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Arnold J Sansevere, Cecil D Hahn, Nicholas S Abend
PURPOSE: To summarize the use of continuous electroencephalographic monitoring (cEEG) in the diagnosis and management of pediatric convulsive status epilepticus (CSE) and subsequent non-convulsive seizures (NCS) with a focus on available guidelines and infrastructure. In addition, we provide an overview of quantitative EEG (QEEG) for the identification of NCS in critically ill children. METHODS: We performed a review of the medical literature on the use of cEEG and QEEG in pediatric CSE...
October 6, 2018: Seizure: the Journal of the British Epilepsy Association
Marc R Nuwer, Paul M Vespa
Coding specifies the work performed when providing patient care. Critical care services mostly use code 99291, and other codes specify additional time and procedures. Current Procedural Terminology defines critically ill as "a high probability of imminent or life-threatening deterioration in the patient's condition," a condition necessary for use of the critical care code. A patient may be critically ill for neurologic reasons even when stable from a cardiorespiratory status. Rules govern who can use these codes, whether they can be used by more than one physician, the locations where the code may be used, and what services are included and excluded...
December 2018: Continuum: Lifelong Learning in Neurology
Christos Lazaridis
The goal of shared decision making in the neurocritical care setting is to form plans of care that are consistent with best medical practice and are respectful of the patient's values. Close cooperation and meaningful interaction must be achieved with family members so that the patient's "person can emerge" through discussions. This article highlights several caveats that can subvert this complex process, including the cognitive biases that affect both clinicians and surrogates. Impact, optimism, and gain-framing biases may be particularly relevant when considering patients who are receiving neurocritical care...
December 2018: Continuum: Lifelong Learning in Neurology
Lucia Rivera Lara, Hans Adrian Püttgen
PURPOSE OF REVIEW: This article focuses on the multiple neuromonitoring devices that can be used to collect bedside data in the neurocritical care unit and the methodology to integrate them into a multimodality monitoring system. The article describes how to apply the collected data to appreciate the physiologic changes and develop therapeutic approaches to prevent secondary injury. RECENT FINDINGS: The neurologic examination has served as the primary monitor for secondary brain injury in patients admitted to the neurocritical care unit...
December 2018: Continuum: Lifelong Learning in Neurology
Chethan P Venkatasubba Rao, Jose I Suarez
PURPOSE OF REVIEW: This article provides updated information regarding the diagnosis and treatment (specifically critical care management) of acute ischemic stroke. This article also discusses the increased use of thrombolysis and thrombectomy in clinical practice. RECENT FINDINGS: Stroke is the leading cause of disability in the United States. A significant proportion of patients with acute ischemic stroke require critical care management. Much has changed in the early evaluation and treatment of patients presenting with acute ischemic stroke...
December 2018: Continuum: Lifelong Learning in Neurology
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Matthew A Koenig
PURPOSE OF REVIEW: This article reviews the management of cerebral edema, elevated intracranial pressure (ICP), and cerebral herniation syndromes in neurocritical care. RECENT FINDINGS: While corticosteroids may be effective in reducing vasogenic edema around brain tumors, they are contraindicated in traumatic cerebral edema. Mannitol and hypertonic saline use should be tailored to patient characteristics including intravascular volume status. In patients with traumatic brain injury who are comatose, elevated ICP should be managed with an algorithmic, multitiered treatment protocol to maintain an ICP of 22 mm Hg or less...
December 2018: Continuum: Lifelong Learning in Neurology
Anton Lund, Mette B Damholt, Jørgen Wiis, Jesper Kelsen, Ditte G Strange, Kirsten Møller
BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients. METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring...
December 3, 2018: Acta Anaesthesiologica Scandinavica
Jane R von Gaudecker
No abstract text is available yet for this article.
November 27, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Sarah Peacock, Jason Siegel, Emily Harmer, David Alejos, W David Freeman
BACKGROUND AND PURPOSE: Thirty-day hospital readmissions have been shown to be a measure of quality and result in higher mortality and increased costs. Readmissions are a target for hospitals and payers; thus, several centers have developed predictive readmission scores to identify high-risk patients. The purpose of this study was to evaluate the current hospital-wide readmission risk calculator and the ability of this tool to predict 30-day readmissions in the neurocritical care population...
November 27, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Annarein J Kerbert, Cornelius Engelmann, Rajiv Jalan
Hepatic encephalopathy (HE) is a severe complication of liver disease, describing a spectrum of neurological and psychiatric abnormalities ranging from subclinical alterations to coma. HE is the leading cause for hospital readmission, intensive care treatment, and mortality in patients with chronic liver disease. The complex and multifaceted pathogenesis is not yet fully understood, but hypotheses focus on ammonia and systemic inflammation, which are the main targets for currently available therapies in clinical practice...
October 2018: Seminars in Respiratory and Critical Care Medicine
Mohammad S Ibrahim, Bennson Samuel, Wazim Mohamed, Kushak Suchdev
A number of neurologic disorders can cause cardiac dysfunction by involving the conductive system and contractile apparatus of the heart. This is especially prominent in the neurocritical care setting where the spectrum of cardiac dysfunction due to acute neurologic injury ranges from trivial and isolated electrocardiographic changes to malignant arrhythmias and sudden death (Table 1). The mechanism of these cardiac complications is complex and not fully understood. An understanding of the neuroanatomical structures and pathways is of immense importance to comprehend the underlying pathophysiology that culminates as cardiac damage and dysregulation...
November 27, 2018: Neurocritical Care
John P Sheppard, Vera Ong, Carlito Lagman, Methma Udawatta, Courtney Duong, Thien Nguyen, Giyarpuram N Prashant, David S Plurad, Dennis Y Kim, Isaac Yang
BACKGROUND: External ventricular drain (EVD) placement is essential for the management of many neurocritical care patients. However, ventriculostomy-related infection (VRI) is a serious complication, and there remains no well-established protocol guiding use of perioperative or extended antibiotic prophylaxis to minimize risk of VRI. OBJECTIVE: To analyze published evidence on the efficacy of extended prophylactic antimicrobial therapy and antibiotic-coated external ventricular drains (ac-EVDs) in reducing VRI incidence...
November 26, 2018: Neurosurgery
Joseph Donnelly, Marek Czosnyka, Hadie Adams, Danilo Cardim, Angelos G Kolias, Frederick A Zeiler, Andrea Lavinio, Marcel Aries, Chiara Robba, Peter Smielewski, Peter J A Hutchinson, David K Menon, John D Pickard, Karol P Budohoski
BACKGROUND: Intracranial pressure (ICP) is a clinically important variable after severe traumatic brain injury (TBI) and has been monitored, along with clinical outcome, for over 25 yr in Addenbrooke's hospital, Cambridge, United Kingdom. This time period has also seen changes in management strategies with the implementation of protocolled specialist neurocritical care, expansion of neuromonitoring techniques, and adjustments of clinical treatment targets. OBJECTIVE: To describe the changes in intracranial monitoring variables over the past 25 yr...
November 23, 2018: Neurosurgery
Christian D Becker, Christian Bowers, Dipak Chandy, Chad Cole, Meic H Schmidt, Corey Scurlock
Background/Rationale: Patients are admitted to Intensive care units (ICUs) either because they need close monitoring despite a low risk of hospital mortality (LRM group) or to receive ICU specific active treatments (AT group). The characteristics and differential outcomes of LRM patients vs. AT patients in Neurocritical Care Units are poorly understood. Methods: We classified 1,702 patients admitted to our tertiary and quaternary care center Neuroscience-ICU in 2016 and 2017 into LRM vs. AT groups. We compared demographics, admission diagnosis, goal of care status, readmission rates and managing attending specialty extracted from the medical record between groups...
2018: Frontiers in Neurology
Hitoshi Kobata
No abstract text is available yet for this article.
November 2018: No Shinkei Geka. Neurological Surgery
Abhijit V Lele, Qian Qiu, Sergii Gorbachov, Christine Fong, Bala G Nair, Pat Blissitt, Rebekah Marsh, Nophanan Chaikittisilpa, Vijay Krishnamoorthy, Monica S Vavilala
Indicator of response urgency (page tag), paging domains, distribution of pages by time of the day, and factors associated with neurocritical care paging remain elusive and were examined in this study. We examined the association between patient, neurocritical care workflow characteristics, and paging domains on frequency of paging using Student's t-test, Chi-square test, and analysis of covariance. A total of 1852 patients generated 36,472 pages. The most common page tagging was "for your information" (n = 15067, 41...
November 16, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Yi-Hsin Tsai, Jie-Ying Lin, Yi-You Huang, Jau-Min Wong
OBJECTIVE: Cushing response (CR) is categorized. Wavelet transform (WT) and decision tree (DT) are utilized to analyze physiological signals from neurocritical patients. A warning model is built for recognition of CR, real-time evaluation of intracranial condition and prediction of neurological outcome. METHODS: Physiological signals of neurocritical patients are preprocessed by WT and compressed by linear regression. An algorithm labels each segment as pathological, physiological, negative or uncertain CR...
September 21, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Ling Xie, Yu Peng, Kaibin Huang, Yongming Wu, Shengnan Wang
BACKGROUND: Iron, an essential mineral for human body, has the potential to cause toxicity at high levels. Previous studies have shown inconsistent predictive value of iron parameters in critically ill patients. Thus, we aimed to evaluate the performance of iron parameters in outcome prediction of neurocritically ill patients. METHODS: Retrospective data were collected from patients admitted to the neurocritical care unit (NCU) of a tertiary teaching hospital between August 2016 and January 2017...
November 19, 2018: Brain and Behavior
Juliette Selb, Kuan-Cheng Wu, Jason Sutin, Pei-Yi Ivy Lin, Parisa Farzam, Sophia Bechek, Apeksha Shenoy, Aman B Patel, David A Boas, Maria Angela Franceschini, Eric S Rosenthal
Monitoring of cerebral blood flow (CBF) and autoregulation are essential components of neurocritical care, but continuous noninvasive methods for CBF monitoring are lacking. Diffuse correlation spectroscopy (DCS) is a noninvasive diffuse optical modality that measures a CBF index ( <mml:math xmlns:mml=""> <mml:mrow> <mml:msub> <mml:mrow> <mml:mi>CBF</mml:mi> </mml:mrow> <mml:mrow> <mml:mi>i</mml:mi> </mml:mrow> </mml:msub> </mml:mrow> </mml:math> ) in the cortex microvasculature by monitoring the rapid fluctuations of near-infrared light diffusing through moving red blood cells...
October 2018: Neurophotonics
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