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Giulia M Benedetti Md, Faye S Silverstein Md
Targeted temperature management encompasses a range of clinical interventions to regulate systemic temperature, and includes both induction of varying degrees of hypothermia and fever prevention ("targeted normothermia"). Targeted temperature management plays a key role in the contemporary management of critically ill neonates and children with acute brain injury. Yet, many unanswered questions remain regarding optimal temperature management in pediatric neurocritical care. The introduction highlights experimental studies that have evaluated the neuroprotective efficacy of therapeutic hypothermia and explored possible mechanisms of action in several brain injury models...
July 21, 2018: Pediatric Neurology
Jose I Suarez
No abstract text is available yet for this article.
October 8, 2018: Neurocritical Care
(no author information available yet)
No abstract text is available yet for this article.
October 4, 2018: Neurocritical Care
Jesse Moskowitz, Thomas Quinn, Muhammad W Khan, Lori Shutter, Robert Goldberg, Nananda Col, Kathleen M Mazor, Susanne Muehlschlegel
Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians' perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians' preferences for communicating prognostic information towards families...
January 2018: MDM Policy & Practice
K M Sauro, A Soo, A Kramer, P Couillard, J Kromm, D Zygun, D J Niven, S M Bagshaw, H T Stelfox
BACKGROUND/OBJECTIVES: Venous thromboembolism (VTE) is a leading cause of preventable, in-hospital deaths; critically ill patients have a higher risk. Effective and efficient strategies to prevent VTE exist; however, neurocritical care patients present unique challenges due to competing risk of bleeding. The objective of this study was to examine current VTE prophylaxis practices among neurocritical care patients, concordance with guideline-recommended care, and the association with clinical outcomes...
October 1, 2018: Neurocritical Care
Megan Lange, Neeraj Badjatia, Wan-Tsu Chang
BACKGROUND: Unsuccessful extubation is associated with increased intensive care unit and hospital length of stays, hospital costs, morbidity, and mortality. The most common cause of reintubation is laryngeal edema, often evidenced by postextubation stridor. OBJECTIVE: To reduce the rates of postextubation stridor and reintubation in the neurocritical care unit at a large urban academic medical center. METHODS: A clinical pathway was created to aid in detecting patients expected to experience postextubation stridor and to guide prophylactic treatment...
October 2018: Critical Care Nurse
Ahmed E Helal, Heba Abouzahra, Ahmed Abdelaziz Fayed, Tarek Rayan, Mahmoud Abbassy
Healthcare spending has become a grave concern to national budgets worldwide, and to a greater extent in low-income countries. Brain tumors are a serious disease that affects a significant percentage of the population, and thus proper allocation of healthcare provisions for these patients to achieve acceptable outcomes is a must. The authors reviewed patients undergoing craniotomy for tumor resection at their institution for the preceding 3 months. All the methods used for preoperative planning, intraoperative management, and postoperative care of these patients were documented...
October 2018: Neurosurgical Focus
Verena Rass, Max Gaasch, Mario Kofler, Alois Josef Schiefecker, Bogdan-Andrei Ianosi, Paul Rhomberg, Ronny Beer, Bettina Pfausler, Elke R Gizewski, Claudius Thomé, Erich Schmutzhard, Raimund Helbok
OBJECTIVES: Subarachnoid hemorrhage is a life-threatening disease associated with high mortality and morbidity. A substantial number of patients develop systemic inflammatory response syndrome. We aimed to identify risk factors for systemic inflammatory response syndrome development and to evaluate the role of systemic inflammatory response syndrome on patients'outcome. DESIGN: Retrospective observational cohort study of prospectively collected data. SETTING: Neurocritical care unit at a tertiary academic medical center...
September 24, 2018: Critical Care Medicine
Carlos Candanedo, Omer Doron, J Claude Hemphill, Fernando Ramirez de Noriega, Geoffrey T Manley, Rani Patal, Guy Rosenthal
BACKGROUND: An external ventricular drain (EVD) is the gold standard for measurement of intracranial pressure (ICP) and allows for drainage of cerebrospinal fluid (CSF). Different causes of elevated ICP, such as CSF outflow obstruction or cerebral swelling, respond differently to CSF drainage. This is a widely recognized but seldom quantified distinction. We sought to define an index to characterize the response to CSF drainage in neurocritical care patients. METHODS: We studied consecutive patients admitted to the neurointensive care unit who had an EVD...
September 24, 2018: Neurocritical Care
DaiWai M Olson, Stefany Ortega Peréz, Jonathan Ramsay, Chethan P Venkatasubba Rao, Jose I Suarez, Molly McNett, Venkatesh Aiyagari
BACKGROUND: Intracranial pressure (ICP) monitoring is fundamental for neurocritical care patient management. For many years, ventricular and parenchymal devices have been available for this aim. The purpose of this paper is to review the published literature comparing ICP recordings via an intraventricular catheter or an intraparenchymal (brain tissue) catheter. METHODS: Literature search of Medline, CINAHL, Embase, and Scopus was performed in which manuscripts discussed both ICP monitoring via an intraventricular catheter and ICP monitoring through intraparenchymal (brain tissue) catheter...
September 24, 2018: Neurocritical Care
Asma M Moheet, Sarah L Livesay, Tamer Abdelhak, Thomas P Bleck, Theresa Human, Navaz Karanjia, Amanda Lamer-Rosen, Joshua Medow, Paul A Nyquist, Axel Rosengart, Wade Smith, Michel T Torbey, Cherylee W J Chang
Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS)...
September 24, 2018: Neurocritical Care
(no author information available yet)
No abstract text is available yet for this article.
September 21, 2018: Neurocritical Care
R Raj, S Bendel, M Reinikainen, S Hoppu, R Laitio, T Ala-Kokko, S Curtze, M B Skrifvars
BACKGROUND: Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU). METHODS: We used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003-2013...
September 20, 2018: Critical Care: the Official Journal of the Critical Care Forum
Eric D Goldstein, Lynda Schnusenberg, Lesia Mooney, Carol C Raper, Sheila McDaniel, Dallas A Thorpe, Michelle T Franke, Linda K Anderson, Lynnae L McClure, Misty M Oglesby, Catina Y Lewis, Cammi Velichko, Belinda G Bradley, William W Horn, Ashley N Reid, Jason L Siegel, Rocco Cannistraro, Perry Bechtle, Maria Thereza Barbosa, Scott M Silvers, Benjamin L Brown, William D Freeman, David A Miller, Kevin M Barrett, Josephine F Huang
Objective: To reduce door-to-angiographic reperfusion (DTR) time to 120 minutes for patients presenting with acute ischemic stroke attributed to anterior circulation large-vessel occlusion amenable to endovascular mechanical thrombectomy. Patients and Methods: Patients treated with mechanical thrombectomy before (April 10, 2015, through April 11, 2016) and after (April 12, 2016, through May 10, 2017) implementation of a multitiered notification system were studied...
June 2018: Mayo Clinic proceedings. Innovations, quality & outcomes
Francesco Corradi, Chiara Robba, Guido Tavazzi, Gabriele Via
When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2 ), also according to the baseline conditions of cerebral autoregulation...
September 17, 2018: Critical Ultrasound Journal
Sheng-Nan Wang, Chun-Ping Gu, Guang-Hui Liu, Zhen-Zhou Lin, Ping Zheng, Su-Yue Pan, Shi-Ting Liu
This study aimed to elucidate the therapeutic concentration range of phenobarbital (PB) for adults, as well as the influence of therapeutic plasma exchange (TPE) on plasma concentration of PB. We retrospectively reviewed consecutive patients diagnosed with refractory status epileptic (RSE) and treated with a bolus injection of PB as well as TPE, admitted to our neurocritical care unit from November 2015 to October 2016. Continuous electroencephalographic monitoring was performed routinely for these patients...
November 7, 2018: Neuroreport
Julianne Yeary, Jeffrey Garavaglia, Richard McKnight, Matthew Smith
Learning Objective: Status epilepticus (SE) is continuous clinical and/or electrographic seizures lasting 5 minutes or more without recovery and carries a high mortality. Medication management varies by institution, as well as administration, combination of antiepileptic drugs (AEDs), and dosing. Methods: Single-center retrospective review of medication management of SE patients admitted to West Virginia University Hospital before and after neurointensivist implemented guidelines. Patients admitted between January 2012 and June 2014 were grouped in the prior to neurointensivist group (pre-NI) and patients admitted between July 2014 and June 2016 were grouped in the postneurointensivist group (post-NI)...
October 2018: Hospital Pharmacy
Ancor Sanz-Garcia, Miriam Perez-Romero, Jesus Pastor, Rafael G Sola, Lorena Vega-Zelaya, Fernando Monasterio, Carmen Torrecilla, Gema Vega, Paloma Pulido, Guillermo J Ortega
To exploring and assessing the relationship between the electroencephalography (EEG) activity with the intracranial pressure (ICP) in patients suffering from Traumatic Brain Injury (TBI) and Subarachnoid Hemorrhage (SAH) during their stay at the Intensive Care Unit (ICU)
 Methods: We performed an observational prospective cohort study of adult patients suffered from TBI or SAH. Continuous EEG-ECG was performed during ICP monitoring. In every patient, derived variables from the EEG were calculated and the Granger Causality (GC) methodology was employed to assess whether, and in which direction, any relationship between EEG and ICP exists...
September 5, 2018: Journal of Neural Engineering
Sara Hocker
Worsening pharmacoresistance to antiseizure drugs is common with ongoing excitotoxic neuronal and systemic injury. Early initiation of anesthetic drugs in refractory status epilepticus (RSE) may halt these processes while allowing time for treatment targeting the cause of the seizures. Current guidelines support the use of anesthetic drugs as the third line pharmacologic therapy in generalized convulsive status epilepticus but do not clearly define the indications for these drugs in other types of status epilepticus...
October 2018: Epilepsia
Mayur B Patel, Josef Bednarik, Patricia Lee, Yahya Shehabi, Jorge I Salluh, Arjen J Slooter, Kate E Klein, Yoanna Skrobik, Alessandro Morandi, Peter E Spronk, Andrew M Naidech, Brenda T Pun, Fernando A Bozza, Annachiara Marra, Sayona John, Pratik P Pandharipande, E Wesley Ely
OBJECTIVES: The Society of Critical Care Medicine recommends routine delirium monitoring, based on data in critically ill patients without primary neurologic injury. We sought to answer whether there are valid and reliable tools to monitor delirium in neurocritically ill patients and whether delirium is associated with relevant clinical outcomes (e.g., survival, length of stay, functional independence, cognition) in this population. DATA SOURCES: We systematically reviewed Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed...
November 2018: Critical Care Medicine
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