Neurovascular assessment in the critically ill patient

Abstract

Aim: To outline the pathophysiological processes involved in neurovascular impairment and compartment syndrome and examine common contributory factors within the development and clinical presentation of neurovascular impairment in critical care patients with musculoskeletal trauma.

Background: Thorough and systematic assessment of neurovascular status in critically ill patients with musculoskeletal trauma is crucial to detect secondary ischaemic injury and implement appropriate and timely treatment of any neurovascular deficits.

Method: Current literature relating to neurovascular assessment and associated patient care was reviewed and utilised to outline distinct assessment components, indicators of neurovascular impairment and highlight the important issues for critical care nursing practice.

Results: Diminished limb perfusion secondary to vascular impairment and compartment syndrome are well documented. Complications associated with musculoskeletal trauma and surgical intervention can have wide-ranging effects on the patient's functional ability and overall outcome. It is crucial that appropriate neurovascular assessment is undertaken for patients admitted to the critical care unit following musculoskeletal trauma, crush injury, orthopaedic surgery (involving internal or external fixation of fractures) and those who may have experienced prolonged external pressure from casts or tight-fitting bandages. Several elements of neurovascular assessment are, however, more complex to undertake in the context of the unconscious or sedated critically ill patient.

Conclusions: Effective practice requires that the critical care nurse has a comprehensive understanding of the aetiology, pathophysiology, physiological responses and clinical presentation associated with neurovascular impairment, secondary ischaemia and compartment syndrome.

Relevance to clinical practice: Undertaking an effective neurovascular assessment for patients at risk of neurovascular impairment or acute compartment syndrome (ACS) in the critical care setting can be problematic when patients are unable to communicate with the nurse. The risk of long-term functional impairment or limb loss can be significant in this group of patients, particularly following musculoskeletal trauma. This article reviews the aetiology and pathophysiology of neurovascular impairment in the critical care context and provides guidance for nurses undertaking this important element of nursing assessment with non-verbal, critically unwell patients. Informed practice in neurovascular assessment has the potential to enable early detection and timely management for these patients, which is crucial to optimise patient outcomes.