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Biomedical subjects

Mary Kay Bader

Publications and source records attributed to Mary Kay Bader.

11 recordsLinked to original sources
PubMed2006

Recognizing and treating ischemic insults to the brain: the role of brain tissue oxygen monitoring.

This article describes the potential application of brain tissue oxygen monitoring technology in the care of patients who have sustained traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH). To accomplish this objective, a review of the intracranial dynamics that are created by primary and secondary brain injury, and the challenges of optimizing oxygen delivery to the injured brain are presented. Furthermore, interventions that facilitate cerebral oxygen supply and reduce oxygen consumption are identified. Finally, application of this technology is highlighted by using case vignettes of patients who have TBI or SAH.

Adolescent↗
PubMed2006

Gizmos and gadgets for the neuroscience intensive care unit.

Managing the critical neuroscience patient population challenges practitioners because of both the devastating injury involved and the complexity of care required. Emerging technology provides the neuroscience intensive care unit team with better information on the intricate physiology and dynamics inside the cranium. In particular, the team is better able to detect changes in pressure, oxygen, and blood flow. With improved data in hand, the team can intervene to optimize intracranial dynamics, possibly reducing disability and death among such patients.

Adolescent↗
PubMed2005

Brain tissue oxygenation in brain death.

INTRODUCTION: The value of brain tissue oxygenation (PbtO2) measurements in determining brain death is unknown. METHODS: Eleven of 72 patients who had brain tissue oxygen monitors placed experienced brain death. Admission diagnoses included six severe traumatic brain injuries, one multiple trauma with cardiac arrest, one brain tumor, one subarachnoid hemorrhage, one intracerebral hemorrhage, and one cerebral stroke. Eleven males and zero females were studied, with an average age of 26 years (range: 20-70 years). Nine patients had Glasgow Coma Scores (GCS) of 3 on admission, one patient had a GCS of 5, and one patient had a GCS of 15. RESULTS: Time from admission to declaration of brain death varied from 5 hours to 7 days; the most common interval was 1 or 2 days. Cerebral perfusion pressure (CPP) fell to 0 in eight patients, which indicated primary failure of cerebral perfusion. CPP stayed above 60 mmHg in three patients, indicating primary tissue failure, possibly of the cerebral microvasculature. PbtO2 fell to 0 in all patients who experienced brain death, and all patients with PbtO2 of 0 experienced brain death. None of the 61 patients who did not experience brain death had confirmed PbtO2 readings of 0. CONCLUSION: PbtO2 can be successfully and accurately used as a bedside adjunctive test for brain death. The use of PbtO2 as a sole confirmatory test for brain death in the setting of an appropriate clinical examination will require the evaluation of a larger number of patients to assess its sensitivity and specificity.

Adult↗
PubMedDate not supplied

Prevention of secondary brain injury: targeting technology.

Use of technology in the management of the severely brain-injured patient has increased over the past decade and can be confusing and overwhelming to the critical care nurse clinicians who are new to the field of neurology. This article will describe normal physiology and cerebral dynamics and potential abnormal physiology encountered after brain injury. The technology reviewed will include intracranial pressure monitoring, cerebral blood flow monitoring and autoregulation, cerebral oxygen consumption and tissue oxygen monitoring, metabolism, sedation, and temperature monitoring. Integration of appropriate technology into patient management will be discussed using a case study to explore the utility of information at the bedside. Recognizing the difficult task of trying to control secondary injury in our patients is the first step to better outcomes. Implementing the use of technology to mitigate the situation must be done with careful consideration and a team approach to achieve the greatest benefit for the patient.

Algorithms↗
PubMedDate not supplied

Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring.

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.

Adult↗
PubMedDate not supplied

What's the "hyper" in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours.

Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset. Guidelines have been established identifying critical elements for hospitals in order to be designated as primary or comprehensive stroke centers. Research studies exploring treatment options for stroke, as well as general care priorities exist in the scientific literature but must be integrated into hospital-based protocols. Recommended interventions are highlighted to assist critical care practitioners in the delivery of care for stroke patients. Coordinated teams using an evidence-based approach can optimize the outcomes of the stroke patient population.

Acute Disease↗