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Critical Care Neurology

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https://www.readbyqxmd.com/read/28328824/early-use-of-noninvasive-techniques-for-clearing-respiratory-secretions-during-noninvasive-positive-pressure-ventilation-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-and-hypercapnic-encephalopathy-a-prospective-cohort-study
#1
Jinrong Wang, Zhaobo Cui, Shuhong Liu, Xiuling Gao, Pan Gao, Yi Shi, Shufen Guo, Peipei Li
Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#2
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28325458/chronic-subdural-hematoma-icu-management
#3
REVIEW
Jeremy T Ragland, Kiwon Lee
Patients with cSDH presenting with new or worsening neurological deficits, especially if they are debilitating and adversely affecting quality of life require urgent medical and surgical attention. Neurological and neurosurgical critical care team need to stabilize the patient by reversing any underlying coagulopathy states in order to prevent further hematoma expansion.In the event of brain herniation and presumed ICP elevation and CPP compromise, step-wise ICP management should be instituted promptly.Seizure prophylaxis treatment is reasonable...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#4
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28306558/monitoring-of-the-physical-exam-in-sepsis
#5
Radu Postelnicu, Laura Evans
PURPOSE OF REVIEW: Monitoring of mental status and peripheral circulatory changes can be accomplished noninvasively in patients in the ICU. Emphasis on physical examination in conditions such as sepsis have gained increased attention as these evaluations can often serve as a surrogate marker for short-term treatment efficacy of therapeutic interventions. Sepsis associated encephalopathy and mental status changes correlate with worse prognosis in patients. Evaluation of peripheral circulation has been shown to be a convenient, easily accessible, and accurate marker for prognosis in patients with septic shock...
March 16, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28301586/influence-of-early-neurological-complications-on-clinical-outcome-following-lung-transplant
#6
Josep Gamez, Maria Salvado, Alejandro Martinez-de La Ossa, Maria Deu, Laura Romero, Antonio Roman, Judith Sacanell, Cesar Laborda, Isabel Rochera, Miriam Nadal, Francesc Carmona, Estevo Santamarina, Nuria Raguer, Merce Canela, Joan Solé
BACKGROUND: Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. METHODS: We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28297827/-application-of-bedside-ultrasound-in-measuring-gastric-residual-volume-in-neurosurgical-critical-patients-with-enteral-nutrition-support
#7
L Cao, X H Ye, J Li, L N Zhang, L Li, W Y Zhang, L L Deng
Objective: To explore the effect of bedside ultrasound in measuring gastric residual volume in neurosurgical critical patients with enteral nutrition support. Method: From March to August 2016, 70 critically neurological patients with continues enteral nutrition who admitted in Intensive Care Unit (ICU) were randomized into two groups. The observation group applied the bedside ultrasound monitoring gastric residual volume every day to guide the implementation of enteral nutrition. The control group used syringes withdrawing every 8 hours to measure the gastric residual volume...
March 7, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28293679/research-conference-summary-from-the-2014-international-task-force-on-atp1a3-related-disorders
#8
Hendrik Rosewich, Matthew T Sweney, Suzanne DeBrosse, Kevin Ess, Laurie Ozelius, Eva Andermann, Frederick Andermann, Gene Andrasco, Alice Belgrade, Allison Brashear, Sharon Ciccodicola, Lynn Egan, Alfred L George, Aga Lewelt, Joshua Magelby, Mario Merida, Tara Newcomb, Vicky Platt, Dominic Poncelin, Sandra Reyna, Masayuki Sasaki, Marcio Sotero de Menezes, Kathleen Sweadner, Louis Viollet, Mary Zupanc, Kenneth Silver, Kathryn Swoboda
OBJECTIVE: ATP1A3-related neurologic disorders encompass a broad range of phenotypes that extend well beyond initial phenotypic criteria associated with alternating hemiplegia of childhood (AHC) and rapid-onset dystonia parkinsonism. METHODS: In 2014, the Alternating Hemiplegia of Childhood Foundation hosted a multidisciplinary workshop intended to address fundamental challenges surrounding the diagnosis and management of individuals with ATP1A3-related disorders...
April 2017: Neurology. Genetics
https://www.readbyqxmd.com/read/28292527/enteral-nutrition-volume-is-not-correlated-with-lower-respiratory-tract-infection-in-patients-on-mechanical-ventilation
#9
A Colomar, B Guardiola, J A Llompart-Pou, I Ayestarán, J Rodríguez-Pilar, M Ferreruela, J M Raurich
OBJECTIVE: To evaluate the effect of enteral nutrition volume, gastrointestinal function and the type of acid suppressive drug upon the incidence of lower respiratory tract infections in critically ill patients on mechanical ventilation (MV). DESIGN: A retrospective secondary analysis was carried out. SETTING: The Intensive Care Unit of a University Hospital. PATIENTS OR PARTICIPANTS: Patients≥18-years-old expected to need MV for more than four days, and receiving enteral nutrition by nasogastric tube within 24h of starting MV...
March 11, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28290470/descriptive-study-of-earthquake-related-spinal-cord-injury-in-nepal
#10
C C Groves, M K Poudel, M Baniya, C Rana, D R House
STUDY DESIGN: Descriptive study. OBJECTIVES: To describe the epidemiological features of spinal cord injury (SCI) following the 2015 earthquakes in Nepal. SETTING: Spinal Injury Rehabilitation Centre, Kavre, Nepal. METHODS: Data were collected from the medical records of all earthquake-related patients seen from 25 April 2015 through to 16 June 2016. Data collected included patient demographics, mechanism of injury, initial medical treatment, neurological assessment, complications, neurological/functional outcomes and length of stay...
March 14, 2017: Spinal Cord
https://www.readbyqxmd.com/read/28282628/blood-transfusion-indications-in-neurosurgical-patients-a-systematic-review
#11
REVIEW
Shefali Bagwe, Lawrance K Chung, Carlito Lagman, Brittany L Voth, Natalie E Barnette, Lekaa Elhajjmoussa, Isaac Yang
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences...
February 20, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28277415/mortality-risk-stratification-after-traumatic-brain-injury-and-hazard-of-death-with-titrated-hypothermia-in-the-eurotherm3235trial
#12
Peter J D Andrews, Aryelly Rodriguez, Peter Suter, Claire G Battison, Jonathan K J Rhodes, Irene Puddu, Bridget A Harris
OBJECTIVES: Hypothermia reduces intracranial hypertension in patients with traumatic brain injury but was associated with harm in the Eurotherm3235Trial. We stratified trial patients by International Mission for Prognosis and Analysis of Clinical Trials in [Traumatic Brain Injury] (IMPACT) extended model sum scores to determine where the balance of risks lay with the intervention. DESIGN: The Eurotherm3235Trial was a randomized controlled trial, with standardized and blinded outcome assessment...
March 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28274986/use-of-simulation-training-to-prepare-pharmacy-residents-for-medical-emergencies
#13
Melissa L Thompson Bastin, Aaron M Cook, Alexander H Flannery
PURPOSE: The use of high-fidelity simulation training for preparing pharmacy residents for various high-stress and high-impact medical emergencies and the impact of this training on pharmacy residents' perception of preparedness are described. SUMMARY: During the 2015-16 residency year at the University of Kentucky Medical Center, simulation training, in addition to lecture-based orientation training, was chosen as a method to reinforce skills and knowledge learned throughout the orientation, before residents began working on-call shifts...
March 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28271450/patient-important-outcomes-in-randomized-controlled-trials-in-critically-ill-patients-a-systematic-review
#14
REVIEW
Stéphane Gaudry, Jonathan Messika, Jean-Damien Ricard, Sylvie Guillo, Blandine Pasquet, Emeline Dubief, Tanissia Boukertouta, Didier Dreyfuss, Florence Tubach
BACKGROUND: Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-important outcomes are reported in published randomized controlled trials (RCTs) in critically ill patients. METHODS: Literature search was conducted to identify eligible trials indexed from January to December 2013...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28265980/outcomes-in-elderly-patients-admitted-to-the-intensive-care-unit-with-solid-tumors
#15
Edouard Auclin, Anaïs Charles-Nelson, Baptiste Abbar, Emmanuel Guérot, Stéphane Oudard, Caroline Hauw-Berlemont, Constance Thibault, Alexandra Monnier, Jean-Luc Diehl, Sandrine Katsahian, Jean-Yves Fagon, Julien Taieb, Nadia Aissaoui
BACKGROUND: As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. METHODS: We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28243999/physiological-effects-of-early-incremental-mobilization-of-a-patient-with-acute-intracerebral-and-intraventricular-hemorrhage-requiring-dual-external-ventricular-drainage
#16
Sowmya Kumble, Elizabeth K Zink, Mackenzie Burch, Sandra Deluzio, Robert D Stevens, Mona N Bahouth
BACKGROUND: Recent trials have challenged the notion that very early mobility benefits patients with acute stroke. It is unclear how cerebral autoregulatory impairments, prevalent in this population, could be affected by mobilization. The safety of mobilizing patients who have external ventricular drainage (EVD) devices for cerebrospinal fluid diversion and intracranial pressure (ICP) monitoring is another concern due to risk of device dislodgment and potential elevation in ICP. We report hemodynamic and ICP responses during progressive, device-assisted mobility interventions performed in a critically ill patient with intracerebral hemorrhage (ICH) requiring two EVDs...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28242531/recent-developments-in-the-management-of-patients-resuscitated-from-cardiac-arrest
#17
REVIEW
Jacob C Jentzer, Casey M Clements, Joseph G Murphy, R Scott Wright
Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury...
February 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28242084/understanding-death-in-children-with-epilepsy
#18
REVIEW
Elizabeth J Donner, Peter Camfield, Linda Brooks, Jeffrey Buchhalter, Carol Camfield, Tobias Loddenkemper, Elaine Wirrell
Death in children with epilepsy is profoundly disturbing, with lasting effects on the family, community, and health care providers. The overall risk of death for children with epilepsy is about ten times that of the general population. However, the risk of premature death for children without associated neurological comorbidities is similar to that of the general population, and most deaths are related to the cause of the epilepsy or associated neurologic disability, not seizures. The most common cause of seizure-related death in children with epilepsy is sudden unexpected death in epilepsy (SUDEP)...
January 31, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28241749/development-and-validation-of-a-score-for-evaluating-comprehensive-stroke-care-capabilities-j-aspect-study
#19
Akiko Kada, Kunihiro Nishimura, Jyoji Nakagawara, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Kazunori Toyoda, Shinya Matsuda, Akifumi Suzuki, Hiroharu Kataoka, Fumiaki Nakamura, Satoru Kamitani, Koji Iihara
BACKGROUND: Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. METHODS: Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education...
February 28, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28241263/bridging-knowledge-gaps-to-understand-how-zika-virus-exposure-and-infection-affect-child-development
#20
Bill G Kapogiannis, Nahida Chakhtoura, Rohan Hazra, Catherine Y Spong
Importance: The Zika virus (ZIKV) epidemic has profoundly affected the lives of children and families across the Americas. As the number of children born with ZIKV-related complications continues to grow, the long-term developmental trajectory for these children and the effect on their families remains largely unknown. In September 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and partner National Institutes of Health institutes convened a workshop to develop a research agenda to improve the evaluation, monitoring, and management of neonates, infants, or children affected by ZIKV and its complications...
February 20, 2017: JAMA Pediatrics
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