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https://www.readbyqxmd.com/read/29455690/effect-of-cerebral-perfusion-pressure-on-acute-respiratory-distress-syndrome
#1
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...
February 19, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29262441/imaging-in-neurocritical-care-practice
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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...
September 2, 2016: Journal of Child Neurology
https://www.readbyqxmd.com/read/27521195/multimodality-neuromonitoring
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/25957201/-nonconvulsive-status-epilepticus-progress-in-clinical-practice-and-research
#16
Masao Nagayama, Sunghoon Yang
Mainly after 2000, we have reported novel manifestations of nonconvulsive status epilepticus (NCSE), such as reversible protracted coma, posthyperventilation apnea, and higher brain dysfunctions, including Klüver-Bucy syndrome. In this review, we discuss the progress in clinical practice and research of NCSE with best available evidence, especially the spectrum of electroencephalographic abnormalities in NCSE, clinical manifestations of malignant NCSE, relationship between sudden unexpected death in epilepsy (SUDEP) and NCSE, and a strategy for real-time neuromonitoring...
May 2015: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/25735719/should-cerebral-near-infrared-spectroscopy-be-standard-of-care-in-adult-cardiac-surgery
#17
REVIEW
Priscilla J W Bevan
Near-infrared spectroscopy (NIRS) is non-invasive, easy to use, and offers real-time monitoring of the oxygen content of cerebral tissue. An effective and user-friendly method of cerebral monitoring stands to offer a significant advance in patient care during adult cardiac surgery, particularly for surgery in which the continuity of cerebral vessels may be compromised. While the current evidence does not definitively show improvement in neurological outcomes, it can be argued that the overall risk to benefit ratio falls on the side of NIRS...
June 2015: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/25632629/-multimodal-neuromonitoring-for-the-critical-care-management-of-acute-coma
#18
REVIEW
Z Ltaief, N Ben-Hamouda, T Suys, R T Daniel, A O Rossetti, M Oddo
Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase...
December 10, 2014: Revue Médicale Suisse
https://www.readbyqxmd.com/read/25608916/the-international-multidisciplinary-consensus-conference-on-multimodality-monitoring-in-neurocritical-care-evidentiary-tables-a-statement-for-healthcare-professionals-from-the-neurocritical-care-society-and-the-european-society-of-intensive-care-medicine
#19
REVIEW
Peter Le Roux, David K Menon, Giuseppe Citerio, Paul Vespa, Mary Kay Bader, Gretchen Brophy, Michael N Diringer, Nino Stocchetti, Walter Videtta, Rocco Armonda, Neeraj Badjatia, Julian Bösel, Randall Chesnut, Sherry Chou, Jan Claassen, Marek Czosnyka, Michael De Georgia, Anthony Figaji, Jennifer Fugate, Raimund Helbok, David Horowitz, Peter Hutchinson, Monisha Kumar, Molly McNett, Chad Miller, Andrew Naidech, Mauro Oddo, DaiWai Olson, Kristine O'Phelan, J Javier Provencio, Corinna Puppo, Richard Riker, Claudia Roberson, Michael Schmidt, Fabio Taccone
A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring...
December 2014: Neurocritical Care
https://www.readbyqxmd.com/read/25208681/the-international-multi-disciplinary-consensus-conference-on-multimodality-monitoring-future-directions-and-emerging-technologies
#20
REVIEW
Paul Vespa, David Menon, Peter Le Roux
Neuromonitoring has evolved rapidly in recent years and there now are many new monitors that have revealed a great deal about the ongoing pathophysiology of brain injury and coma. Further evolution will include the consolidation of multi-modality monitoring (MMM), the development of next-generation informatics tools to identify complex physiologic events and decision support tools to permit targeted individualized care. In this review, we examine future directions and emerging technologies in neuromonitoring including: (1) device development, (2) what is the current limitation(s) of MMM in its present format(s), (3) what would improve the ability of MMM to enhance neurocritical care, and (4) how do we develop evidence for use of MMM?...
December 2014: Neurocritical Care
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