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Neurocritical care update

Zhe Kang Law, Jason P Appleton, Philip M Bath, Nikola Sprigg
Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage...
April 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
Ravi Garg, Barak Bar
Many systemic complications follow aneurysmal subarachnoid hemorrhage and are primarily due to sympathetic nervous system activation. These complications play an important role in the overall outcome of patients. The purpose of this review is to provide an update on the diagnosis, pathophysiology, and management of systemic complications specifically associated with aneurysmal subarachnoid hemorrhage. Special focus has been made on systemic complications that occur more frequently in patients with aneurysmal subarachnoid hemorrhage compared to other stroke subtypes and in the neurocritical care patient population...
January 2017: Current Neurology and Neuroscience Reports
D Chiumello, M Gotti, G Vergani
Fever, which is arbitrary defined as an increase in body temperature above 38.3°C, can affect up to 90% of patients admitted in intensive care unit. Induction of fever is mediated by the release of pyrogenic cytokines (tumor necrosis factor α, interleukin 1, interleukin 6, and interferons). Fever is associated with increased length of stay in intensive care unit and with a worse outcome in some subgroups of patients (mainly neurocritically ill patients). Although fever can increase oxygen consumption in unstable patients, on the contrary, it can activate physiologic systems that are involved in pathogens clearance...
April 2017: Journal of Critical Care
Yasuhiro Kuroda
[This corrects the article DOI: 10.1186/s40560-016-0141-8.].
2016: Journal of Intensive Care
Yasuhiro Kuroda
This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition...
2016: Journal of Intensive Care
David Dornbos Iii, Ciaran J Powers, Yuchuan Ding, Liping Liu
In this review, we briefly introduce recent developments and updates in neurocritical care in the treatment of stroke, including both ischemic and hemorrhagic stroke. Time to recanalization remains the major rate limiting step in the treatment of acute ischemic stroke as only a minority of patients arrive within a timeframe appropriate for treatment. Whether caring for a patient following ischemic or hemorrhagic stroke, the principle focus of neurocritical care for acute brain catastrophes is the identification and prevention of secondary brain injury...
June 2016: Neurological Research
Jia-Wei Wang, Jin-Ping Li, Ying-Lun Song, Ke Tan, Yu Wang, Tao Li, Peng Guo, Xiong Li, Yan Wang, Qi-Huang Zhao
Recently, several randomized controlled trials (RCT) investigating the effectiveness of decompressive craniectomy in the context of neurocritical illnesses have been completed. Thus, a meta-analysis to update the current evidence regarding the effects of decompressive craniectomy is necessary. We searched PUBMED, EMBASE and the Cochrane Central Register of Controlled Trials. Other sources, including internet-based clinical trial registries and grey literature, were also searched. After searching the literature, two investigators independently performed literature screening, assessing the quality of the included trials and extracting the data...
May 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jian-min Zhang
Aneurysmal subarachnoid hemorrhage (aSAH) is a kind of hemorrhagic stroke with high mortality and morbidity. Although the preoperative diagnosis, surgical clipping, endovascular treatment, and intensive care have progressed in recent years, the overall prognosis of aSAH patients remains poor. In 2011, the Neurocritical Care Society organized an international, multidisciplinary consensus conference addressed the critical care management of SAH. In 2012, the American Stroke Association (AHA) updated the guidelines of diagnosis and treatment of aSAH published in 2009...
July 2015: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Aziz S Alali, Kirsteen Burton, Robert A Fowler, David M J Naimark, Damon C Scales, Todd G Mainprize, Avery B Nathens
BACKGROUND: Economic evaluations provide a unique opportunity to identify the optimal strategies for the diagnosis and management of traumatic brain injury (TBI), for which uncertainty is common and the economic burden is substantial. OBJECTIVE: The objective of this study was to systematically review and examine the quality of contemporary economic evaluations in the diagnosis and management of TBI. METHODS: Two reviewers independently searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment Database, EconLit, and the Tufts CEA Registry for comparative economic evaluations published from 2000 onward (last updated on August 30, 2013)...
July 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Michael Rubin, Jordan Bonomo, Barak Bar, Edward Collins, Salvador Cruz-Flores, Rachel Garvin, Scott Glickman, Jonah Grossman, Galen Henderson, Tom Lawson, Dea Mahanes, Jessica McFarlin, Sarah Monchar, Harry Peled, James Szalados
Part of the responsibility of a professional society is to establish the expectations for appropriate behavior for its members. Some codes are so essential to a society that the code itself becomes the central document defining the organization and its tenets, as we see with the Hippocratic Oath. In that tradition, we have revised the code of professional conduct for the Neurocritical Care Society into its current version, which emphasizes guidelines for personal behavior, relationships with fellow members, relationships with patients, and our interactions with society as a whole...
October 2015: Neurocritical Care
Peter J Hutchinson, Ibrahim Jalloh, Adel Helmy, Keri L H Carpenter, Elham Rostami, Bo-Michael Bellander, Martyn G Boutelle, Jeff W Chen, Jan Claassen, Claire Dahyot-Fizelier, Per Enblad, Clare N Gallagher, Raimund Helbok, Lars Hillered, Peter D Le Roux, Sandra Magnoni, Halinder S Mangat, David K Menon, Carl-Henrik Nordström, Kristine H O'Phelan, Mauro Oddo, Jon Perez Barcena, Claudia Robertson, Elisabeth Ronne-Engström, Juan Sahuquillo, Martin Smith, Nino Stocchetti, Antonio Belli, T Adrian Carpenter, Jonathan P Coles, Marek Czosnyka, Nil Dizdar, J Clay Goodman, Arun K Gupta, Troels H Nielsen, Niklas Marklund, Ambroise Montcriol, Mark T O'Connell, Maria A Poca, Asita Sarrafzadeh, Richard J Shannon, Jane Skjøth-Rasmussen, Peter Smielewski, John F Stover, Ivan Timofeev, Paul Vespa, Elizabeth Zavala, Urban Ungerstedt
Microdialysis enables the chemistry of the extracellular interstitial space to be monitored. Use of this technique in patients with acute brain injury has increased our understanding of the pathophysiology of several acute neurological disorders. In 2004, a consensus document on the clinical application of cerebral microdialysis was published. Since then, there have been significant advances in the clinical use of microdialysis in neurocritical care. The objective of this review is to report on the International Microdialysis Forum held in Cambridge, UK, in April 2014 and to produce a revised and updated consensus statement about its clinical use including technique, data interpretation, relationship with outcome, role in guiding therapy in neurocritical care and research applications...
September 2015: Intensive Care Medicine
Carolina B Maciel, Kevin N Sheth
Despite a decline over the past decade in overall stroke mortality, hemispheric strokes retain a strikingly high mortality due to their potential for malignant edema and herniation. The pathogenesis of ischemic cerebral edema is steered by disruption of ionic homeostasis in the neurogliovascular unit. Significant effort has been made to identify potential medical therapies targeting edema formation with promising results. To date, decompressive craniectomy remains the therapy with the most robust impact on mortality...
July 2015: Current Atherosclerosis Reports
Alicia M Zha, Murat Sari, Michel T Torbey
PURPOSE OF REVIEW: Large hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema. RECENT FINDINGS: The most recent changes in management of large hemispheric infarct include the American Heart Association and Neurocritical Care Guidelines...
April 2015: Current Opinion in Critical Care
Juliet G Beniga, Katherine G Johnson, Debra D Mark
Fever is a significant contributor to secondary brain insult and management is a challenge for the neurocritical care team. The absence of standardized guidelines likely contributes to poor surveillance and undertreatment of increased temperature. A need for practice change was identified and this evidence-based practice project was initiated to compile sufficient evidence to develop, implement, and evaluate a treatment guideline to manage fever and maintain normothermia in the neurocritical care population...
September 2014: Nursing Clinics of North America
Tumul Chowdhury, Stephen Kowalski, Yaseen Arabi, Hari Hara Dash
BACKGROUND: Traumatic brain injury (TBI) is a growing epidemic throughout the world and may present as major global burden in 2020. Some intensive care units throughout the world still have no access to specialized monitoring methods, equipments and other technologies related to intensive care management of these patients; therefore, this review is meant for providing generalized supportive measurement to this subgroup of patients so that evidence based management could minimize or prevent the secondary brain injury...
April 2014: Saudi Journal of Anaesthesia
Robert C Tasker
Paralytic poliomyelitis, Reye syndrome, Hemophilus Influenzae type B epiglottitis, bacterial meningitis, and meningococcal septic shock are catastrophic illnesses that in the last 60 years have shaped the development of pediatric intensive care. Neurocritical care has been at the forefront of our thinking and, more latterly, as a specialty we have had the technology and means to develop this focus, educate the next generation and show that outcomes can be improved-first in adult critical care and now the task is to translate these benefits to critically ill children...
July 2014: Paediatric Anaesthesia
Leif-Erik Bohman, Joshua M Levine
PURPOSE OF REVIEW: Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia. RECENT FINDINGS: Current guidelines generally recommend maintenance of normothermia after brain injury but have scant recommendations on methods to do this...
April 2014: Current Opinion in Critical Care
Daniel Agustin Godoy, Leonardo Jardim Vaz de Mello, Luca Masotti, Mario Di Napoli
Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC) is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation...
September 2013: Arquivos de Neuro-psiquiatria
Ahilan Sivaganesan, Geoffrey T Manley, Michael C Huang
Neurocritical care relies on the continuous, real-time measurement of numerous physiologic parameters. While our capability to obtain such measurements from patients has grown markedly with multimodal monitoring in many neurologic or neurosurgical intensive care units (ICUs), our ability to transform the raw data into actionable information is limited. One reason is that the proprietary nature of medical devices and software often prevents neuro-ICUs from capturing and centrally storing high-density data. Also, ICU alarm systems are often unreliable because the data that are captured are riddled with artifacts...
February 2014: Neurocritical Care
David Y Hwang, Emily J Gilmore, David M Greer
This article reviews current guidelines for death by neurologic criteria and addresses topics relevant to the determination of brain death in the intensive care unit. The history of brain death as a concept leads into a discussion of the evolution of practice parameters, focusing on the most recent 2010 update from the American Academy of Neurology and the practice variability that exists worldwide. Proper transition from brain death determination to possible organ donation is reviewed. This review concludes with a discussion regarding ethical and religious concerns and suggestions on how families of patients who may be brain dead might be optimally approached...
July 2013: Neurosurgery Clinics of North America
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