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Neurointensive care

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https://www.readbyqxmd.com/read/29932382/microsurgical-treatment-of-unruptured-middle-cerebral-artery-aneurysms-a-large-contemporary-experience
#1
Eric S Nussbaum, Michael T Madison, James K Goddard, Jeffrey P Lassig, Kevin M Kallmes, Leslie A Nussbaum
OBJECTIVE Advances in endovascular therapy for the treatment of middle cerebral artery (MCA) aneurysms have led to scrutiny of its benefits compared with microsurgical repair. To provide information regarding complication rates and outcomes, the authors reviewed the results of a large series of unruptured MCA aneurysms treated with open microsurgery. METHODS The authors included all patients who underwent surgical repair of an unruptured MCA aneurysm between 1997 and 2015. All surgical procedures, including clipping, wrapping, bypass, and parent artery occlusion, were performed by a single neurosurgeon...
June 22, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29894442/sleep-deprivation-in-neurointensive-care-unit-patients-from-serial-neurological-checks-how-much-is-too-much
#2
Diane C McLaughlin, Tonja M Hartjes, William D Freeman
OBJECTIVE: Hourly neurological examinations are frequently performed in the neurointensive care unit (NICU) to quickly detect neurological deterioration. These examinations require the patient to be awakened hourly for days disrupting the sleep cycle and potentially causing neurological deterioration through sleep deprivation and the development of delirium. This pilot study's aim was to describe the prevalence of neurologic deterioration and delirium in patients receiving hourly neuro checks...
June 12, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/29799079/forewarning-of-hypotensive-events-using-a-bayesian-artificial-neural-network-in-neurocritical-care
#3
Rob Donald, Tim Howells, Ian Piper, P Enblad, P Nilsson, I Chambers, B Gregson, G Citerio, K Kiening, J Neumann, A Ragauskas, J Sahuquillo, R Sinnott, A Stell
Traumatically brain injured (TBI) patients are at risk from secondary insults. Arterial hypotension, critically low blood pressure, is one of the most dangerous secondary insults and is related to poor outcome in patients. The overall aim of this study was to get proof of the concept that advanced statistical techniques (machine learning) are methods that are able to provide early warning of impending hypotensive events before they occur during neuro-critical care. A Bayesian artificial neural network (BANN) model predicting episodes of hypotension was developed using data from 104 patients selected from the BrainIT multi-center database...
May 24, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29744244/can-amantadine-ameliorate-neurocognitive-functions-after-subarachnoid-haemorrhage-a-preliminary-study
#4
Eren Fatma Akçıl, Özlem Korkmaz Dilmen, Hayriye Vehid, Yusuf Tunalı
Objective: Aneurysmal subarachnoid haemorrhage (SAH) may have devastating effects on patients. Motor and neurocognitive impairments may arise depending on the location and grade of the SAH. Although the effects of amantadine on neurocognitive function after traumatic brain injury have been widely studied to the best of our knowledge, their effects on recovery from SAH in humans have not been studied. The present study aimed to evaluate how amantadine influences improvement in neurocognitive function in patients with aneurysmal SAH over a period of six months...
April 2018: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29712529/cost-effectiveness-development-for-the-postoperative-care-of-craniotomy-patients-a-safe-transitions-pathway-in-neurological-surgery
#5
Joseph A Osorio, Michael M Safaee, Jennifer Viner, Sujatha Sankaran, Sarah Imershein, Ezekiel Adigun, Gabriela Weigel, Mitchel S Berger, Michael W McDermott
OBJECTIVE The authors' institution is in the top 5th percentile for hospital cost in the nation, and the neurointensive care unit (NICU) is one of the costliest units. The NICU is more expensive than other units because of lower staff/patient ratio and because of the equipment necessary to monitor patient care. The cost differential between the NICU and Neuro transitional care unit (NTCU) is $1504 per day. The goal of this study was to evaluate and to pilot a program to improve efficiency and lower cost by modifying the postoperative care of patients who have undergone a craniotomy, sending them to the NTCU as opposed to the NICU...
May 2018: Neurosurgical Focus
https://www.readbyqxmd.com/read/29662203/potent-antitumor-efficacy-of-anti-gd2-car-t-cells-in-h3-k27m-diffuse-midline-gliomas
#6
Christopher W Mount, Robbie G Majzner, Shree Sundaresh, Evan P Arnold, Meena Kadapakkam, Samuel Haile, Louai Labanieh, Esther Hulleman, Pamelyn J Woo, Skyler P Rietberg, Hannes Vogel, Michelle Monje, Crystal L Mackall
Diffuse intrinsic pontine glioma (DIPG) and other diffuse midline gliomas (DMGs) with mutated histone H3 K27M (H3-K27M)1-5 are aggressive and universally fatal pediatric brain cancers 6 . Chimeric antigen receptor (CAR)-expressing T cells have mediated impressive clinical activity in B cell malignancies7-10 , and recent results suggest benefit in central nervous system malignancies11-13 . Here, we report that patient-derived H3-K27M-mutant glioma cell cultures exhibit uniform, high expression of the disialoganglioside GD2...
May 2018: Nature Medicine
https://www.readbyqxmd.com/read/29514600/low-incidence-of-multidrug-resistant-bacteria-and-nosocomial-infection-due-to-a-preventive-multimodal-nosocomial-infection-control-a-10-year-single-centre-prospective-cohort-study-in-neurocritical-care
#7
Vera Spatenkova, Ondrej Bradac, Daniela Fackova, Zdenka Bohunova, Petr Suchomel
BACKGROUND: Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU...
March 7, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29502719/nosocomial-infections-in-the-neurointensive-care-unit
#8
REVIEW
Katharina Maria Busl
Infectious complications in the neurointensive care unit (neuro-ICU) are common, including pneumonia, urinary tract infection, bloodstream infection, and intracranial infection. The neuro-ICU population poses a specific challenge in the diagnosis of infections, because of the high incidence of fever in acutely brain-injured patients. Furthermore, susceptibility to infections is likely enhanced by brain-injury (induced immune modulation). This article reviews the concept of brain injury-induced immune modulation, and summarizes available data and knowledge on nosocomial meningitis and ventriculitis, and systemic infectious complications in patients with traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and status epilepticus...
April 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29500701/fluid-therapy-in-neurointensive-care-patients-esicm-consensus-and-clinical-practice-recommendations
#9
Mauro Oddo, Daniele Poole, Raimund Helbok, Geert Meyfroidt, Nino Stocchetti, Pierre Bouzat, Maurizio Cecconi, Thomas Geeraerts, Ignacio Martin-Loeches, Hervé Quintard, Fabio Silvio Taccone, Romergryko G Geocadin, Claude Hemphill, Carole Ichai, David Menon, Jean-François Payen, Anders Perner, Martin Smith, José Suarez, Walter Videtta, Elisa R Zanier, Giuseppe Citerio
OBJECTIVE: To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients. DESIGN: A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process. METHODS: Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated...
April 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29492558/medical-waveform-format-encoding-rules-representation-of-neurointensive-care-waveform-data
#10
Ian Piper, Martin Shaw, Christopher Hawthorne, John Kinsella, Laura Moss
OBJECTIVE: Technology in neurointensive care units can collect and store vast amounts of complex patient data. The CHART-ADAPT project is aimed at developing technology that will allow for the collection, analysis and use of these big data at the patient's bedside in neurointensive care units. A requirement of this project is to automatically extract and transfer high-frequency waveform data (e.g. ICP) from monitoring equipment to high performance computing infrastructure for analysis...
2018: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/29434566/assessment-of-platelet-function-in-traumatic-brain-injury-a-retrospective-observational-study-in-the-neuro-critical-care-setting
#11
Caroline Lindblad, Eric Peter Thelin, Michael Nekludov, Arvid Frostell, David W Nelson, Mikael Svensson, Bo-Michael Bellander
Background: Despite seemingly functional coagulation, hemorrhagic lesion progression is a common and devastating condition following traumatic brain injury (TBI), stressing the need for new diagnostic techniques. Multiple electrode aggregometry (MEA) measures platelet function and could aid in coagulopathy assessment following TBI. The aims of this study were to evaluate MEA temporal dynamics, influence of concomitant therapy, and its capabilities to predict lesion progression and clinical outcome in a TBI cohort...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29388863/saved-by-the-pupillometer-a-role-for-pupillometry-in-the-acute-assessment-of-patients-with-traumatic-brain-injuries
#12
John A Emelifeonwu, Kirsten Reid, Jonathan Kj Rhodes, Lynn Myles
There is good evidence that pupil reactivity is useful for prognostication in acute head injuries. Despite this, most pupil assessments are subjective and are performed by physicians who may not be experts. They can therefore be unreliable. We present a case of a patient with seemingly irreversible demise from an acute traumatic subdural haematoma. This was determined by assessment of his pupils, which were non-reactive to light at the time of arrival to the neurosurgical theatre. He was transferred to the neurointensive care for brainstem death testing, where assessment by objective pupillometry determined that his pupils were in fact reactive...
2018: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29368635/cerebral-metabolic-effects-of-strict-versus-conventional-glycaemic-targets-following-severe-traumatic-brain-injury
#13
Mark P Plummer, Natalia Notkina, Ivan Timofeev, Peter J Hutchinson, Mark E Finnis, Arun K Gupta
BACKGROUND: Optimal glycaemic targets for patients with severe traumatic brain injury remain unclear. The primary objective of this microdialysis study was to compare cerebral metabolism with strict versus conventional glycaemic control. METHODS: We performed a prospective single-centre randomised controlled within-subject crossover study of 20 adult patients admitted to an academic neurointensive care unit with severe traumatic brain injury. Patients underwent randomised, consecutive 24-h periods of strict (4-7 mmol/L; 72-126 mg/dl) and conventional (<10 mmol/L; 180 mg/dl) glycaemic control with microdialysis measurements performed hourly...
January 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29362771/orpheus-descent-into-the-neurointensive-care-unit
#14
Francesco Brigo
No abstract text is available yet for this article.
January 23, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29234973/decompressive-craniectomy-in-traumatic-brain-injury-usage-and-clinical-outcome-in-a-single-centre
#15
Teodor Svedung Wettervik, Samuel Lenell, Lena Nyholm, Tim Howells, Anders Lewén, Per Enblad
BACKGROUND: Two randomised controlled trials (RCTs) of decompressive craniectomy (DC) in traumatic brain injury (TBI) have shown poor outcome, but there are considerations of how these protocols relate to real practice. The aims of this study were to evaluate usage and outcome of DC and thiopental in a single centre. METHOD: The study included all TBI patients treated at the neurointensive care unit, Akademiska sjukhuset, Uppsala, Sweden, between 2008 and 2014. Of 609 patients aged 16 years or older, 35 treated with DC and 23 treated with thiopental only were studied in particular...
February 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29218511/optical-monitoring-of-cerebral-microcirculation-in-neurointensive-care
#16
Peter Rejmstad, Neda Haj-Hosseini, Oscar Åneman, Karin Wårdell
Continuous optical monitoring of local cerebral microcirculation could benefit neurointensive care patients treated for subarachnoid hemorrhage (SAH). The aim of the study was to evaluate laser Doppler flowmetry (LDF) and diffuse reflectance spectroscopy (DRS) for long-term monitoring of brain microcirculation and oxygen saturation (SO2 ) in the neurointensive care unit (NICU). A fiber optic probe was designed for intraparenchymal use and connected to LDF and DRS for assessment of the local blood flow (perfusion and tissue reflectance (TLI)) and SO2 in the brain...
December 8, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/29203481/concentrations-of-cefuroxime-in-brain-tissue-of-neurointensive-care-patients
#17
A Hosmann, L C Ritscher, H Burgmann, Z Oesterreicher, W Jäger, S Poschner, E Knosp, A Reinprecht, A Gruber, M Zeitlinger
Effective concentrations of antibiotics in brain tissue are essential for antimicrobial therapy of brain infections. However, data concerning cerebral penetration properties of antibiotics for treatment or prophylaxis of central nervous system infections are rare. Six patients suffering subarachnoid hemorrhage and requiring cerebral microdialysis for neurochemical monitoring were included in this study. Free interstitial concentrations of cefuroxime after intravenous application of 1,500 mg were measured by microdialysis in brain tissue, as well as in plasma at steady-state ( n = 6) or after single-dose administration ( n = 1)...
February 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29180981/cerebral-microdialysis-monitoring-to-improve-individualized-neurointensive-care-therapy-an-update-of-recent-clinical-data
#18
REVIEW
Laurent Carteron, Pierre Bouzat, Mauro Oddo
Cerebral microdialysis (CMD) allows bedside semicontinuous monitoring of patient brain extracellular fluid. Clinical indications of CMD monitoring are focused on the management of secondary cerebral and systemic insults in acute brain injury (ABI) patients [mainly, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)], specifically to tailor several routine interventions-such as optimization of cerebral perfusion pressure, blood transfusion, glycemic control and oxygen therapy-in the individual patient...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29177800/-neurointensive-care-medicine-from-where-where-to
#19
EDITORIAL
W Stummer, S Schwab, G R Fink
No abstract text is available yet for this article.
February 2018: Der Nervenarzt
https://www.readbyqxmd.com/read/29102527/functional-assessment-of-a-series-of-paediatric-patients-receiving-neurointensive-treatment-new-functional-status-scale
#20
P Madurga-Revilla, J López-Pisón, P Samper-Villagrasa, R Garcés-Gómez, J P García-Íñiguez, M Domínguez-Cajal, I Gil-Hernández, S Viscor-Zárate
INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function...
November 1, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
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