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Shishir Keekana Rao, Advait Mahulikar, Mohammad Ibrahim, Aashit Shah, Navid Seraji-Bozorgzad, Wazim Mohamed
Status epilepticus (SE) is defined as ongoing seizures lasting longer than five minutes or multiple seizures without recovery. Benzodiazepines (BZDs) are first-line agents for the management of SE. Our objective was to evaluate BZD dosing in SE patients and its effects on clinical/electrographic outcomes. A retrospective analysis was conducted from a prospective database of SE patients admitted to a university-based neurocritical care unit. The initial presentation and progression to refractory SE (RSE) and non-convulsive SE (NCSE) with coma was evaluated...
August 1, 2018: Epileptic Disorders: International Epilepsy Journal with Videotape
Yasuhiro Norisue, Yoshihisa Fujimoto, Kazuma Nakagawa
Background: Because of the complex pathophysiological processes involved, neurocritical care has been driven by anecdotal experience and physician preferences, which has led to care variation worldwide. Standardization of practice has improved outcomes for many of the critical conditions encountered in the intensive care unit. Main body: In this review article, we introduce preliminary guideline- and pathophysiology-based protocols for (1) prompt shivering management, (2) traumatic brain injury and intracranial pressure management, (3) neurological prognostication after cardiac arrest, (4) delayed cerebral ischemia after subarachnoid hemorrhage, (5) nonconvulsive status epilepticus, and (6) acute or subacute psychosis and seizure...
2018: Journal of Intensive Care
Ruchira M Jha, Patrick M Kochanek, J Marc Simard
Cerebral edema (CE) and resultant intracranial hypertension are associated with unfavorable prognosis in traumatic brain injury (TBI). CE is a leading cause of in-hospital mortality, occurring in >60% of patients with mass lesions, and ∼15% of those with normal initial computed tomography scans. After treatment of mass lesions in severe TBI, an important focus of acute neurocritical care is evaluating and managing the secondary injury process of CE and resultant intracranial hypertension. This review focuses on a contemporary understanding of various pathophysiologic pathways contributing to CE, with a subsequent description of potential targeted therapies...
August 4, 2018: Neuropharmacology
Michelle Hill, Jessica DeWitt
OBJECTIVE: To enhance nursing staff retention and ensure a consistently high standard of care, a study was conducted to determine an appropriate nurse staffing model for a neurocritical care unit. In addition to being critically ill, these patients often require extensive diagnostic testing to determine treatment. Nurses traveling with patients leave higher nurse-patient ratios remaining on the unit. METHODS: Prospective observation was used to assess relationships between neurologic assessment, documentation, and the amount of time spent traveling with patients...
August 1, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
(no author information available yet)
Assessment of Complications from Decompressive Hemicraniectomy.
July 27, 2018: Neurocritical Care
Nicholas R Nelson, Kathryn A Morbitzer, J Dedrick Jordan, Denise H Rhoney
BACKGROUND: Traumatic brain injury (TBI) is associated with secondary complications, including infection, and patients with TBI often exhibit augmented renal clearance (ARC). This phenomenon has been associated with subtherapeutic levels of renally cleared drugs such as vancomycin, which is dosed based on body weight and creatinine clearance (CrCl). Many clinicians, however, cap CrCl at 120 mL/min/1.73 m2 when calculating vancomycin dosing regimens. We hypothesize that capping patient CrCl, as opposed to utilizing the non-capped CrCl, when determining vancomycin dosing schemes results in subtherapeutic serum trough concentrations in patients with TBI...
July 26, 2018: Neurocritical Care
Amel Hessington, Parmenion P Tsitsopoulos, Andreas Fahlström, Niklas Marklund
BACKGROUND: In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. METHOD: Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH...
July 26, 2018: Acta Neurochirurgica
Giulia M Benedetti, Faye S Silverstein, Stephanie M Rau, Shannon G Lester, Marco H Benedetti, Renée A Shellhaas
OBJECTIVES: We assessed neuroactive medication use in critically ill children who require neurological consultation and evaluated the associations between administration of these medications and continuous electroencephalography (cEEG) utilization and seizure frequency. METHODS: We evaluated exposure to sedatives, analgesics, anesthetics, and paralytics in consecutive patients (0 days to 18 years) for whom neurological consultation was requested in three intensive care units (ICUs) [neonatal (NICU), pediatric (PICU), and cardiothoracic (PCTU)]) at one children's hospital...
May 18, 2018: Pediatric Neurology
Abhijit Lele, Chong Cheever, Larry Healey, Kellie Hurley, Louis J Kim, Claire J Creutzfeldt
INTRODUCTION: Transition to comfort measures only (CMO) is common in the neurocritical care unit, and close communication between interdisciplinary health-care teams is vital to a smooth transition. We developed and implemented a CMO huddle in an effort to reduce inconsistencies during the process of CMO transition. METHODS: The CMO huddle was a multiphase quality improvement project in a neurocritical care unit of a level-1 trauma and comprehensive stroke center...
July 24, 2018: American Journal of Hospice & Palliative Care
Danielle Burch, Silke Bernert, Justin F Fraser
OBJECT: Recent efforts in neurocritical care have emphasized optimal timing and employment of rehabilitation services. However, there is sparse literature on the effect of team approaches to the intensive care patient. The aim of this study was to evaluate the effect of increased coordination between a physical therapist and an attending cerebrovascular neurosurgeon through daily multidisciplinary rounds. METHODS: A retrospective review was performed of 235 patients who were admitted to the neuroscience service under a single cerebrovascular neurosurgeon over a 16-month period (April 2014 through July 2015) in a level-I trauma hospital...
July 16, 2018: NeuroRehabilitation
N S Rocchetti, J J Egea-Guerrero, Z Ruiz de Azua-Lopez, L Martin-Villen, A Rodriguez-Rodriguez, A Vilches-Arenas, E Correa-Chamorro, C J Settecase, D H Bagilet
AIM: To assess the prognostic value of APACHE II and SAPS II scales to predict brain death evolution of neurocritical care patients. PATIENTS AND METHODS: Retrospective observational study performed in a tertiary hospital. Include 508 patients over 16 years old, hospitalized in ICU for at least 24 hours. The variables of interest were: demographic data, risk factors, APACHE II, SAPS II and outcome. RESULTS: Median age: 41 years old (IR: 25-57)...
August 16, 2018: Revista de Neurologia
Axel Forsse, Anders Hedegaard Clausen, Troels Halfeld Nielsen, Carl-Henrik Nordström, Frantz Rom Poulsen
The neurointensive care field emerged as a separate medical speciality in the 1980s, driven by the development of new monitoring tools. The most important goal of neurointensive care is avoiding secondary brain injuries or detecting them in time to implement effective treatment. Understanding cerebral metabolism is key in the care of neurocritical patients, and continuous monitoring through intracerebral microdialysis allows for differentiation of different pathological mechanisms, in turn catalysing development of novel treatments...
July 23, 2018: Ugeskrift for Laeger
Yuichi Kubota, Hidetoshi Nakamoto, Satoshi Egawa, Takakazu Kawamata
Background: Continuous electroencephalogram (CEEG) monitoring is increasingly being used for brain monitoring in neurocritical care setting. This is because of the proven effectiveness of CEEG in diagnosing nonconvulsive status epilepticus (NCSE) as a cause of unexplained consciousness disorder. CEEG has been demonstrated to be effective in determining the response to, and outcome of, NCSE treatment. Main body: In this review article, the authors described the indication and methods of CEEG and diagnosis based on EEG pattern...
2018: Journal of Intensive Care
Kaibin Huang, Yanhong Hu, Yongming Wu, Zhong Ji, Shengnan Wang, Zhenzhou Lin, Suyue Pan
Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients. Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min...
2018: Frontiers in Neurology
Boris D Heifets, Pedro Tanaka, Mark A Burbridge
PURPOSE OF REVIEW: The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. RECENT FINDINGS: In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint against which we can titrate our patients' fluid balance; and agreement on the composition of fluid we should give in various clinical contexts...
July 14, 2018: Current Opinion in Anaesthesiology
Dhuleep S Wijayatilake, Dominic P D Nielsen, Elinor Baker, Vinod Patil
PURPOSE OF REVIEW: Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. RECENT FINDINGS: Prehospital care teams which include a physician may reduce mortality...
July 12, 2018: Current Opinion in Anaesthesiology
Aaron Sylvan Lord, Joseph Nicholson, Ariane Lewis
Hospital-acquired infections are common in neurointensive care units. We sought to review interventions which may reduce infection rates in neurocritically ill populations. We conducted a systematic review of studies targeting adult patients in neuro-intensive care units (neuro-ICUs) with an intervention designed to prevent ICU-acquired infections. Our outcome of interest was change in the prevalence or rates of infection between active and control arms of these studies. We excluded studies based on the following criteria: no English full-text version available; pediatric population; non-neurosciences ICU population; pre- or intraoperative methods to prevent infection; lack of discrete data for infection rates/prevalence; studies that were purely observational in nature and did not test an intervention; and studies performed in resource limited settings...
July 11, 2018: Neurocritical Care
Angela Builes-Aguilar, Jose L Diaz-Gomez, Federico Bilotta
PURPOSE OF REVIEW: We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. RECENT FINDINGS: Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies...
July 9, 2018: Current Opinion in Anaesthesiology
Gülay Altun Uğraş, Serpil Yüksel, Zeynep Temiz, Selin Eroğlu, Keziban Şirin, Yüksel Turan
PURPOSE: The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. METHODS: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU)...
August 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Simon S Buttrick, Iahn Cajigas, Justin K Achua, Kristine O'Phelan, Kenneth W Goodman, Ronald J Benveniste
OBJECTIVE: To determine whether a set of simple criteria can identify patients in the NICU at high risk of poor outcome and delivery of nonbeneficial care early in the course of their illness. Secondarily, factors affecting limitation of care protocols were assessed. METHODS: We prospectively identified patients who were admitted to the NICU with partial loss of brainstem reflexes persisting for >24 hours due to an intrinsic lesion of the brain (trauma, stroke, hemorrhage, etc...
July 5, 2018: World Neurosurgery
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