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Vicente Joanes
OBJECTIVE: The main objective of the study is to obtain knowledge about the organisation of care for severe head trauma as well as the initial management of these patients in Neurosurgical Departments in Spain. MATERIAL AND METHOD: A 22-item questionnaire was designed and sent to 59 Neurosurgical Departments. The aim of the questionnaire was to collect data regarding the general profile of the patients with a severe head injury, the general characteristics of the hospitals, the initial care of these patients, the monitoring techniques used, and the measures used to control Intracranial pressure (ICP)...
February 24, 2017: Neurocirugía
Christian Roth, Hubertus Stitz, Jens Kleffmann, Stefanie Kaestner, Wolfgang Deinsberger, Andreas Ferbert, Markus Gehling
Background Studies investigating multimodal cerebral monitoring including partial brain tissue oxygen monitoring (ptiO2) in neuro-intensive care patients during physiotherapy are completely lacking in the literature. Materials and Methods We performed a post hoc analysis of prospectively collected data of patients on multimodal cerebral monitoring by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurement as well as ptiO2. Patients with severe brain diseases were treated with passive range of motion (PROM)...
September 27, 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Kang Wang, Zachary M Smith, Richard B Buxton, Erik R Swenson, David J Dubowitz
Low doses of the carbonic anhydrase inhibitor acetazolamide provides accelerated acclimatization to high-altitude hypoxia and prevention of cerebral and other symptoms of acute mountain sickness. We previously observed increases in cerebral O2 metabolism (CMRO2 ) during hypoxia. In this study, we investigate whether low-dose oral acetazolamide (250 mg) reduces this elevated CMRO2 and in turn might improve cerebral tissue oxygenation (PtiO2 ) during acute hypoxia. Six normal human subjects were exposed to 6 h of normobaric hypoxia with and without acetazolamide prophylaxis...
December 15, 2015: Journal of Applied Physiology
Thomas Kerz, Christian Beyer, Alexandra Huthmann, Darius Kalasauskas, Amr Nimer Amr, Stephan Boor, Stefan Welschehold
Near-infrared spectroscopy (NIRS) has gained acceptance for cerebral monitoring, especially during cardiac surgery, though there are few data showing its validity. We therefore aimed to correlate invasive brain tissue oxygen measurements (PtiO2) with the corresponding NIRS-values (regional oxygen saturation, rSO2). We also studied whether NIRS was able to detect ischemic events, defined as a PtiO2-value of <15 mmHg. Eleven patients were studied with invasive brain tissue oxygen monitoring and continuous-wave NIRS...
October 2016: Journal of Clinical Monitoring and Computing
Feng Zheng, Olivier Collange, Julien Davidson, Grégoire Barthel, Walid Oulehri, Simon N Thornton, Dan Longrois, Bruno Levy, Gérard Audibert, Jean-Marc Malinovsky, Paul-Michel Mertes
BACKGROUND: In contrast to other types of shock, anaphylactic shock decreases cerebral blood flow more than would be expected from severe arterial hypotension, thus potentially affecting survival through brain ischaemia/hypoxia. We hypothesised that epinephrine (EPI) used as a first-line treatment of anaphylactic shock and arginine vasopressin (AVP) proposed in case of EPI refractoriness may have different effects on brain oxygenation. OBJECTIVES: To compare the effect of EPI and AVP on brain oxygenation under similar macro-haemodynamic target values in an anaphylactic shock model...
August 2015: European Journal of Anaesthesiology
Fuat Arikan, Jordi Vilalta, Ramon Torne, Montserrat Noguer, Carles Lorenzo-Bosquet, Juan Sahuquillo
BACKGROUND: In moyamoya disease (MMD), cerebral revascularization is recommended in patients with recurrent or progressive ischemic events and associated reduced cerebral perfusion reserve. Low-flow bypass with or without indirect revascularization is generally the standard surgical treatment. Intraoperative monitoring of cerebral partial pressure of oxygen (PtiO2) with polarographic Clark-type probes in cerebral artery bypass surgery for MMD-induced chronic cerebral ischemia has not yet been described...
March 2015: Neurosurgery
Anna Leidorf, Marius M Mader, Andreas Hecker, Axel Heimann, Beat Alessandri, Petra Mayr, Oliver Kempski, Gabriele Wöbker
AIM: Monitoring of intracranial pressure (ICP), local cerebral blood flow (CBF) and oxygen is part of modern intensive critical care medicine. Preclinical evaluation of newly developed catheters that should monitor several parameters simultaneously is reported poorly in the literature. The goal of our study was (1) to evaluate a new multi-parametric sensor in brain tissue and (2) to establish a testing protocol using pathophysiological challenges that target measured parameters of the sensor and autoregulatory boundaries and could be used as preclinical standard protocol in future studies...
2014: Turkish Neurosurgery
Claudia Ditz, Ludger Bahlmann, Stephan Klaus, Alexander Keck, Nils Onken, Jan Gliemroth
PURPOSE: Preconditioning with low doses of monophosphoryl lipid A (MPL) has been shown to induce endotoxin tolerance and to reduce the metabolic and hemodynamic consequences of endotoxin shock. However, no data are available about the effects of endotoxin preconditioning on cerebral metabolism during endotoxemia. The study was designed to determine the effects of endotoxin preconditioning with MPL on cerebral metabolism via microdialysis compared to muscle tissue metabolism during experimental endotoxemia...
November 2014: Clinical Neurology and Neurosurgery
Sun Hye Hwang, Hee Song, Jungsup Lee, Jyongsik Jang
Designing the photoanode structure in dye-sensitized solar cells (DSSCs) is vital to realizing enhanced power conversion efficiency (PCE). Herein, novel multifunctional silver-decorated porous titanium dioxide nanofibers (Ag/pTiO2 NFs) made by simple electrospinning, etching, and chemical reduction processes are introduced. The Ag/pTiO2 NFs with a high surface area of 163 m(2)  g(-1) provided sufficient dye adsorption for light harvesting. Moreover, the approximately 200 nm diameter and rough surface of the Ag/pTiO2 NFs offered enough light scattering, and the enlarged interpores among the NFs in the photoanode also permitted electrolyte circulation...
September 26, 2014: Chemistry: a European Journal
Fuat Arikan, Jordi Vilalta, Ramon Torne, Ivette Chocron, Ana Rodriguez-Tesouro, Juan Sahuquillo
Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures...
November 2014: Neurocirugía
A M Domínguez-Berrot, M González-Vaquero, F J Díaz-Domínguez, J Robla-Costales
The main goal of exhaustively monitoring neurocritical patients is to avoid secondary injury. In the last few years we have witnessed an increase in brain monitoring tools, beyond the checking of intracranial and brain perfusion pressures. These widely used systems offer valuable but possibly insufficient information. Awareness and correction of brain hypoxia is a useful and interesting measure, not only for diagnostic purposes but also when deciding treatment, and to predict an outcome. In this context, it would be of great interest to use all the information gathered from brain oxygenation monitoring systems in conjunction with other available multimodal monitoring devices, in order to offer individualized treatment for each patient...
November 2014: Medicina Intensiva
Michael A De Georgia
Brain injury results from ischemia, tissue hypoxia, and a cascade of secondary events. The cornerstone of neurocritical care management is optimization and maintenance of cerebral blood flow (CBF) and oxygen and substrate delivery to prevent or attenuate this secondary damage. New techniques for monitoring brain tissue oxygen tension (PtiO2) are now available. Brain PtiO2 reflects both oxygen delivery and consumption. Brain hypoxia (low brain PtiO2) has been associated with poor outcomes in patients with brain injury...
December 2015: Journal of Intensive Care Medicine
John F Stover
Evolving brain damage following traumatic brain injury (TBI) is strongly influenced by complex pathophysiologic cascades including local as well as systemic influences. To successfully prevent secondary progression of the primary damage we must actively search and identify secondary insults e.g. hypoxia, hypotension, uncontrolled hyperventilation, anemia, and hypoglycemia, which are known to aggravate existing brain damage. For this, we must rely on specific cerebral monitoring. Only then can we unmask changes which otherwise would remain hidden, and prevent adequate intensive care treatment...
February 4, 2012: World Journal of Critical Care Medicine
K Tajima, F Zheng, O Collange, G Barthel, S N Thornton, D Longrois, B Levy, G Audibert, J M Malinovsky, P M Mertes
Anaphylactic shock is a rare, but potentially lethal complication, combining life-threatening circulatory failure and massive fluid shifts. Treatment guidelines rely on adrenaline and volume expansion by intravenous fluids, but there is no solid evidence for the choice of one specific type of fluid over another. Our purpose was to compare the time to achieve target mean arterial pressure upon resuscitation using adrenaline alone versus adrenaline with different resuscitation fluids in an animal model and to compare the tissue oxygen pressures (PtiO2) with the various strategies...
November 2013: Anaesthesia and Intensive Care
M Rahimi Nedjat, M Wähmann, H Bächli, E Güresir, H Vatter, A Raabe, A Heimann, O Kempski, B Alessandri
Recombinant human erythropoietin (EPO) has been successfully tested as neuroprotectant in brain injury models. The first large clinical trial with stroke patients, however, revealed negative results. Reasons are manifold and may include side-effects such as thrombotic complications or interactions with other medication, EPO concentration, penetration of the blood-brain-barrier and/or route of application. The latter is restricted to systemic application. Here we hypothesize that EPO is neuroprotective in a rat model of acute subdural hemorrhage (ASDH) and that direct cortical application is a feasible route of application in this injury type...
May 15, 2013: Neuroscience
J Adam Wilson, Lori A Shutter, Jed A Hartings
Neuromonitoring in patients with severe brain trauma and stroke is often limited to intracranial pressure (ICP); advanced neuroscience intensive care units may also monitor brain oxygenation (partial pressure of brain tissue oxygen, P(bt)O(2)), electroencephalogram (EEG), cerebral blood flow (CBF), or neurochemistry. For example, cortical spreading depolarizations (CSDs) recorded by electrocorticography (ECoG) are associated with delayed cerebral ischemia after subarachnoid hemorrhage and are an attractive target for novel therapeutic approaches...
2013: Acta Neurochirurgica. Supplement
Julien Davidson, Feng Zheng, Keiko Tajima, Grégoire Barthel, Ionel Alb, Adriana Tabarna, Simon N Thornton, Maud Lambert, Dan Longrois, Gérard Audibert, Jean-Marc Malinovsky, Paul-Michel Mertes
The effects of acute reduction in arterial blood pressure in severe anaphylactic shock (AS) on cerebral blood flow are of paramount importance to be investigated. We studied cerebral circulation and oxygenation in a model of severe AS and compared it with a pharmacologically induced arterial hypotension of similar magnitude. Anaphylactic shock was induced by 1 mg intravenous ovalbumin (OVA) in sensitized rats. Rats were randomized to three groups: (i) no resuscitation (OVA; n = 10) (ii) intravenous volume expansion (10 mL in 10 min after OVA injection) (OVA + VE; n = 10); (iii) control hypotension (100 μg of nicardipine followed by continuous infusion of 1 mg · 100 g · h intravenously; NICAR; n = 10)...
October 2012: Shock
Boret Henry, Carre Emilie, Prunet Bertrand, D'Aranda Erwan
Decompressive craniectomy (DC) following brain injury can induce complications (hemorrhage, infection, and hygroma). It is then considered as a last-tier therapy, and can be deleteriously delayed. Focal neuromonitoring (microdialysis and PtiO2) can help clinicians to decide bedside to perform DC in case of intracranial pressure (ICP) around 20 to 25 mmHg despite maximal medical treatment. This was the case of a hunter, brain injured by gunshot. DC was performed at day 6, because of unstable ICP, ischemic trend of PtiO2, and decreased cerebral glucose but normal lactate/pyruvate ratio...
January 2012: Journal of Emergencies, Trauma, and Shock
R Meierhans, G Brandi, M Fasshauer, J Sommerfeld, R Schüpbach, M Béchir, J Stover
BACKGROUND: Lactate fuels cerebral energy-consuming processes and it is neuroprotective. The impact of arterial lactate on brain metabolism determined by microdialysis was investigated retrospectively in patients with severe traumatic brain injury (TBI). METHODS: Cerebral microdialysis (glucose, lactate), neuromonitoring (ICP, CPP, ptiO2, SjvO2) and blood gas data collected in 20 patients during pharmacologic coma were grouped within predefined arterial lactate clusters (<1, 1-2, >2 mM)...
February 2012: Minerva Anestesiologica
John F Stover
Therapeutic interventions following severe traumatic brain injury (TBI) are substantially influenced by complex and interwoven pathophysiological cascades involving both, local and systemic alterations. Our main duty is to prevent secondary progression of the primary damage. This, in turn, obliges us to actively search and identify secondary insults related, for example, to hypoxia, hypotension, uncontrolled hyperventilation, anaemia, and hypoglycaemia. During pharmacological coma we must rely on specific cerebral monitoring which is indispensable in unmasking otherwise occult changes...
July 21, 2011: Swiss Medical Weekly
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