1. Yamamoto, Linda BSN, MBA/HCA, RN, PHN

Article Content

Neurological injury is a life-altering event. Everyone is affected: the patients, their families, and their friends. This issue of Critical Care Nursing Quarterly addresses current care of the neurologically injured patients in the intensive care setting. It gives an update of the diagnostics, and treatment modalities, that are affecting or will affect the direction of medical and surgical management of the neurologically injured individual.


The first article addresses the question "Coma Stimulation: Are We Doing Everything We Can?" With the rise in cases of traumatic brain injury, the number of patients who will experience some form of coma or deficits is climbing. The focus is not only on saving our patients but on how to figure out what else we can do for them. Gerber's article helps educate healthcare professionals on managing and implementing structured sensory stimulation sessions.


The second article is an overview of meningococcal meningitis and how this disease can become deadly in a short amount of time. Estep covers the pathophysiology, signs and symptoms, and assessment. New and effective known treatments and prevention strategies are also discussed. This article educates healthcare professionals that it is imperative to correctly, quickly assess their patients for rapid response to treatment.


The third article, "Cerebral Vasospasm After Subarachnoid Hemorrhage," gives an in-depth overview of what a vasospasm is and how it is treated. It is a significant problem, often with devastating consequences. Kosty reviews the current body of knowledge as it pertains to vasospasm and outlines the direction of ongoing research.


The fourth article, "Innovations in the Management of Cerebral Injury," explores brain tissue oxygen monitoring in the severe brain-injured patient. Pathophysiology and technological advances provide information on factors that affect the cellular dynamics of oxygenation. Practice guidelines and interventions are discussed.


The fifth article discusses therapeutic hypothermia and how it has been shown to decrease morbidity and mortality and improve long-term outcomes by protecting the brain from secondary brain injury. Wright defines hypothermia and provides critical information necessary to provide care for the critically ill patient under therapeutic hypothermia. She also includes reviews of major trials that have been instrumental in establishing guidelines and directing further research.


The sixth article presents an in-depth overview of case management "within the walls." It is carried out differently, depending on the setting and the facility. The authors give an overview of within-the-walls case management. A case scenario is used to show the process the nurse case manager used with a patient in the critical care unit who sustained an aneurysmal subarachnoid hemorrhage. She explains the elements of the patient's case management. Trends, challenges, and changes that will affect case management practice and policies of case management in the future are viewed.


The seventh article discusses the advantages of critical rehabilitation in spinal cord injuries. Most nurses have worked with patients that have had spinal cord injuries at one time or another. In the past, spinal cord-injured patients were in the intensive care units only for a brief time before they were transferred. Today, their stay in the units are longer and nurses must be cognizant of indications, contraindications, and best-practice interventions to ensure the best positive outcome for the patient. Fries's article, "Critical Rehabilitation of the Patient With Spinal Cord Injury," educates healthcare practitioners in this process.


Hopefully the articles that are highlighted in this issue will help provide ICU nurses with an increased awareness to promptly identify and manage these conditions to ensure the best outcomes for their patients.


I would like to thank Penny Ward and Micki Robinson, our 2 librarians, for the wonderful support and assistance they gave to each of the authors.


Linda Yamamoto, BSN, MBA/HCA, RN, PHN


San Diego, Calif, Issue Editor