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Neurocritical Care

C Ong, M Hutch, S Smirnakis
BACKGROUND: Automated devices collecting quantitative measurements of pupil size and reactivity are increasingly used for critically ill patients with neurological disease. However, there are limited data on the effect of ambient light conditions on pupil metrics in these patients. To address this issue, we tested the range of pupil reactivity in healthy volunteers and critically ill patients in both bright and dark conditions. METHODS: We measured quantitative pupil size and reactivity in seven healthy volunteers and seven critically ill patients with the Neuroptics-200 pupillometer in both bright and dark ambient lighting conditions...
September 14, 2018: Neurocritical Care
Joanna Solek-Pastuszka, Jowita Biernawska, Waldemar Iwańczuk, Klaudyna Kojder, Kornel Chelstowski, Romuald Bohatyrewicz, Marcin Sawicki
INTRODUCTION: Deterioration of the pulmonary function after the apnea test (AT) conducted with the classic oxygen insufflation AT (I-AT) is often observed during the brain death (BD) diagnosis procedure. In the present study, two AT methods were compared before a method is recommended for the currently revised Polish BD criteria. METHODS: Classic I-AT and continuous positive airway pressure AT (CPAP-AT) were performed in 60 intensive care unit patients. I-AT was performed at the end of two series of clinical tests, and approximately 1-1...
September 12, 2018: Neurocritical Care
Jan Küchler, Franziska Tronnier, Emma Smith, Jan Gliemroth, Volker M Tronnier, Claudia Ditz
BACKGROUND: Patients with severe acute brain injury (ABI) often require intrahospital transports (IHTs) for repeated computed tomography (CT) scans. IHTs are associated with serious adverse events (AE) that might pose a risk for secondary brain injury. The goal of this study was to assess IHT-related alterations of cerebral metabolism in ABI patients. METHODS: We included mechanically ventilated patients with ABI who had continuous multimodality neuromonitoring during an 8-h period before and after routine IHT...
September 10, 2018: Neurocritical Care
Tanuwong Viarasilpa, Nicha Panyavachiraporn, Gamaleldin Osman, Christopher Parres, Panayiotis Varelas, Meredith Van Harn, Stephan A Mayer
INTRODUCTION: Clinical seizures and status epilepticus are frequent complications of encephalitis, can lead to depressed level of consciousness, and are associated with poor outcome. We sought to determine the frequency, risk factors, and clinical impact of electrographic seizures detected with continuing electroencephalography (cEEG) in patients with encephalitis and altered level of consciousness. METHODS: We retrospectively identified all patients with presumed or definite viral or autoimmune encephalitis who underwent cEEG monitoring at Henry Ford Hospital from January 2012 to October 2017...
September 10, 2018: Neurocritical Care
Bruno Adler Maccagnan Pinheiro Besen, Roberta Muriel Longo Roepke
No abstract text is available yet for this article.
September 6, 2018: Neurocritical Care
Paul Pham, Jessica Bindra, Anders Aneman, Alwin Chuan, John M Worthington, Matthias Jaeger
BACKGROUND: Cerebrovascular autoregulation can be continuously monitored from slow fluctuations of arterial blood pressure (ABP) and regional cerebral oxygen saturation (rSO2 ). The purpose of this study was to evaluate the index of dynamic cerebrovascular autoregulation (TOx) and the associated 'optimal' ABP in normal adult healthy subjects. METHODS: Twenty-eight healthy volunteers were studied. TOx was calculated as the moving correlation coefficient between spontaneous fluctuations of ABP and rSO2 ...
September 6, 2018: Neurocritical Care
Ariane Lewis
No abstract text is available yet for this article.
September 5, 2018: Neurocritical Care
Binod Balakrishnan, Katherine T Flynn-O'Brien, Pippa M Simpson, Mahua Dasgupta, Sheila J Hanson
BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition. METHODS: This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013...
August 31, 2018: Neurocritical Care
Khalid Alsherbini, Nitin Goyal, E Jeffrey Metter, Abhi Pandhi, Georgios Tsivgoulis, Tracy Huffstatler, Hallie Kelly, Lucas Elijovich, Marc Malkoff, Andrei Alexandrov
BACKGROUND AND PURPOSE: Ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients often require endotracheal intubation (EI) and mechanical ventilation (MV). Predicting the need for prolonged EI and timing of tracheostomy (TR) is challenging. While TR is performed for about 10-15% of patients in the general intensive care unit (ICU), the rate in the neurological ICU and for stroke patients ranges between 15 and 35%. Thus, we performed an external validation of the recently published SETscore...
August 30, 2018: Neurocritical Care
Andrew Martin, Monica L Chen, Abhinaba Chatterjee, Alexander E Merkler, Caroline D Chung, Xian Wu, Nicholas A Morris, Hooman Kamel
BACKGROUND: We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease. METHODS: Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care...
August 28, 2018: Neurocritical Care
Christos Lazaridis
BACKGROUND: Withdrawal of life-sustaining treatment (WOLST) is the leading proximate cause of death in patients with perceived devastating brain injury (PDBI). There are reasons to believe that a potentially significant proportion of WOLST decisions, in this setting, are premature and guided by a number of assumptions that falsely confer a sense of certainty. METHOD: This manuscript proposes that these assumptions face serious challenges, and that we should replace unwarranted certainty with an appreciation for the great degree of multi-dimensional uncertainty involved...
August 24, 2018: Neurocritical Care
Robert H Bonow, Alex Quistberg, Frederick P Rivara, Monica S Vavilala
BACKGROUND: Patients with mild traumatic brain injury (TBI) are frequently admitted to an intensive care unit (ICU), but routine ICU use may be unnecessary. It is not clear to what extent this practice varies between hospitals. METHODS: We conducted a retrospective cohort study using the National Trauma Data Bank. Patients with at least one TBI ICD-9-CM diagnosis code, a head abbreviated injury score (AIS) ≤ 4, and Glasgow coma scale (GCS) ≥ 13 were included; individuals with only a concussion and those with a non-head AIS > 2 were excluded...
August 22, 2018: Neurocritical Care
Ward Eertmans, Cornelia Genbrugge, Jolien Haesen, Carolien Drieskens, Jelle Demeestere, Margot Vander Laenen, Willem Boer, Dieter Mesotten, Jo Dens, Ludovic Ernon, Frank Jans, Cathy De Deyne
BACKGROUND: We previously validated simplified electroencephalogram (EEG) tracings obtained by a bispectral index (BIS) device against standard EEG. This retrospective study now investigated whether BIS EEG tracings can predict neurological outcome after cardiac arrest (CA). METHODS: Bilateral BIS monitoring (BIS VISTA™, Aspect Medical Systems, Inc. Norwood, USA) was started following intensive care unit admission. Six, 12, 18, 24, 36 and 48 h after targeted temperature management (TTM) at 33 °C was started, BIS EEG tracings were extracted and reviewed by two neurophysiologists for the presence of slow diffuse rhythm, burst suppression, cerebral inactivity and epileptic activity (defined as continuous, monomorphic, > 2 Hz generalized sharp activity or continuous, monomorphic, < 2 Hz generalized blunt activity)...
August 15, 2018: Neurocritical Care
D Alan Shewmon
This article clarifies some issues raised by Dr. Ariane Lewis in her recent "Current Opinion/Arguments" article on the case of Jahi McMath. Review of case materials. Jahi's case most likely represents an instance of global ischemic penumbra (GIP) mimicking brain death (BD), with intracranial blood flow too low to support neuronal function or to be detected by radionuclide scan but sufficient to prevent widespread necrosis. Her MRI scan 9 months after the ischemic insult showed gross preservation of cortical and internal structures, incompatible with there ever having been a period of completely absent blood flow...
August 15, 2018: Neurocritical Care
V Petkus, A Preiksaitis, S Rocka, A Ragauskas
No abstract text is available yet for this article.
August 10, 2018: Neurocritical Care
J F Willms, O Boss, E Keller
BACKGROUND: Fever control plays a key role in therapy of patients with acute brain injury. The infusion of cold saline could serve as an alternative or additional method for targeted temperature management. However, it is difficult to estimate the amount of fluid required to achieve normothermia merely on the basis of body weight. There is no standardized load management regarding the administration of cold saline, and no closed-loop systems based on continuous temperature-controlled feedback are available...
August 10, 2018: Neurocritical Care
Frederick A Zeiler
No abstract text is available yet for this article.
August 10, 2018: Neurocritical Care
Nicholas A Morris, Abhinaba Chatterjee, Oluwayemisi L Adejumo, Monica Chen, Alexander E Merkler, Santosh B Murthy, Hooman Kamel
BACKGROUND: Case series have reported reversible left ventricular dysfunction, also known as stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), in the setting of acute neurological diseases such as subarachnoid hemorrhage. The relative associations between various neurological diseases and Takotsubo remain incompletely understood. METHODS: We performed a cross-sectional study of all adults in the National Inpatient Sample, a nationally representative sample of US hospitalizations, from 2006 to 2014...
August 9, 2018: Neurocritical Care
Ali Daneshmand, Leonardo Rangel-Castilla, Charlotte Rydberg, Eelco Wijdicks
No abstract text is available yet for this article.
August 7, 2018: Neurocritical Care
Ariane Lewis
No abstract text is available yet for this article.
August 6, 2018: Neurocritical Care
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