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Neurocritical Care

A Almojuela, M Hasen, F A Zeiler
BACKGROUND: The Full Outline of UnResponsivness (FOUR) score is a neurological assessment score. Its theoretical benefit over preexisting scores is its evaluation of brainstem reflexes and respiratory pattern which may allow better assessment of patients with severe neurologic impairment. OBJECTIVE: Our goal was to perform a scoping systematic review on the available literature for FOUR score and outcome prediction in critically ill patients. The primary outcome of interest was patient global outcome, as assessed by any of: mortality, modified Rankin Score, Glasgow Outcome Score, or any other functional or neuropsychiatric outcome...
November 8, 2018: Neurocritical Care
Jing Wang, Yun Fang, Subhashini Ramesh, Asma Zakaria, Maryann T Putman, Dan Dinescu, James Paik, Romergryko G Geocadin, Pouya Tahsili-Fahadan, Laith R Altaweel
BACKGROUND/OBJECTIVE: Prompt treatment of acute intracranial hypertension is vital to preserving neurological function and frequently includes administration of 23.4% NaCl. However, 23.4% NaCl administration requires central venous catheterization that can delay treatment. Intraosseous catheterization is an alternative route of venous access that may result in more rapid administration of 23.4% NaCl. METHODS: Single-center retrospective analysis of 76 consecutive patients, between January 2015 and January 2018, with clinical signs of intracranial hypertension received 23...
November 5, 2018: Neurocritical Care
Victor Curvello, Philip Pastor, Hugh Hekierski, William M Armstead
OBJECTIVE: Traumatic brain injury (TBI) is an important contributor to morbidity and mortality. Cerebral autoregulation is impaired after TBI, contributing to poor outcome. Extracellular signal-related kinase (ERK) mitogen activated protein kinase (MAPK) and ET-1 are upregulated and contribute to impairment of cerebral autoregulation and histopathology after porcine fluid percussion brain injury (FPI). Recent studies show that inhaled nitric oxide (iNO) prevents impairment of cerebral autoregulation and histopathology after FPI in pigs...
November 1, 2018: Neurocritical Care
Pierre Esnault, Johanna Roubin, Mickael Cardinale, Erwan D'Aranda, Ambroise Montcriol, Pierre-Julien Cungi, Philippe Goutorbe, Christophe Joubert, Arnaud Dagain, Eric Meaudre
BACKGROUND: Hypocapnia induces cerebral vasoconstriction leading to a decrease in cerebral blood flow, which might precipitate cerebral ischemia. Hypocapnia can be intentional to treat intracranial hypertension or unintentional due to a spontaneous hyperventilation (SHV). SHV is frequent after subarachnoid hemorrhage. However, it is understudied in patients with severe traumatic brain injury (TBI). The objective of this study was to describe the incidence and consequences on outcome of SHV after severe TBI...
November 1, 2018: Neurocritical Care
Byunghyun Kim, Inwon Park, Jae Hyuk Lee, Seonghye Kim, Min Ji Lee, You Hwan Jo
BACKGROUND: Vagus nerve stimulation (VNS) during post-resuscitation may increase recovery of cerebral blood flow (CBF) and reduce neurological injury. OBJECTIVE: This study was designed to investigate the effect of electrical VNS on neurological outcomes following cardiac arrest (CA). METHODS: Male Sprague-Dawley rats (n = 48) were subjected to the asphyxial CA model and blindly allocated to the VN isolation (CA + VN isolation) or VNS group (CA + VNS group)...
October 31, 2018: Neurocritical Care
Christopher Beynon, Steffen Brenner, Alexander Younsi, Timolaos Rizos, Jan-Oliver Neumann, Johannes Pfaff, Andreas W Unterberg
BACKGROUND: Anticoagulation therapy is a major risk factor for unfavorable patient outcomes following (traumatic) intracranial hemorrhage. Direct oral anticoagulants (DOAC) are increasingly used for the prevention and treatment of thromboembolic diseases. Data on patients treated for acute subdural hemorrhage (SDH) during anticoagulation therapy with DOAC are limited. METHODS: We analyzed the medical records of consecutive patients treated at our institution for acute SDH during anticoagulation therapy with DOAC or vitamin K antagonists (VKA) during a period of 30 months...
October 31, 2018: Neurocritical Care
Jia Xu Lim, Julian Xinguang Han, Angela An Qi See, Voon Hao Lew, Wan Ting Chock, Vin Fei Ban, Sohil Pothiawala, Winston Eng Hoe Lim, Louis Elliot McAdory, Michael Lucas James, Nicolas Kon Kam King
BACKGROUND: Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian population. METHODS: A prospective cohort of 123 spontaneous ICH patients admitted to a tertiary hospital (certified stroke center) in Singapore was recruited...
October 30, 2018: Neurocritical Care
Venkatakrishna Rajajee, Craig A Williamson, Robert J Fontana, Anthony J Courey, Parag G Patil
The authors note that the number 14 was inadvertently omitted from the formula listed on page 5 of the article. It currently reads.
October 30, 2018: Neurocritical Care
Kai Liu, Lulu Pei, Yuan Gao, Lu Zhao, Hui Fang, Bridget Bunda, Lindsay Fisher, Yunchao Wang, Shen Li, Yusheng Li, Sheng Guan, Xinbin Guo, Haowen Xu, Yuming Xu, Bo Song
BACKGROUND: Dehydration is associated with a higher risk of poor outcome and venous thromboembolism in acute ischemic stroke patients. However, the relationship between dehydration and prognosis in patients with cerebral venous thrombosis (CVT) has not yet been investigated. METHODS: Consecutive CVT patients at the First Affiliated Hospital of Zhengzhou University were retrospectively identified from November 2011 through January 2017. Dehydration was evaluated by blood urea/creatinine (U/Cr) ratio > 80...
October 25, 2018: Neurocritical Care
Nicholas A Morris, Barry M Czeisler, Aarti Sarwal
Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient...
October 25, 2018: Neurocritical Care
Rebekah A Yataco, Scott M Arnold, Suzanne M Brown, W David Freeman, C Carmen Cononie, Michael G Heckman, Luke W Partridge, Craig M Stucky, Laurie N Mellon, Jennifer L Birst, Kristien L Daron, Martha H Zapata-Cooper, Danton M Schudlich
BACKGROUND/OBJECTIVE: Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy...
October 24, 2018: Neurocritical Care
Ryne Jenkins, Nicholas A Morris, Bryce Haac, Richard Van Besien, Deborah M Stein, Wan-Tsu Chang, Gary Schwartzbauer, Gunjan Parikh, Neeraj Badjatia
BACKGROUND: Data regarding who will require tracheostomy are lacking which may limit investigations into therapeutic effects of early tracheostomy. METHODS: We performed an observational study of adult traumatic brain injury (TBI) patients requiring intensive care unit (ICU) admission for ≥ 72 h and mechanical ventilation for ≥ 24 h between January 2014 and December 2014 at a level 1 trauma center. Patients who had life-sustaining measures withdrawn were excluded...
October 17, 2018: Neurocritical Care
Florence R A Hogg, Mathew J Gallagher, Suliang Chen, Argyro Zoumprouli, Marios C Papadopoulos, Samira Saadoun
BACKGROUND/OBJECTIVES: We recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt ) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring. METHODS: Sixty-four TSCI patients, grades A-C (American spinal injuries association Impairment Scale, AIS), were analyzed...
October 16, 2018: Neurocritical Care
Aulbrey Drisaldi, Erin Weeda, Ron Neyens, Nicholas Orvin, Leonardo Bonilha, Zeke Campbell, Nicole Bohm
BACKGROUND: Patient-specific factors can alter the pharmacokinetic disposition of valproic acid. Specifically, the free fraction of valproic acid can increase substantially in patients with hypoalbuminemia or as serum drug concentrations rise due to saturable protein binding. Direct measurement of free serum drug concentrations allows for accurate assessment of drug levels, but the assay may not be readily available in all institutions. The effect of hypoalbuminemia on free fraction has been quantified and serves as the basis of an equation used to "correct" measured total valproic acid concentrations...
October 16, 2018: Neurocritical Care
Alejandro A Rabinstein
No abstract text is available yet for this article.
October 9, 2018: Neurocritical Care
C Ong, M Hutch, M Barra, A Kim, S Zafar, S Smirnakis
BACKGROUND: Osmotic therapy is a critical component of medical management for cerebral edema. While up to 90% of neurointensivists report using these treatments, few quantitative clinical measurements guide optimal timing, dose, or administration frequency. Its use is frequently triggered by a qualitative assessment of neurologic deterioration and/or pupil size, and anecdotally appears to improve pupil asymmetry suggestive of uncal herniation. However, subjective pupil assessment has poor reliability, making it difficult to detect or track subtle changes...
October 8, 2018: Neurocritical Care
Hormuzdiyar H Dasenbrock, Robert F Rudy, William B Gormley, Kai U Frerichs, M Ali Aziz-Sultan, Rose Du
BACKGROUND: The goal of this study was to investigate the association of tracheostomy timing with outcomes after aneurysmal subarachnoid hemorrhage (SAH) in a national population. METHODS: Poor-grade aneurysmal SAH patients were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable linear regression was used to analyze predictors of tracheostomy timing and multivariable logistic regression was used to evaluate the association of timing of intervention with mortality, complications, and discharge to institutional care...
October 8, 2018: Neurocritical Care
Jigang Chen, Xiaolin Qu, Zhenxing Li, Danfeng Zhang, Lijun Hou
BACKGROUND: Studies suggested that the neutrophil-to-lymphocyte ratio (NLR) was associated with unfavorable outcomes in different diseases such as intracerebral hemorrhage, cardiovascular problem, cancer, and severe traumatic brain injury (sTBI). We aimed to evaluate the relationship between peak NLR and 1-year outcomes in patients with sTBI. METHODS: We retrospectively reviewed the clinical data of patients with sTBI who were treated in our department between January 2013 and January 2017...
October 4, 2018: Neurocritical Care
(no author information available yet)
No abstract text is available yet for this article.
October 4, 2018: Neurocritical Care
K M Sauro, A Soo, A Kramer, P Couillard, J Kromm, D Zygun, D J Niven, S M Bagshaw, H T Stelfox
BACKGROUND/OBJECTIVES: Venous thromboembolism (VTE) is a leading cause of preventable, in-hospital deaths; critically ill patients have a higher risk. Effective and efficient strategies to prevent VTE exist; however, neurocritical care patients present unique challenges due to competing risk of bleeding. The objective of this study was to examine current VTE prophylaxis practices among neurocritical care patients, concordance with guideline-recommended care, and the association with clinical outcomes...
October 1, 2018: Neurocritical Care
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