Intracerebral Hemorrhage for the Palliative Care Provider: What You Need to Know

Simmons, B Brent; Parks, Susan

doi:10.1089/jpm.2008.0169

Cited by 13 publications

(5 citation statements)

References 24 publications

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“…This should include the further development and validation of stroke clinical prediction rules, as well as methods to assess for the presence and magnitude of various biases that can enter into the decision-making process, including prognosticating illness, estimating benefits and burdens of procedures, and valuation of health states. [17][18][19][20] Finally, more research is needed on the emerging palliative care needs in those patients and their families who survive the acute event but remain with significant disability and at heightened risk of mortality.…”

Section: Figmentioning

confidence: 99%

Palliative Care Consultations in Hospitalized Stroke Patients

Holloway

Ladwig

Robb

et al. 2010

Journal of Palliative Medicine

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Objective: To determine the pattern and characteristics of palliative care (PC) consultations in patients with stroke and compare them with the characteristics of nonstroke consultations. Methods: The palliative care program at Strong Memorial Hospital (SMH) was established in October 2001. SMH is a 765-bed academic medical center with approximately 38,000 discharges. For each consult from 2005 to 2007, we collected demographic, clinical, and service-related information. We explored similarities and differences in patients with different types of stroke, including patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hematoma. In addition, we compared these data to the nonstroke patients who had a palliative care consultation during the same time period. Results: Over the 3-year period from 2005 to 2007, there were a total of 101 consultations in patients with stroke (6.3% of all PC consultations). Of the 101 consultations, 31 were in patients with ischemic stroke, 26 in patients with intracerebral hemorrhage, 30 in patients with subarachnoid hemorrhage, and 14 in patients with subdural hematoma. Patients with stroke who had a PC consult were more functionally impaired, less likely to have capacity, more likely to die in the hospital, and to have fewer traditional symptom burdens than other common diagnoses seen on the PC consultation service. The most common trajectory to death was withdrawal of mechanical ventilation, but varied by type of stroke. Common treatments negotiated in these consultations included mechanical ventilation, artificial nutrition, tracheostomy, and less likely antibiobics, intravenous fluids, and various neurosurgical procedures. Conclusions: Patients with stroke are a common diagnosis seen on an inpatient palliative care consult service. Each stroke type represents patients with potentially distinct palliative care needs.

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Section: Figmentioning

confidence: 99%

Palliative Care Consultations in Hospitalized Stroke Patients

Holloway

Ladwig

Robb

et al. 2010

Journal of Palliative Medicine

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“…Understanding the need for tracheostomy during these discussions with family is critical as it is commonly a major factor in the decision to continue with aggressive care, transition to comfort measures, or consider organ donation. 23 33) …”

Section: Discussionmentioning

confidence: 99%

Glasgow Coma Scale Motor Score Predicts Need for Tracheostomy After Decompressive Craniectomy for Traumatic Brain Injury

Guillotte,

Fry,

Gattozzi

et al. 2023

Korean J Neurotrauma

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Objective Many patients with severe traumatic brain injury (TBI) require a tracheostomy after decompressive craniectomy. Determining which patients will require tracheostomy is often challenging. The existing methods for predicting which patients will require tracheostomy are more applicable to stroke and spontaneous intracranial hemorrhage. The aim of this study was to investigate whether the Glasgow Coma Scale (GCS) motor score can be used as a screening method for predicting which patients who undergo decompressive craniectomy for severe TBI are likely to require tracheostomy. Methods The neurosurgery census at the University of Kansas Medical Center was retrospectively reviewed to identify adult patients aged over 18 years who underwent decompressive craniectomy for TBI. Eighty patients met the inclusion criteria for the study. There were no exclusion criteria. The primary outcome of interest was the need for tracheostomy. The secondary outcome was the comparison of the total length of stay (LOS) and intensive care unit LOS between the early and late tracheostomy patient groups. Results All patients (100%) with a GCS motor score of 4 or less on post operative (POD) 5 required tracheostomy. Setting the threshold at GCS motor score of 5 on POD 5 for recommending tracheostomy resulted in 86.7% sensitivity, 91.7% specificity, and 90.5% positive predictive value, with an area under the receiver operator curve of 0.9101. Conclusion GCS motor score of 5 or less on POD 5 of decompressive craniectomy is a useful screening threshold for selecting patients who may benefit from tracheostomy, or may be potential candidates for extubation.

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“…La sopravvivenza è inferiore a 6 mesi anche in caso di ricovero in terapia intensiva legato a severo scompenso epatico con grave ipotensione, creatininemia >1,5 mg/dl oppure in presenza di sindrome epatopolmonare o sindrome epatorenale progressiva. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Nel 2016 uno studio cinese, pubblicato sul Journal of Gastroenterology and Hepatology, ha validato un nuovo score prognostico di sopravvivenza a 3 mesi nei pazienti con cirrosi epatica in fase avanzata, ricoverati in terapia intensiva, per cercare di individuare quali pazienti potranno beneficiare di un trattamento intensivo. Lo score, denominato MSCIC, si basa su alcuni criteri registrati all'ingresso in terapia intensiva: PT-INR, bilirubina sierica, uso di farmaci vasopressori, presenza di encefalopatia, SIRS.…”

Section: Cirrosi Epaticaunclassified

“…39 Due strumenti relativamente semplici sono disponibili per una valutazione prognostica nelle emorragie intracerebrali (intracerebral hemorrhage-ICH): l'ICH score di Hemphill ed il punteggio di Essen (Tabella 11). [40][41][42] Lo studio originale sull'ICH comprendeva 152 pazienti: di questi, tutti quelli con un punteggio di 0 erano vivi a 30 giorni, mentre tutti coloro che avevano un punteggio di 5 erano deceduti a 1 mese (nessun paziente in questo studio ha presentato uno score di 6); negli altri pazienti con un punteggio 1, 2, 3 e 4 sono stati evidenziati tassi di mortalità a 30 giorni rispettivamente del 13%, 26%, 72%, e 97%.…”

Section: Ictus Emorragicounclassified

Saper desistere per curare fino in fondo: come intraprendere il migliore percorso di assistenza nel Paziente con grave insufficienza d’organo in Medicina Interna?

et al. 2017

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<img src="/public/site/images/pgranata/rass.jpg" alt="" /> La futilità in medicina e le difficoltà a desistere L. Lusiani, L. MagnaniLe prospettive Slow Medicine sulla desistenza terapeutica S. Spinsanti, S. VerneroLa desistenza terapeutica: il punto di vista del magistrato V. Castiglione, V. PedoneLa desistenza terapeutica è giustificabile sul piano etico? E. FurlanIl punto di vista di un credente G. PinnaIl buon samaritano, la misericordia del medico e desistenza terapeutica: concetti fra loro compatibili? A. Greco, M. Greco, L. Cascavilla, G. FasanellaLe grandi insufficienze d’organo end stage: il documento SIAARTI G.R. Gristina, L. RiccioniI determinanti della mortalità a breve termine dei pazienti non oncologici ricoverati in medicina interna: un’esperienza sul campo M. Tiraboschi, S. Ghidoni, A. Zucchi, A. Carobbio, A. Ghirardi, M. Casati, F. Dentali, A. Squizzato, D. Torzillo, F. De Stefano, V. Gessi, E. Tamborini Permunian, S. Moretti, A. Assolari, A. BrucatoLe parole per dirlo: la comunicazione al paziente, ai familiari e al caregiver M. Felici, S. Lenti, L. Occhini, A. PuleràLe alternative possibili che il medico internista può proporre alla dimissione, rispetto all’aumento di intensità di cura e l’assistenza ospedaliera ordinaria: la rete di cure palliative D. Valenti, F. MoggiaScompenso cardiaco avanzato: dalla terapia attiva alle cure palliative G. MathieuIctus ischemico ed emorragia cerebrale: problematiche di fine vita C. TrocinoDemenza avanzata M. CoveriLa dispnea al termine della vita M. Giorgi-Pierfranceschi, S. OrlandoDialisi M. Meschi, S. Pioli, A. Magnano, F. Spagnoli, M. SaccòVentilazione meccanica invasiva e non M. La Regina, F. OrlandiniIl diabete mellito L. MorbidoniComunicare la scelta di desistere in medicina: una esperienza sul campo C. Bullo, G. Bordin, L. LusianiLe prospettive future in Italia e all’interno del nostro SSN A. Fontanella<img src="/public/site/images/pgranata/appendix.jpg" alt="" /> APPENDICE Metodi di riconoscimento e di valutazione del paziente in fase terminale o a rischio di elevata mortalità in ospedale: le malattie più frequentemente riscontrabili in Medicina Interna R. Nardi, G. Belmonte, P. Gnerre, G. Pinna, D. Borioni, M. Campanini, R. Gerloni, A. Fontanella

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Intracerebral Hemorrhage for the Palliative Care Provider: What You Need to Know

Cited by 13 publications

References 24 publications

Palliative Care Consultations in Hospitalized Stroke Patients

Palliative Care Consultations in Hospitalized Stroke Patients

Glasgow Coma Scale Motor Score Predicts Need for Tracheostomy After Decompressive Craniectomy for Traumatic Brain Injury

Saper desistere per curare fino in fondo: come intraprendere il migliore percorso di assistenza nel Paziente con grave insufficienza d’organo in Medicina Interna?

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