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Neurocritical Care

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https://www.readbyqxmd.com/read/28819737/further-controversies-about-brain-tissue-oxygenation-pressure-reactivity-after-traumatic-brain-injury
#1
Morten Andresen, Joseph Donnelly, Marcel Aries, Marianne Juhler, David Menon, Pja Hutchinson, Peter Smielewski
BACKGROUND: Continuous monitoring of cerebral autoregulation is considered clinically useful due to its ability to warn against brain ischemic insults, which may translate to a relationship with adverse outcome. It is typically performed using the pressure reactivity index (PRx) based on mean arterial pressure and intracranial pressure. A new ORx index based on brain tissue oxygenation and cerebral perfusion pressure (CPP) has been proposed that similarly allows for evaluation of cerebrovascular reactivity...
August 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28808901/the-utility-of-routine-intensive-care-admission-for-patients-undergoing-intracranial-neurosurgical-procedures-a-systematic-review
#2
Cesar Cimonari de Almeida, M Dustin Boone, Yosef Laviv, Burkhard S Kasper, Clark C Chen, Ekkehard M Kasper
BACKGROUND: Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. METHODS: We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission...
August 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28799114/neurogenic-stress-cardiomyopathy-precipitated-by-acute-hydrocephalus-after-aneurysmal-subarachnoid-hemorrhage
#3
Kamel Gharaibeh, Jackie Scott, Nicholas A Morris
No abstract text is available yet for this article.
August 10, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28799021/malnutrition-in-stroke-patients-risk-factors-assessment-and-management
#4
Toni Sabbouh, Michel T Torbey
No abstract text is available yet for this article.
August 10, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28791561/electro-radiological-observations-of-grade-iii-iv-hepatic-encephalopathy-patients-with-seizures
#5
Christopher R Newey, Pravin George, Aarti Sarwal, Norman So, Stephen Hantus
BACKGROUND: Neurological complications in liver failure are common. Often under-recognized neurological complications are seizures and status epilepticus. These may go unrecognized without continuous electroencephalography (CEEG). We highlight the observed electro-radiological changes in patients with grade III/IV hepatic encephalopathy (HE) found to have seizures and/or status epilepticus on CEEG and the associated neuroimaging. METHODS: This study was a retrospective review of patients with West Haven grade III/IV HE and seizures/status epilepticus on CEEG...
August 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28762185/consideration-of-the-intracranial-pressure-threshold-value-for-the-initiation-of-traumatic-brain-injury-treatment-a-xenon-ct-and-perfusion-ct-study
#6
Mitsuru Honda, Ryo Ichibayashi, Ginga Suzuki, Hiroki Yokomuro, Yoshikatsu Seiki, Shigeru Sase, Taichi Kishi
BACKGROUND: Monitoring of intracranial pressure (ICP) is considered to be fundamental for the care of patients with severe traumatic brain injury (TBI) and is routinely used to direct medical and surgical therapy. Accordingly, some guidelines for the management of severe TBI recommend that treatment be initiated for ICP values >20 mmHg. However, it remained to be accounted whether there is a scientific basis to this instruction. The purpose of the present study was to clarify whether the basis of ICP values >20 mmHg is appropriate...
July 31, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28744847/factors-considered-by-clinicians-when-prognosticating-intracerebral-hemorrhage-outcomes
#7
David Y Hwang, Stacy Y Chu, Cameron A Dell, Mary J Sparks, Tiffany D Watson, Carl D Langefeld, Mary E Comeau, Jonathan Rosand, Thomas W K Battey, Sebastian Koch, Mario L Perez, Michael L James, Jessica McFarlin, Jennifer L Osborne, Daniel Woo, Steven J Kittner, Kevin N Sheth
BACKGROUND: The early subjective clinical judgment of clinicians outperforms formal prognostic scales for accurate determination of outcome after intracerebral hemorrhage (ICH), with the judgment of physicians and nurses having equivalent accuracy. This study assessed specific decisional factors that physicians and nurses incorporate into early predictions of functional outcome. METHODS: This prospective observational study enrolled 121 ICH patients at five US centers...
July 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28744846/extubation-failure-and-tracheostomy-placement-in-children-with-acute-neurocritical-illness
#8
Ellen C Cohn, Tammy S Robertson, Stacey A Scott, Andre M Finley, Rong Huang, Darryl K Miles
BACKGROUND: There is a lack of data describing the risk factors for extubation failure (EF) or tracheostomy placement in pediatric neurocritical care (NCC) patients. METHODS: A retrospective chart review of children admitted to the pediatric intensive care unit who were intubated for >24 h with an acute neurocritical illness and had an extubation attempt. Bivariate and multivariate statistical analysis was performed to determine significant associations of demographic, neurologic, pulmonary, and clinical variables with EF and tracheostomy placement...
July 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28730561/men-experience-higher-risk-of-pneumonia-and-death-after-intracerebral-hemorrhage
#9
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/28699144/palliative-care-needs-assessment-in-the-neuro-icu-effect-on-family
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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