Department of Neurology, University Hospital of Köln, Cologne, Germany.
Neurocrit Care. 2014 Apr;20(2):176-86. doi: 10.1007/s12028-013-9893-3.
Optimal management of physiological parameters in neurological/neurosurgical intensive care units (NICUs) is largely unclear as high-quality evidence is lacking. The aim of this survey was to investigate if standards exist in the use of clinical scores, systemic and cerebral monitoring and the targeting of physiology values and in what way this affects clinical management in German NICUs.
National survey, on-line anonymized questionnaire. German departments stating to run a neurological, neurosurgical or interdisciplinary neurological/neurosurgical intensive care unit were identified by a web-based search of all German hospitals and contacted via email.
Responses from 78 German NICUs were obtained. Of 19 proposed clinical/laboratory/radiological scores only 5 were used regularly by >60 %. Bedside neuromonitoring (NM) predominantly consisted of transcranial Doppler sonography (94 %), electroencephalography (92 %) and measurement of intracranial pressure (ICP) (90 %), and was installed if patients had or were threatened by elevated ICP (86 %), had specific diseases like subarachnoid hemorrhage (51 %) or were comatose (35 %). Although mean trigger values for interventions complied with guidelines or wide-spread customs, individual trigger values varied widely, e.g., for hyperglycemia (maximum blood glucose between 120 and 250 mg/dl) or for anemia (minimum hemoglobin values between 5 and 10 g/dl).
Although apparently aiming for standardization in neurocritical care, German NICUs show substantial differences in NM and monitoring-associated interventions. In terms of scoring and monitoring methods, German NICUs seem to be quite conservative. These survey results suggest a need of prospective and randomized interventional trials in neurocritical care to help define standards and target values.
由于缺乏高质量的证据，神经科/神经外科重症监护病房（NICU）中生理参数的最佳管理方法仍不清楚。本调查旨在研究德国 NICU 中是否存在临床评分、系统和脑监测以及生理值目标的使用标准，以及这对临床管理有何影响。
全国性调查，在线匿名问卷。通过在互联网上搜索所有德国医院来确定表示运行神经科、神经外科或神经科/神经外科综合重症监护病房的德国科室，并通过电子邮件联系他们。
获得了 78 家德国 NICU 的回复。在提出的 19 项临床/实验室/影像学评分中，只有 5 项被>60%的单位常规使用。床边神经监测（NM）主要包括经颅多普勒超声（94%）、脑电图（92%）和颅内压（ICP）测量（90%），如果患者存在或有升高的 ICP 风险（86%）、有特定疾病（如蛛网膜下腔出血（51%）或昏迷（35%），则会进行 NM。尽管干预的平均触发值符合指南或广泛的惯例，但个体的触发值差异很大，例如，对于高血糖（最大血糖水平在 120 至 250mg/dl 之间）或贫血（最低血红蛋白值在 5 至 10g/dl 之间）。
尽管德国 NICU 在神经危重症护理中显然旨在实现标准化，但 NM 和监测相关干预存在很大差异。在评分和监测方法方面，德国 NICU 似乎相当保守。这些调查结果表明，神经危重症护理需要前瞻性和随机干预试验来帮助定义标准和目标值。
