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Neurocritical Care

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https://www.readbyqxmd.com/read/28730561/men-experience-higher-risk-of-pneumonia-and-death-after-intracerebral-hemorrhage
#1
Sandro Marini, Andrea Morotti, Umme K Lena, Joshua N Goldstein, Steven M Greenberg, Jonathan Rosand, Christopher D Anderson
BACKGROUND: Infectious complications worsen outcome after intracerebral hemorrhage (ICH). We investigated the impact of sex on post-ICH infections and mortality. METHODS: Consecutive ICH patients (admitted to a single hospital between 1994 and 2015) were retrospectively assessed via chart review to ascertain the following in-hospital infections: urinary tract infection (UTI), pneumonia, and sepsis. Adjusted logistic regression was performed to identify associations between sex, infection, and mortality at 90 days...
July 20, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28721662/ctp-and-dci-we-need-clarification
#2
EDITORIAL
Thomas Mattingly
No abstract text is available yet for this article.
July 18, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28699144/palliative-care-needs-assessment-in-the-neuro-icu-effect-on-family
#3
Claire J Creutzfeldt, Marina G Hanna, C Sherry Cheever, Abhijit V Lele, Charles Spiekerman, Ruth A Engelberg, J Randall Curtis
BACKGROUND: Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS: We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds...
July 11, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28685395/what-families-need-and-physicians-deliver-contrasting-communication-preferences-between-surrogate-decision-makers-and-physicians-during-outcome-prognostication-in-critically-ill-tbi-patients
#4
Thomas Quinn, Jesse Moskowitz, Muhammad W Khan, Lori Shutter, Robert Goldberg, Nananda Col, Kathleen M Mazor, Susanne Muehlschlegel
BACKGROUND: Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA. METHODS: We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20)...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28685394/functional-improvement-among-intracerebral-hemorrhage-ich-survivors-up-to-12%C3%A2-months-post-injury
#5
Anirudh Sreekrishnan, Audrey C Leasure, Fu-Dong Shi, David Y Hwang, Joseph L Schindler, Nils H Petersen, Emily J Gilmore, Hooman Kamel, Lauren H Sansing, David M Greer, Kevin N Sheth
BACKGROUND AND PURPOSE: As survival rates have increased for intracerebral hemorrhage (ICH) patients, there is limited information regarding recovery beyond 3-6 months. This study was conducted to examine recovery curves using the modified Rankin Scale (mRS) and Barthel Index (BI) up to 12 months post-injury. METHODS: We prospectively enrolled 173 patients admitted with ICH who were subsequently evaluated using the mRS and BI at discharge as well as 3, 6, and 12 months...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28685393/side-effects-of-long-term-continuous-intra-arterial-nimodipine-infusion-in-patients-with-severe-refractory-cerebral-vasospasm-after-subarachnoid-hemorrhage
#6
Martin Kieninger, Julia Flessa, Nicole Lindenberg, Sylvia Bele, Andreas Redel, André Schneiker, Gerhard Schuierer, Christina Wendl, Bernhard Graf, Vera Silbereisen
BACKGROUND: Long-term continuous intra-arterial nimodipine infusion (CIAN) is a rescue therapy option in cases of severe refractory cerebral vasospasm (CV) following acute non-traumatic subarachnoid hemorrhage (SAH). However, CIAN therapy can be associated with relevant side effects. Available studies focus on intracerebral complications, whereas extracerebral side effects are rarely examined. Aim of the present study was to generate descriptive data on the clinical course during CIAN therapy and expectable extracerebral side effects...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28664392/validation-of-near-infrared-spectroscopy-for-monitoring-cerebral-autoregulation-in-comatose-patients
#7
Lucia Rivera-Lara, Romergryko Geocadin, Andres Zorrilla-Vaca, Ryan Healy, Batya R Radzik, Caitlin Palmisano, Marek Mirski, Wendy C Ziai, Charles Hogue
BACKGROUND: Transcranial Doppler (TCD) noninvasively measures cerebral blood flow (CBF) velocity and is a well-studied method to monitor cerebral autoregulation (CA). Near-infrared spectroscopy (NIRS) has emerged as a promising noninvasive method to determine CA continuously by using regional cerebral oxygen saturation (rSO2) as a surrogate for CBF. Little is known about its accuracy to determine CA in patients with intracranial lesions. The purpose of this study was to assess the accuracy of rSO2-based CA monitoring with TCD methods in comatose patients with acute neurological injury...
June 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28664391/dobutamine-a-%C3%AE-1-adrenoceptor-agonist-increases-cerebral-oxygenation-during-acute-anemia-and-apneic-hypoxia
#8
Tadayoshi Kurita, Shingo Kawashima, Koji Morita, Yoshiki Nakajima
BACKGROUND: β1 blockers increase the risk of cerebral hypoxia during acute anemia and apneic hypoxia. We hypothesized that β1 stimulants conversely increase cerebral tolerance to anemia and hypoxia. METHODS: After induction with isoflurane, twelve swine (mean ± SD: 25.2 ± 0.6 kg) received 200 µg kg(-1) min(-1) landiolol and 20 µg kg(-1) min(-1) dobutamine. Reversal of the order of drug administration was performed in six animals each. Before and during each drug infusion, apnea was induced until reaching <70% oxygen saturation (SpO2) after 5 min of 100% oxygen ventilation...
June 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28660341/low-dose-prothrombin-complex-concentrate-for-warfarin-associated-intracranial-hemorrhage-with-inr-less-than-2-0
#9
Wesley R Zemrak, Kathryn E Smith, Stephen S Rolfe, Teresa May, Robert L Trowbridge, Timothy L Hayes, Gene A Grindlinger, David B Seder
BACKGROUND: Prothrombin complex concentrates (PCCs) have become the first-line therapy for warfarin reversal in the setting of central nervous system (CNS) hemorrhage. Randomized, controlled studies comparing agents for warfarin reversal excluded patients with international normalized ratio (INR) <2, yet INR values of 1.6-1.9 are also associated with poor outcomes. METHODS: We retrospectively reviewed our use of a low-dose (15 units/kg) strategy of 4-factor PCC (4F-PCC) on warfarin reversal (INR 1...
June 28, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28660340/electroencephalographic-patterns-in-neurocritical-care-pathologic-contributors-or-epiphenomena
#10
Brian Appavu, James J Riviello
No abstract text is available yet for this article.
June 28, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28646267/quantitative-eeg-metrics-differ-between-outcome-groups-and-change-over-the-first-72%C3%A2-h-in-comatose-cardiac-arrest-patients
#11
Sara Leingang Wiley, Babak Razavi, Prashanth Krishnamohan, Michael Mlynash, Irina Eyngorn, Kimford J Meador, Karen G Hirsch
BACKGROUND: Forty to sixty-six percent of patients resuscitated from cardiac arrest remain comatose, and historic outcome predictors are unreliable. Quantitative spectral analysis of continuous electroencephalography (cEEG) may differ between patients with good and poor outcomes. METHODS: Consecutive patients with post-cardiac arrest hypoxic-ischemic coma undergoing cEEG were enrolled. Spectral analysis was conducted on artifact-free contiguous 5-min cEEG epochs from each hour...
June 23, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28639001/sanguinate%C3%A2-pegylated-carboxyhemoglobin-bovine-improves-cerebral-blood-flow-to-vulnerable-brain-regions-at-risk-of-delayed-cerebral-ischemia-after-subarachnoid-hemorrhage
#12
Rajat Dhar, Hemant Misra, Michael N Diringer
BACKGROUND: Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) has been linked to focal reductions in cerebral blood flow (CBF) and microvascular impairments in oxygen delivery. Effective therapies that restore flow and oxygen transport to vulnerable brain regions are currently lacking. SANGUINATE is a dual-action carbon monoxide-releasing and hemoglobin-based oxygen transfer agent with efficacy in animal models of focal brain ischemia and tolerability in patients with sickle cell disease...
June 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28639000/infections-in-neurocritical-care
#13
John C O'Horo, Priya Sampathkumar
Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patients. The purpose of this review is to summarize the approach to suspected infection in the NICU and discuss management of several infectious syndromes in the NICU setting.
June 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28620846/the-role-of-mast-cells-in-intracerebral-hemorrhage
#14
Mustafa Yehya, Michel T Torbey
Mast cells are first responders to intracerebral hemorrhage. They release potent mediators that can disrupt the blood-brain barrier promoting injury, vasogenic edema formation, and hematoma exacerbation. Also, mast cells recruit other inflammatory cells that maintain and amplify brain damage. Given their early role in the cascade of events in intracerebral hemorrhage, mast cells may offer an alternative target for antichemotactic interventions.
June 15, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28612133/brain-specific-serum-biomarkers-predict-neurological-morbidity-in-diagnostically-diverse-pediatric-intensive-care-unit-patients
#15
Alicia K Au, Michael J Bell, Ericka L Fink, Rajesh K Aneja, Patrick M Kochanek, Robert S B Clark
BACKGROUND: Unexpected neurological morbidity in Pediatric Intensive Care Units (PICUs) remains high and is difficult to detect proactively. Brain-specific biomarkers represent a novel approach for early detection of neurological injury. We sought to determine whether serum concentrations of neuron-specific enolase (NSE), myelin basic protein (MBP), and S100B, specific for neurons, oligodendrocytes, and glia, respectively, were predictive of neurological morbidity in critically ill children...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28612132/hemorrhage-rate-after-external-ventricular-drain-placement-in-subarachnoid-hemorrhage-time-to-heparin-administration
#16
Andrew P Gard, Brian D Sayles, J Will Robbins, William E Thorell, Daniel L Surdell
OBJECTIVE: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. PATIENTS AND METHODS: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28612131/three-factor-versus-four-factor-prothrombin-complex-concentrate-for-the-emergent-management-of-warfarin-associated-intracranial-hemorrhage
#17
Daniel Fischer, Jeffrey Sorensen, Gabriel V Fontaine
BACKGROUND: Four-factor prothrombin complex concentrates (PCC) produce a more rapid and complete INR correction compared with 3-factor PCC in patients receiving warfarin. It is unknown if this improves clinical outcomes in the setting of intracranial hemorrhage (ICH). METHODS: This multicenter, retrospective cohort study included patients presenting with warfarin-associated ICH reversed with either 4- or 3-factor PCC. The primary outcome was in-hospital mortality...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28612130/acute-brain-diseases-as-triggers-for-stress-cardiomyopathy-clinical-characteristics-and-outcomes
#18
Deena M Nasr, Sara Tomasini, Abhiram Prasad, Alejandro A Rabinstein
OBJECTIVE: To determine the clinical characteristics and outcomes of patients with neurogenic stress cardiomyopathy (NSC) among patients admitted to our neuroscience intensive care unit (NICU). METHODS: Following institutional review board approval, consecutive adult patients admitted to the NICU between 2009 and 2013 with definite and possible NSC were included. Data on patient demographics, baseline clinical information, cardiac function, and laboratory values were collected...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28573388/medical-management-of-the-severe-traumatic-brain-injury-patient
#19
Jonathan Marehbian, Susanne Muehlschlegel, Brian L Edlow, Holly E Hinson, David Y Hwang
Severe traumatic brain injury (sTBI) is a major contributor to long-term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with prehospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of sTBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care...
June 1, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28569348/black-tar-heroin-skin-popping-as-a-cause-of-wound-botulism
#20
Ihtesham A Qureshi, Mohtashim A Qureshi, Mohammad Rauf Afzal, Alberto Maud, Gustavo J Rodriguez, Salvador Cruz-Flores, Darine Kassar
BACKGROUND: Botulism is a rare potentially fatal and treatable disorder caused by a bacteria-produced toxin that affects the presynaptic synaptic membrane resulting in a characteristic neuromuscular dysfunction. It is caused by either the ingestion of the toxin or the bacteria, inhalation, or wound infection. We present our observations with a descriptive case series of wound botulism secondary to black tar heroin (BTH) injection. METHODS: We report a retrospective single-center case series of 15 consecutive cases of wound botulism presenting to University Medical Center of El Paso...
May 31, 2017: Neurocritical Care
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