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Neurological critical care

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https://www.readbyqxmd.com/read/29467568/commentary-addressing-racial-disparities-in-stroke-the-wide-spectrum-investigation-of-stroke-outcome-disparities-on-multiple-levels-wissdom
#1
EDITORIAL
Robert J Adams, Charles Ellis, Gayenell Magwood, Mark S Kindy, Leonardo Bonilha, Daniel T Lackland
Racial-ethnic disparities in stroke recovery are well-established in the United States but the underlying causes are not well-understood. The typical assumption that racial-ethnic disparities in stroke recovery are explained by health care access inequities may be simplistic as access to stroke-related rehabilitation, for example, does not adequately explain the observed disparities. To approach the problem in a more comprehensive fashion, the Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM) was developed to bring together scientists from Regenerative Medicine, Neurology, Rehabilitation, and Nursing to examine disparities in stroke "recovery...
2018: Ethnicity & Disease
https://www.readbyqxmd.com/read/29462084/physician-training-in-critical-care-in-the-united-states-update-2018
#2
Lena M Napolitano, Venkatakrishna Rajajee, Kyle J Gunnerson, Michael D Maile, Michael Quasney, Robert C Hyzy
Critical care fellowship training in the United States differs based on specific specialty, and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine and neurocritical care training pathways. We provide an update regarding the number and growth of U.S. critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) and specialty boards [American Board of Internal Medicine (ABIM), American Board of Surgery (ABS), American Board of Anesthesiology (ABA), American Board of Pediatrics (ABP), American Board of Emergency Medicine (ABEM)] and the United Council for Neurologic Subspecialties (UCNS) for the last 16 years (2001-2017)...
February 17, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29458125/pluripotent-stem-cells-for-uncovering-the-role-of-mitochondria-in-human-brain-function-and-dysfunction
#3
REVIEW
Annika Zink, Josef Priller, Alessandro Prigione
Mitochondrial dysfunctions are a known pathogenetic mechanism of a number of neurological and psychiatric disorders. At the same time, mutations in genes encoding for components of the mitochondrial respiratory chain cause mitochondrial diseases, which commonly exhibit neurological symptoms. Mitochondria are therefore critical for the functionality of the human nervous system. The importance of mitochondria stems from their key roles in cellular metabolism, calcium handling, redox and protein homeostasis, and overall cellular homeostasis through their dynamic network...
February 16, 2018: Journal of Molecular Biology
https://www.readbyqxmd.com/read/29455690/effect-of-cerebral-perfusion-pressure-on-acute-respiratory-distress-syndrome
#4
Sonny Thiara, Donald E Griesdale, William R Henderson, Mypinder S Sekhon
BACKGROUND: Increased cerebral perfusion pressure (CPP)>70 mmHg has been associated with acute respiratory distress syndrome (ARDS) after traumatic brain injury (TBI). Since this reported association, significant changes in ventilation strategies and fluid management have been accepted as routine critical care. Recently, individualized perfusion targets using autoregulation monitoring suggest CPP titration>70 mmHg. Given these clinical advances, the association between ARDS and increased CPP requires further delineation...
February 19, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29443814/danger-signals-in-the-icu
#5
Edward J Schenck, Kevin C Ma, Santosh B Murthy, Augustine M K Choi
OBJECTIVES: Sterile and infectious critical illnesses often result in vasoplegic shock and a robust systemic inflammatory response that are similar in presentation. The innate immune system is at the center of the response to both infectious and traumatic insults. Damage-associated molecular patterns are small molecules that are released from stressed or dying cells. Damage-associated molecular patterns activate pattern recognition receptors and coordinate the leading edge of the innate immune response...
February 13, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29437077/delirium-assessment-tools-for-use-in-critically-ill-adults-a-psychometric-analysis-and-systematic-review
#6
Céline Gélinas, Mélanie Bérubé, Annie Chevrier, Brenda T Pun, E Wesley Ely, Yoanna Skrobik, Juliana Barr
BACKGROUND: Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial. OBJECTIVE: To analyze the development and psychometric properties of delirium assessment tools for critically ill adults. METHODS: Databases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old)...
February 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29432248/neurologic-complications-in-the-pediatric-intensive-care-unit
#7
Mark S Wainwright
PURPOSE OF REVIEW: All critical care is directed at maintaining brain health, but recognizing neurologic complications of critical illness in children is difficult, and limited data exist to guide practice. This article discusses an approach to the recognition and management of seizures, stroke, and cardiac arrest as complications of other critical illnesses in the pediatric intensive care unit. RECENT FINDINGS: Convulsive and nonconvulsive seizures occur frequently in children after cardiac arrest or traumatic brain injury and during extracorporeal membrane oxygenation...
February 2018: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/29430447/mechanisms-involved-in-brain-dysfunction-in-mechanically-ventilated-critically-ill-patients-implications-and-therapeutics
#8
REVIEW
Marc Turon, Sol Fernández-Gonzalo, Candelaria de Haro, Rudys Magrans, Josefina López-Aguilar, Lluís Blanch
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29428919/randomized-control-trial-comparing-pain-control-interventions-in-preterm-neonates
#9
Vivek V Shukla, Satvik Bansal, Archana Nimbalkar, Apurva Chapla, Ajay Phatak, Dipen Patel, Somashekhar Nimbalkar
OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 weeks gestational age) requiring heel-stick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions...
February 9, 2018: Indian Pediatrics
https://www.readbyqxmd.com/read/29426814/exploring-the-specific-needs-of-persons-with-multiple-sclerosis-for-mhealth-solutions-for-physical-activity-mixed-methods-study
#10
Guido Giunti, Jan Kool, Octavio Rivera Romero, Enrique Dorronzoro Zubiete
BACKGROUND: Multiple sclerosis (MS) is one of the world's most common neurologic disorders, with symptoms such as fatigue, cognitive problems, and issues with mobility. Evidence suggests that physical activity (PA) helps people with MS reduce fatigue and improve quality of life. The use of mobile technologies for health has grown in recent years with little involvement from relevant stakeholders. User-centered design (UCD) is a design philosophy with the goal of creating solutions specific to the needs and tasks of the intended users...
February 9, 2018: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29419556/determining-the-upper-and-lower-limits-of-cerebral-autoregulation-with-cerebral-oximetry-autoregulation-curves-a-case-series
#11
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Ryan J Healy, Wendy Ziai, Charles Hogue, Romergryko Geocadin, Batya Radzik, Caitlin Palmisano, Marek A Mirski
OBJECTIVE: Critical care guidelines recommend a single target value for mean arterial blood pressure in critically ill patients. However, growing evidence regarding cerebral autoregulation challenges this concept and supports individualizing mean arterial blood pressure targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation derived from near-infrared spectroscopy is an acceptable surrogate for cerebral blood flow and has been validated to measure cerebral autoregulation...
February 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29407008/cardiac-intensive-care-unit-management-of-patients-after-cardiac-arrest-now-the-real-work-begins
#12
REVIEW
Varinder K Randhawa, Brian E Grunau, Derek B Debicki, Jian Zhou, Ahmed F Hegazy, Terry McPherson, A Dave Nagpal
Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness...
February 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29406894/neurologic-illness-in-zambia-a-neurointensivist-s-experience
#13
Merritt W Brown, Katie Ellen Foy, Christopher Chanda, Jacqueline Mulundika, Igor J Koralnik, Omar K Siddiqi
INTRODUCTION: Management of critically ill patients in dedicated intensive care units (ICUs) is the standard of care in high income countries (HICs), but remains uncommon in low and middle-income countries (LMICs). We sought to determine the prevalence of neurologic disorders in the ICU of a LMIC and examine if resource appropriate specialized neurocritical care training could benefit these patients. METHODS: From February to March 2017, a trained neurocritical care intensivist recorded encounters in the sole ICU at the University Teaching Hospital (UTH) in Lusaka, Zambia...
February 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29405803/prehospital-rapid-sequence-intubation-by-intensive-care-flight-paramedics
#14
Ashleigh Delorenzo, Toby St Clair, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia...
February 6, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29405671/light-sedation-with-dexmedetomidine-a-practical-approach-for-the-intensivist-in-different-icu-patients
#15
Stefano Romagnoli, Angela Amigoni, Ilaria Blangetti, Giampaolo Casella, Cosimo Chelazzi, Francesco Forfori, Cristiana Garisto, Maria C Mondardini, Marco Moltrasio, Daniela Pasero, Tiziana Principi, Zaccaria Ricci, Fabio Tarantino, Giorgio Conti
Light sedation, corresponding to a Richmond AgitationSedation Scale between 0 and 1 is a priority of modern critical care practice. Dexmedetomidine, a highly selective, central, 2adrenoceptor agonist, is increasingly administered in the intensive care units (ICUs) as an effective drug to induce light sedation, analgesia and a quasiphysiological sleep in critically ill patients. Although in general dexmedetomidine is well tolerated, side effects as bradycardia, hypertension, and hypotension may occur. Although a general dosing range is suggested, different ICU patients may require different and highly precise titration that may significantly vary due to neurological status, cardiorespiratory function, baseline blood pressure, heart rate, liver efficiency, age and coadministration of other sedatives...
February 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29401139/therapeutic-plasma-exchange-in-critically-ill-children-requiring-intensive-care
#16
Gerard Cortina, Rosemary McRae, Roberto Chiletti, Warwick Butt
OBJECTIVE: To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange. DESIGN: Retrospective observational study based on a prospective registry. SETTING: Tertiary and quaternary referral 30-bed PICU. PATIENTS: Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007-2014) were included in the study...
February 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29400600/cocaine-abuse-longitudinal-mr-imaging-of-lasting-diffused-leukoencephalopathy
#17
Shuo Li, Roni Manyevitch, Kaltrina Sedaliu, Ahmed Abdelbaki, Nishant Gupta, Anil Kumar, Yogesh Kumar, Mark Rosovsky
Cocaine use has been known to cause a number of adverse neurological conditions, such as cerebral ischemia and posterior reversible leukoencephalopathy. The radiologic appearance of cocaine-induced leukoencephalopathy is confounded by a common contaminant, levamisole, which is also known to cause multifocal leukoencephalopathy. However, we encountered a case of diffuse leukoencephalopathy in a patient with cocaine use that had extensive involvement of the cerebral white matter, globus pallidi as well as the cerebellum...
January 1, 2018: Neuroradiology Journal
https://www.readbyqxmd.com/read/29399791/proposed-consensus-definitions-for-new-onset-refractory-status-epilepticus-norse-febrile-infection-related-epilepsy-syndrome-fires-and-related-conditions
#18
Lawrence J Hirsch, Nicolas Gaspard, Andreas van Baalen, Rima Nabbout, Sophie Demeret, Tobias Loddenkemper, Vincent Navarro, Nicola Specchio, Lieven Lagae, Andrea O Rossetti, Sara Hocker, Teneille E Gofton, Nicholas S Abend, Emily J Gilmore, Cecil Hahn, Houman Khosravani, Felix Rosenow, Eugen Trinka
We convened an international group of experts to standardize definitions of New-Onset Refractory Status Epilepticus (NORSE), Febrile Infection-Related Epilepsy Syndrome (FIRES), and related conditions. This was done to enable improved communication for investigators, physicians, families, patients, and other caregivers. Consensus definitions were achieved via email messages, phone calls, an in-person consensus conference, and collaborative manuscript preparation. Panel members were from 8 countries and included adult and pediatric experts in epilepsy, electroencephalography (EEG), and neurocritical care...
February 5, 2018: Epilepsia
https://www.readbyqxmd.com/read/29396136/renal-replacement-therapy-in-the-neonatal-intensive-care-unit
#19
Tze Yee Diane Mok, Min-Hua Tseng, Ming-Chou Chiang, Ju-Li Lin, Shih Ming Chu, Jen-Fu Hsu, Reyin Lien
BACKGROUND: Renal replacement therapy (RRT) is becoming increasingly necessary for supporting critically ill neonates. Few studies have reported the use of RRT in the neonatal intensive care unit (NICU). Therefore, we performed a retrospective study to describe the use of RRT in our NICU and its associated efficacy, complications, and outcomes. METHODS: We identified patients requiring RRT between January 2009 and January 2017. Demographic data, mode of RRT, and associated factors were recorded...
December 21, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/29394221/functional-recovery-in-critically-ill-children-the-weecover-multicenter-study
#20
Karen Choong, Douglas Fraser, Samah Al-Harbi, Asm Borham, Jill Cameron, Saoirse Cameron, Ji Cheng, Heather Clark, Tim Doherty, Nora Fayed, Jan-Willem Gorter, Margaret Herridge, Mary Khetani, Kusum Menon, Jamie Seabrook, Racquel Simpson, Lehana Thabane
OBJECTIVES: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. DESIGN: Prospective observational longitudinal cohort study. SETTING: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. PATIENTS: Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible...
February 2018: Pediatric Critical Care Medicine
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