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Abstract

240 physicians 72% of them were Critical care physicians, 21% were neurologist and 7% were neurosurgeons. Results: 30% of the responders consider Non convulsive seizures as an underestimated problem in the ICU. When NCS is diagnosed in mechanically ventilated patients 70% of the responders will start loading phenytoin immediately while about 25% of the responders will start other medications via naso gastric route. 70% of the responders prefer propofol as the anesthetic drug of choice to control non convulsive status epileptics while 80% of the responses considered the levetiracitam as the first drug of choice for long term control. Conclusions: Although the advances in diagnosis still large number of physicians need more orientation about the diagnosis and the complications of non convulsive seizures and non convulsive status epileptics in the ICU. High variability in practice that require further investigations Learning Objectives: Neuro checks are necessary to detect neurologic events and deterioration in brain injured patients. Prolonged hourly checks over days may lead to profound sleep deprivation which could masquerade as a neurologic change necessitating workup. We aimed to identify the standard frequency of neuro checks in a variety of patient populations in neurocritical care and to evaluate recognition of serial neuro checks as a contributor to sleep deprivation and potential for subsequent neurologic deterioration. Methods: We conducted a survey of 10 questions to Mayo Clinic (Minnesota, Arizona and Florida) critical care nurses, advanced practice providers (APP) and physicians over 3 weeks to evaluate current practices of neurologic monitoring of brain injured patients. A categorical scale was developed to measure the frequencies of neuro checks in a variety of neurocritical care populations. Results: We received 103 responses from 518 invitations. RN's constituted 58% of respondents, physicians 28% and advanced practice providers 14%. The most common frequency (60/103) reported for neuro checks in high risk intracranial hemorrhage populations was q1hr. The majority of respondents (58/103) estimated that high risk patients were monitored for at least every 2 hr more than 5 days. The respondents (57/103) reported an observed relationship between neurologic deterioration and sleep deprivation that required evaluation including imaging. Only 1 physician noted delayed intervention as a result of less frequent checks. Conclusions: Sleep deprivation from ICU neuro checks may be an underappreciated phenomenon in neurocritical care, particularly in patients with prolonged ICU stays and may lead to unnecessary testing, including imaging. The data suggest respondents perceive an association between frequent neuro checks and neurologic deterioration caused by sleep deprivation. The survey underscores the need for studying the optimal frequency of neuromonitoring to detect secondary neurologic events and deterioration while counterbalancing potential for harm from sleep deprivation and unnecessary testing.