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Neurological critical care

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https://www.readbyqxmd.com/read/28991058/red-cell-distribution-width-after-subarachnoid-hemorrhage
#1
Vito Fontana, Ottavia Bond, Savino Spadaro, Filippo Annoni, Leda Nobile, Rafael Badenes, Carlo A Volta, Jean-L Vincent, Jacques Creteur, Fabio S Taccone
BACKGROUND: High red cell distribution width (RDW) values have been associated with increased hospital mortality in critically ill patients, but few data are available for subarachnoid hemorrhage (SAH). METHODS: We analyzed an institutional database of adult (>18 y) patients admitted to the Department of Intensive Care after nontraumatic SAH between January 2011 and May 2016. RDW (normal value, 10.9% to 13.4%) was obtained daily from admission for a maximum of 7 days, from routine blood analysis...
October 5, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28987857/intracranial-hemorrhage-in-patients-with-durable-mechanical-circulatory-support-devices-institutional-review-and-proposed-treatment-algorithm
#2
Wyatt L Ramey, Robyn L Basken, Christina M Walter, Zain Khalpey, G Michael Lemole, Travis M Dumont
OBJECTIVE: Spontaneous intracranial hemorrhage (ICH) is frequently managed in neurosurgery. Patients with durable mechanical circulatory support devices, including total artificial hearts (TAHs) and left ventricular assist devices (LVADs) are often encountered in the setting of ICH. While durable mechanical circulatory support devices have improved survival and quality of life for patients with advanced heart failure, ICH is one of the most feared complications following LVAD and TAH implantation...
October 4, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28982489/palliative-care-in-neurology
#3
REVIEW
Maisha T Robinson, Robert G Holloway
Palliative medicine is a specialty that focuses on improving the quality of life for patients with serious or advanced medical conditions, and it is appropriate at any stage of disease, including at the time of diagnosis. Neurologic conditions tend to have high symptom burdens, variable disease courses, and poor prognoses that affect not only patients but also their families and caregivers. Patients with a variety of neurologic conditions such as Parkinson disease, dementia, amyotrophic lateral sclerosis, brain tumors, stroke, and acute neurologic illnesses have substantial unmet needs that can be addressed through a combination of primary and specialty palliative care...
October 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28977260/prevalence-of-multiple-organ-dysfunction-in-the-pediatric-intensive-care-unit-pediatric-risk-of-mortality-iii-versus-pediatric-logistic-organ-dysfunction-scores-for-mortality-prediction
#4
Azza Abd Elkader El Hamshary, Seham Awad El Sherbini, HebatAllah Fadel Elgebaly, Samah Abdelkrim Amin
OBJECTIVES: To assess the frequency of primary multiple organ failure and the role of sepsis as a causative agent in critically ill pediatric patients; and calculate and evaluate the accuracy of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores to predict the outcomes of critically ill children. METHODS: Retrospective study, which evaluated data from patients admitted from January to December 2011 in the pediatric intensive care unit of the Children's Hospital of the University of Cairo...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28970179/creation-and-efficacy-of-a-cadaver-based-prosection-anatomical-course-for-critical-care-advanced-practice-providers
#5
Melissa K Stewart, Stephen Gondek, Roslyn Green, Jason Young, Raeanna C Adams, Timothy Nunez
OBJECTIVE: Intensive care units (ICUs) increasingly rely on advanced practice providers (APPs) to care for critically ill patients. Our institutional APPs perceived functional anatomical knowledge deficits. To meet this need, a cadaver-based prosection course was developed. The purpose of our study was to describe and evaluate the learner-perceived course efficacy. DESIGN: A precourse survey collected participant demographics. Precourse and postcourse surveys assessed perceived confidence in 13 anatomical areas...
September 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28954604/untapped-potential-in-australian-hospitals-for-organ-donation-after-circulatory-death
#6
Sandeep S Rakhra, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell, David V Pilcher
OBJECTIVE: To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates. DESIGN: Retrospective cohort study. Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife...
September 2, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28948850/the-impact-of-airway-strategy-on-the-patient-outcome-after-out-of-hospital-cardiac-arrest-a-propensity-score-matched-analysis
#7
Patrick Sulzgruber, Philip Datler, Fritz Sterz, Michael Poppe, Elisabeth Lobmeyr, Markus Keferböck, Sebastian Zeiner, Alexander Nürnberger, Andreas Schober, Pia Hubner, Peter Stratil, Christian Wallmueller, Christoph Weiser, Alexandra-Maria Warenits, Andreas Zajicek, Florian Ettl, Ingrid Magnet, Thomas Uray, Christoph Testori, Raphael van Tulder
BACKGROUND: While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive. METHODS: To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed...
September 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28946862/long-term-outcome-in-survivors-of-neonatal-tetanus-following-specialist-intensive-care-in-vietnam
#8
Huynh T Trieu, Nguyen Thi Kim Anh, Huynh Ngoc Thien Vuong, T T M Dao, Nguyen Thi Xuan Hoa, Vo Ngoc Cat Tuong, Pham Tam Dinh, Bridget Wills, Phan Tu Qui, Le Van Tan, Lam Minh Yen, Saraswathy Sabanathan, Catherine Louise Thwaites
BACKGROUND: Neonatal tetanus continues to occur in many resource-limited settings but there are few data regarding long-term neurological outcome from the disease, especially in settings with critical care facilities. METHODS: We assessed long-term outcome following neonatal tetanus in infants treated in a pediatric intensive care unit in southern Vietnam. Neurological and neurodevelopmental testing was performed in 17 survivors of neonatal tetanus and 18 control children from the same communities using tools previously validated in Vietnamese children...
September 25, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28946588/changing-the-culture-of-neurodisability-through-language-and-sensitivity-of-providers-creating-a-safe-place-for-lgbtqia-people
#9
Alexander Moreno, Ari Laoch, Nathan D Zasler
BACKGROUND: There is an increasing interest in sexual and gender diversity in neurorehabilitation. Healthcare professionals wanting to improve their practice know the importance of understanding the needs and expectations of specific communities. OBJECTIVE: To critically review the literature about neurological disorders in people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+)...
September 16, 2017: NeuroRehabilitation
https://www.readbyqxmd.com/read/28932651/extracorporeal-membrane-oxygenation-ecmo-and-the-critical-cardiac-patient
#10
REVIEW
David A Baran
PURPOSE OF REVIEW: This review is to summarize the basics of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) as it is utilized for critically ill cardiac patients. RECENT FINDINGS: ECMO may be instituted in a variety of health care settings, from the emergency room to the operating room. The types of patients who may benefit from ECMO are reviewed in detail. The complications of ECMO are reviewed, including access-related issues and hematologic and neurologic problems...
2017: Current Transplantation Reports
https://www.readbyqxmd.com/read/28932559/pupillary-abnormalities-in-non-selected-critically-ill-patients-an-observational-study
#11
Philippe Portran, Martin Cour, Romain Hernu, Sylvie de la Salle, Laurent Argaud
BACKGROUND: Repeated pupillary examination is a key element of neurologic surveillance in intensive care units (ICU). However, in non-selected critically ill patients, the clinical interest of monitoring pupillary diameter and light reflex is poorly documented. We aimed to determine the prevalence and the etiologies of pupillary abnormalities (PAs) in this ICU patient population. METHODS: We performed a prospective, observational study in a medical university affiliated ICU over a 6-month period...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28929324/stress-ulcer-prophylaxis-in-neurocritical-care
#12
Jeffrey F Barletta, Alicia J Mangram, Joseph F Sucher, Victor Zach
Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse...
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28925974/if-you-build-it-they-will-come-initial-experience-with-a-multi-disciplinary-pediatric-neurocritical-care-follow-up-clinic
#13
Cydni N Williams, Aileen Kirby, Juan Piantino
Pediatric Neurocritical Care diagnoses account for a large proportion of intensive care admissions. Critical care survivors suffer high rates of long-term morbidity, including physical disability, cognitive impairment, and psychosocial dysfunction. To address these morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals apply to all Pediatric Neurocritical Care patients regardless of admission severity of illness...
September 19, 2017: Children
https://www.readbyqxmd.com/read/28922669/a-critical-commentary-on-the-2017-agnp-consensus-guidelines-for-therapeutic-drug-monitoring-in-neuropsychopharmacology
#14
Jose de Leon
In 2004, 2011, and 2017, the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP), a group of German-speaking psychiatric researchers and psychiatrists, published successive versions of therapeutic drug monitoring (TDM) expert group consensus guidelines. The 2017 version has as a major strength its encyclopedic nature, including 1358 references. The guideline has 3 major sections: 1) theoretical aspects of TDM, 2) drug concentration levels in blood to guide neuropsychopharmacotherapy, and 3) practical aspects of TDM in psychiatry and neurology...
September 18, 2017: Pharmacopsychiatry
https://www.readbyqxmd.com/read/28916353/outcomes-of-adults-with-in-hospital-cardiac-arrest-after-implementation-of-the-2010-resuscitation-guidelines
#15
Chih-Hung Wang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Wen-Jone Chen
BACKGROUND: The 2015 guidelines for cardiopulmonary resuscitation (CPR) are based on an update of the 2010 guidelines with minor revisions. It is important to assess the 2010 guidelines to ensure their efficacy, which may help promote widespread adoption of the 2015 guidelines. METHODS: We conducted a retrospective observational study in a single center that evaluated patients with in-hospital cardiac arrest (IHCA) between 2006 and 2014. Multivariable logistic regression analysis was used to evaluate associations between independent variables and outcomes...
September 11, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28913813/pharmacotherapy-pearls-for-emergency-neurological-life-support
#16
Gretchen M Brophy, Theresa Human
The appropriate use of medications during Emergency Neurological Life Support (ENLS) is essential to optimize patient care. Important considerations when choosing the appropriate agent include the patient's organ function and medication allergies, potential adverse drug effects, drug interactions and critical illness and aging pathophysiologic changes. Critical medications used during ENLS include hyperosmolar therapy, anticonvulsants, antithrombotics, anticoagulant reversal and hemostatic agents, anti-shivering agents, neuromuscular blockers, antihypertensive agents, sedatives, vasopressors and inotropes, and antimicrobials...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913754/emergency-neurological-life-support-severe-traumatic-brain-injury
#17
Rachel Garvin, Halinder S Mangat
Severe traumatic brain injury (TBI) causes substantial morbidity and mortality, and is a leading cause of death in both the developed and developing world. The need for a systematic evidence-based approach to the care of severe TBI patients within the emergency setting has led to its inclusion as an Emergency Neurological Life Support topic. This protocol was designed to enumerate the practice steps that should be considered within the first critical hours of neurological injury from severe TBI.
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913708/emergency-neurological-life-support-intracerebral-hemorrhage
#18
J Claude Hemphill, Arthur Lam
Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913605/emergency-neurological-life-support-status-epilepticus
#19
Jan Claassen, Joshua N Goldstein
Patients with prolonged or rapidly recurring convulsions lasting more than 5 min should be considered to be in status epilepticus (SE) and receive immediate resuscitation. Although there are few randomized clinical trials, available evidence and experience suggest that early and aggressive treatment of SE improves patient outcomes, for which reason this was chosen as an Emergency Neurological Life Support protocol. The current approach to the emergency treatment of SE emphasizes rapid initiation of adequate doses of first line therapy, as well as accelerated second line anticonvulsant drugs and induced coma when these fail, coupled with admission to a unit capable of neurological critical care and electroencephalography monitoring...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28906147/carbon-monoxide-poisoning-from-waterpipe-smoking-a-retrospective-cohort-study
#20
Lars Eichhorn, Dirk Michaelis, Michael Kemmerer, Björn Jüttner, Kay Tetzlaff
OBJECTIVE: Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. METHODS: This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016...
September 14, 2017: Clinical Toxicology
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