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https://www.readbyqxmd.com/read/30100271/cerebral-neuromonitoring-during-cardiac-surgery-a-critical-appraisal-with-an-emphasis-on-near-infrared-spectroscopy
#1
REVIEW
Choy Lewis, Suraj D Parulkar, John Bebawy, Saadia Sherwani, Charles W Hogue
Neurological complications of cardiac surgery have a large effect on patient outcomes. In this review, the value of several modes of central nervous system monitoring for improving perioperative care is critiqued. The electroencephalogram (EEG) has been used as a means for detecting brain ischemia. Even though EEG changes are specific for ischemia, the reliability is tempered by many confounding factors. The effectiveness of the processed EEG for ensuring amnesia during surgery is controversial, but it may have value for optimizing anesthetic dose and thus reducing the risk for delirium...
March 20, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29979290/multimodal-approach-to-decision-to-treat-critically-ill-patients-with-periodic-or-rhythmic-patterns-using-an-ictal-interictal-continuum-spectral-severity-score
#2
Gregory Kapinos, Eugen Trinka, Peter W Kaplan
We propose a comprehensive review of the subject of epileptiform and potentially harmful EEG patterns that lie on the interictal continuum (IIC) to help with therapeutic decision-making and target future research. This approach to "electro-physiological SE" encompasses five dimensions of the IIC: it characterizes a periodic or rhythmic pattern, not only regarding its ictal morphology and potential harm with secondary neuronal injury, but also addresses the "metabolic footprint," clinical repercussion, and epileptogenic potential...
July 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/29702712/development-of-a-neuronicu-with-a-broader-focus-on-all-newborns-at-risk-of-brain-injury-the-first-2-years
#3
Krisa P Van Meurs, Elisabeth S Yan, Kathi S Randall, Valerie Y Chock, Alexis S Davis, Cecelia S Glennon, Catherine L Clark, Courtney J Wusthoff, Sonia L Bonifacio
OBJECTIVE:  Many critically ill neonates have an existing brain injury or are at risk of neurologic injury. We developed a "NeuroNICU" (neurologic neonatal intensive care unit) to better provide neurologically focused intensive care. STUDY DESIGN:  Demographic and clinical variables, services delivered, and patient outcomes were recorded in a prospective database for all neonates admitted to the NeuroNICU between April 23, 2013, and June 25, 2015. RESULTS:  In total, 546 neonates were admitted to the NeuroNICU representing 32% of all NICU admissions...
April 27, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29671295/monitoring-the-injured-brain
#4
Anna T Mazzeo, Deepak Gupta
Traumatic brain injury can be defined as the most complex disease in the most complex organ. When an acute brain injury occurs, several pathophysiological cascades are triggered, leading to further exacerbation of the primary damage. A number of events potentially occurring after TBI can compromise the availability or utilization of energy substrates in the brain, ultimately leading to brain energy crisis. The frequent occurrence of secondary insults in the acute phase after TBI, such as intracranial hypertension, hypotension, hypoxia, hypercapnia, hyperthermia, seizures, can then increase cerebral damage, and adversely affect outcome...
October 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29465895/-clinical-neurophysiological-methods-in-diagnosis-and-treatment-of-cerebrovascular-diseases
#5
REVIEW
Ildikó Nagy, Dániel Fabó
Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient's condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols...
January 30, 2018: Ideggyógyászati Szemle
https://www.readbyqxmd.com/read/29455690/effect-of-cerebral-perfusion-pressure-on-acute-respiratory-distress-syndrome
#6
Sonny Thiara, Donald E Griesdale, William R Henderson, Mypinder S Sekhon
BACKGROUND: Increased cerebral perfusion pressure (CPP)>70 mmHg has been associated with acute respiratory distress syndrome (ARDS) after traumatic brain injury (TBI). Since this reported association, significant changes in ventilation strategies and fluid management have been accepted as routine critical care. Recently, individualized perfusion targets using autoregulation monitoring suggest CPP titration>70 mmHg. Given these clinical advances, the association between ARDS and increased CPP requires further delineation...
May 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29262441/imaging-in-neurocritical-care-practice
#7
REVIEW
Craig Williamson, Larry Morgan, Joshua P Klein
The use of neuroimaging in conjunction with serial neurological examinations is a core component of modern neurocritical care practice. Although there is a growing role for other neuromonitoring techniques, the ability to quickly and accurately interpret images in the context of a patient's clinical status arguably remains the indispensable skill for neurocritical care practitioners. Due to its rapid acquisition time and excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and signs of elevated intracranial pressure, computed tomography (CT) remains the most useful neuroimaging technique for intensive care unit (ICU) patients...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29174722/functional-progression-of-patients-with-neurological-diseases-in-a-tertiary-paediatric-intensive-care-unit-our-experience
#8
P Madurga Revilla, J López Pisón, P Samper Villagrasa, J P García Íñiguez, R Garcés Gómez, M Domínguez Cajal, I Gil Hernández
INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS)...
November 23, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/29163332/clinical-use-of-cerebral-microdialysis-in-patients-with-aneurysmal-subarachnoid-hemorrhage-state-of-the-art
#9
REVIEW
Raimund Helbok, Mario Kofler, Alois Josef Schiefecker, Maxime Gaasch, Verena Rass, Bettina Pfausler, Ronny Beer, Erich Schmutzhard
Objective: To review the published literature on the clinical application of cerebral microdialysis (CMD) in aneurysmal subarachnoid hemorrhage (SAH) patients and to summarize the evidence relating cerebral metabolism to pathophysiology, secondary brain injury, and outcome. Methods: Study selection : Two reviewers identified all manuscripts reporting on the clinical use of CMD in aneurysmal SAH patients from MEDLINE. All identified studies were grouped according to their focus on brain metabolic changes during the early and subacute phase after SAH, their association with mechanisms of secondary brain injury and outcome...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28958773/pathophysiological-central-nervous-system-changes-in-a-porcine-model-of-acetaminophen-induced-acute-liver-failure
#10
Christian Thiel, Johannes Lauber, Wilfried Klingert, Kathrin Klingert, Matthias H Morgalla, Rudi Beschorner, Andreas Peter, Christian Grasshoff, Alfred Königsrainer, Martin Schenk, Karolin Thiel
BACKGROUND: Critical care management of patients suffering from acute liver failure (ALF) continues to be challenging. Animal models studying the pathophysiological central nervous system alterations during the course of ALF provide an opportunity to improve diagnostic and therapeutic strategies. The aim of this study was to analyse the course of cerebral oxygenation in addition to conventional neuromonitoring during the course of acetaminophen-induced ALF. METHODS: ALF was induced by intrajejunal acetaminophen administration in 20 German landrace pigs...
November 5, 2017: Toxicology Letters
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#11
REVIEW
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28145850/characterization-of-end-of-life-electroencephalographic-surges-in-critically-ill-patients
#12
Lakhmir S Chawla, Megan Terek, Christopher Junker, Seth Akst, Bona Yoon, Ermira Brasha-Mitchell, Michael G Seneff
Neuromonitoring devices to assess level of sedation are now used commonly in many hospital settings. The authors previously reported that electroencephalicgraphic (EEG) spikes frequently occurred after the time of death in patients being neuromonitored at the time of cessation of circulation. In addition to the initial report, end-of-life electrical surges (ELES) have been subsequently documented in animal and human studies by other investigators. The frequency, character, intensity, and significance of ELES are unknown...
July 2017: Death Studies
https://www.readbyqxmd.com/read/27591003/description-and-contribution-of-brain-magnetic-resonance-imaging-in-nontraumatic-critically-ill-children
#13
Guillaume Mortamet, Manoelle Kossorotoff, Amandine Baptiste, Nathalie Boddaert, Martin Castelle, Philippe Hubert, Fabrice Lesage, Sylvain Renolleau, Mehdi Oualha
BACKGROUND: The authors aimed to collect all brain magnetic resonance imaging (MRI) performed in critically ill children in the authors' medical pediatric intensive care unit over a 2-year period (2012-2013) to (1) describe the findings and (2) assess its contribution on practical patient care. METHODS: This is a single-center and retrospective study. All children without traumatic brain injury who underwent a brain MRI during pediatric intensive care unit stays were included...
December 2016: Journal of Child Neurology
https://www.readbyqxmd.com/read/27521195/multimodality-neuromonitoring
#14
REVIEW
Matthew A Kirkman, Martin Smith
The monitoring of systemic and central nervous system physiology is central to the management of patients with neurologic disease in the perioperative and critical care settings. There exists a range of invasive and noninvasive and global and regional monitors of cerebral hemodynamics, oxygenation, metabolism, and electrophysiology that can be used to guide treatment decisions after acute brain injury. With mounting evidence that a single neuromonitor cannot comprehensively detect all instances of cerebral compromise, multimodal neuromonitoring allows an individualized approach to patient management based on monitored physiologic variables rather than a generic one-size-fits-all approach targeting predetermined and often empirical thresholds...
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27399554/356%C3%A2-microsurgical-anatomy-of-the-brainstem-safe-entry-zones-a-cadaveric-study-with-high-resolution-magnetic-resonance-imaging-and-fiber-tracking
#15
Debraj Mukherjee, Veysel Antar, Bora Gurer, Ulas Cikla, Gabriel Neves, Mehmet Ekici, Tomer Hananya, Aaron S Field, Shahriar M Salamat, Mustafa Kemal Baskaya
INTRODUCTION: Operative management of intrinsic brainstem lesions remains challenging despite advances in electrophysiological monitoring and neuroimaging. Surgical intervention in this region requires detailed knowledge of adjacent, critical white matter tracts and cranial nerve nuclei. Our aim was to systematically verify internal anatomy associated with each brainstem safety zone entry zone (BSEZ) using a cadaveric model supplemented with neuroimaging modalities commonly used in preoperatively planning, namely high-resolution magnetic resonance imaging (MRI) and fiber tracking...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27206707/-specialized-neurological-neurosurgical-intensive-care-medicine
#16
REVIEW
J B Kuramatsu, H B Huttner, S Schwab
In Germany dedicated neurological-neurosurgical critical care (NCC) is the fastest growing specialty and one of the five big disciplines integrated within the German critical care society (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin; DIVI). High-quality investigations based on resilient evidence have underlined the need for technical advances, timely optimization of therapeutic procedures, and multidisciplinary team-work to treat those critically ill patients. This evolution has repeatedly raised questions, whether NCC-units should be run independently or better be incorporated within multidisciplinary critical care units, whether treatment variations exist that impact clinical outcome, and whether nowadays NCC-units can operate cost-efficiently? Stroke is the most frequent disease entity treated on NCC-units, one of the most common causes of death in Germany leading to a great socio-economic burden due to long-term disabled patients...
June 2016: Der Nervenarzt
https://www.readbyqxmd.com/read/26873760/invasive-neuromonitoring
#17
REVIEW
Carey Heck
Advances in technology have resulted in a plethora of invasive neuromonitoring options for practitioners to manage while caring for the complex needs of the critical care patient. Although many types of invasive neuromonitoring are available to the practitioner, intraparenchymal monitors and external ventricular devices are used most frequently in the clinical setting and are the focus of this article. In addition, multimodality monitoring has been noted to confer a survival benefit in patients with this complex type of invasive neuromonitoring and is discussed as well...
March 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/26849251/emerging-strategies-for-the-treatment-of-patients-with-acute-hepatic-failure
#18
REVIEW
Prem A Kandiah, Jody C Olson, Ram M Subramanian
PURPOSE OF REVIEW: The objective of this article is to review the latest developments related to the treatment of patients with acute liver failure (ALF). RECENT FINDINGS: As the treatment of ALF has evolved, there is an increasing recognition regarding the risk of intracranial hypertension related to advanced hepatic encephalopathy. Therefore, there is an enhanced emphasis on neuromonitoring and therapies targeting intracranial hypertension. Also, new evidence implicates systemic proinflammatory cytokines as an etiology for the development of multiorgan system dysfunction in ALF; the recent finding of a survival benefit in ALF with high-volume plasmapheresis further supports this theory...
April 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/26801901/the-critical-care-management-of-poor-grade-subarachnoid-haemorrhage
#19
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Tom R Marotta, Tom A Schweizer, Simon Abrahamson, R Loch Macdonald
Aneurysmal subarachnoid haemorrhage is a neurological syndrome with complex systemic complications. The rupture of an intracranial aneurysm leads to the acute extravasation of arterial blood under high pressure into the subarachnoid space and often into the brain parenchyma and ventricles. The haemorrhage triggers a cascade of complex events, which ultimately can result in early brain injury, delayed cerebral ischaemia, and systemic complications. Although patients with poor-grade subarachnoid haemorrhage (World Federation of Neurosurgical Societies 4 and 5) are at higher risk of early brain injury, delayed cerebral ischaemia, and systemic complications, the early and aggressive treatment of this patient population has decreased overall mortality from more than 50% to 35% in the last four decades...
January 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26315001/cocaine-use-as-an-independent-predictor-of-seizures-after-aneurysmal-subarachnoid-hemorrhage
#20
Tiffany R Chang, Robert G Kowalski, J Ricardo Carhuapoma, Rafael J Tamargo, Neeraj S Naval
OBJECTIVE: Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH. METHODS: Prospectively collected data from aSAH patients admitted to 2 institutional neuroscience critical care units between 1991 and 2009 were reviewed...
March 2016: Journal of Neurosurgery
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