; Hydrocephalus, Normal Pressure/surgery ; Male ; Retrospective Studies ; Treatment Outcome ; Ventriculoperitoneal Shunt
    Language English
    Publishing date 2016-09-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2016.6.JNS16496
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