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Neurology ICU

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https://www.readbyqxmd.com/read/28622004/six-month-morbidity-and-mortality-among-icu-patients-receiving-life-sustaining-therapy-a-prospective-cohort-study
#1
Michael E Detsky, Michael O Harhay, Dominique F Bayard, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Elizabeth Cooney, Nicole B Gabler, Sarah J Ratcliffe, Mark E Mikkelsen, Scott D Halpern
RATIONALE: Understanding long-term outcomes of critically ill patients may inform shared decision making in the ICU. OBJECTIVE: To quantify six-month functional outcomes of general ICU patients, and develop a multivariable model comprising factors present during the first ICU day to predict which patients will return to their baseline function 6 months later. METHODS: We conducted a prospective cohort study in three medical ICUs and two surgical ICUs in three hospitals...
June 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#2
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28608136/early-impairment-of-intracranial-conduction-time-predicts-mortality-in-deeply-sedated-critically-ill-patients-a-prospective-observational-pilot-study
#3
Eric Azabou, Benjamin Rohaut, Nicholas Heming, Eric Magalhaes, Régine Morizot-Koutlidis, Stanislas Kandelman, Jeremy Allary, Guy Moneger, Andrea Polito, Virginie Maxime, Djillali Annane, Frederic Lofaso, Fabrice Chrétien, Jean Mantz, Raphael Porcher, Tarek Sharshar
BACKGROUND: Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP's ICCT and/or BAEP's IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28605922/surgical-coronary-revascularization-on-pump-versus-off-pump-in-patients-with-stenosis-of-the-main-tree-of-the-left-coronary-artery-and-carotid-stenosis
#4
Edin Kabil, Bedrudin Banjanović, Emir Mujanović
OBJECTIVE: The aim of this study was to show perioperative complications of CABG procedure with and without cardiopulmonary bypass (CPB) in patients with combined coronary and carotid disease. PATIENTS AND METHODS: This retrospective survey included patients with left main stenosis greater than 50% and carotid stenosis over 50%, who had undergone CABG without carotid endarterectomy at the BH Heart Centre, from May 2009 to May 2014. The patients were divided into two groups according to the surgical method used...
May 2017: Acta Medica Academica
https://www.readbyqxmd.com/read/28598990/neurological-failure-in-icu-patients-with-hematological-malignancies-a-prospective-cohort-study
#5
Chiara Marzorati, Djamel Mokart, Frederic Pène, Virginie Lemiale, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Dominique Benoit, Giuseppe Citerio, Elie Azoulay, Stephane Legriel
BACKGROUND: Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure. METHODS: Post hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010-2012)...
2017: PloS One
https://www.readbyqxmd.com/read/28598043/clinical-profile-of-hypertensive-emergencies-in-an-intensive-care-unit
#6
Shubhangi V Dhadke, Vithal N Dhadke, Dhruv S Batra
AIMS AND OBJECTIVE: To study the prevalence of hypertensive emergencies in an ICU set up and to study the clinical presentation of hypertensive emergencies related to cardiovascular, neurological and renovascular system. METHODS: Type of Study: Cross-sectional, descriptive study. DURATION OF STUDY: Two years from 1st December 2011 till 30th November 2013. SAMPLE SIZE: 50 patients of hypertensive emergencies admitted to the intensive care unit of Dr...
May 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28591679/serial-blood-lactate-measurements-and-its-prognostic-significance-in-intensive-care-unit-management-of-aneurysmal-subarachnoid-hemorrhage-patients
#7
Tomoya Okazaki, Toru Hifumi, Kenya Kawakita, Hajime Shishido, Daisuke Ogawa, Masanobu Okauchi, Atsushi Shindo, Masahiko Kawanishi, Shigeaki Inoue, Takashi Tamiya, Yasuhiro Kuroda
PURPOSE: This study assesses the behavior of serial blood lactate measurements during intensive care unit (ICU) stay to identify prognostic factors of unfavorable neurological outcomes (UO) in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: We retrospectively reviewed all patients who were consecutively hospitalized with SAH between 2009 and 2016. Arterial blood lactate levels were routinely obtained on admission and every 6h in the ICU. Univariate/multivariate analyses were performed to identify independent predictors of UO (modified Rankin scale of 3-6 upon hospital discharge)...
June 1, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28591056/epidemiology-and-clinical-analysis-of-critical-patients-with-child-maltreatment-admitted-to-the-intensive-care-units
#8
En-Pei Lee, Shao-Hsuan Hsia, Jing-Long Huang, Jainn-Jim Lin, Oi-Wa Chan, Chia-Ying Lin, Kuang-Lin Lin, Yu-Ching Chang, I-Jun Chou, Fu-Song Lo, Jung Lee, Yi-Chen Hsin, Pei-Chun Chan, Mei-Hua Hu, Cheng-Hsun Chiu, Han-Ping Wu
Children with abuse who are admitted to the intensive care unit (ICU) may have high mortality and morbidity and commonly require critical care immediately. It is important to understand the epidemiology and clinical characteristics of these critical cases of child maltreatment.We retrospectively evaluated the data for 355 children with maltreatments admitted to the ICU between 2001 and 2015. Clinical factors were analyzed and compared between the abuse and the neglect groups, including age, gender, season of admission, identifying settings, injury severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical outcomes, and mortality...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28577016/clinical-and-epidemiological-characterization-of-influenza-a-h1n1pdm-and-b-among-hospitalized-children-georgia-season-2010-2011
#9
A Machablishvili, D Tsereteli, Kh Zakhashvili, I Karseladze, P Imnadze
The aim of the study was to describe, analyze and compare clinical and epidemiological characteristics of laboratory confirmed influenza A(H1N1)pdm and B cases in hospitalized children during post pandemic season. Between 1st January and 1st May, 2011 retrospective observational study was conducted in M. Iashvili Children's Central Hospital. From 1028 patients with influenza like illness hospitalized at Children's Hospital 871 specimens were collected and 360 tested positive for influenza: A(H1N1)pdm - 139 and B - 221...
April 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28569131/safety-of-phenylephrine-infusion-through-peripheral-intravenous-catheter-in-the-neurological-intensive-care-unit
#10
Sudhir Datar, Eddy Gutierrez, Adam Schertz, Vidula Vachharajani
OBJECTIVE: The traditional approach for infusing vasopressors is to insert central venous catheters, which is associated with several complications. Phenylephrine is a commonly used vasopressor in the neurologic intensive care unit (neuro ICU), and due to its modest potency, the risk of local tissue injury from extravasation may be overestimated. The purpose of this study was to evaluate the safety of phenylephrine infusion through peripheral intravenous catheter (PIV) in the neuro ICU...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28551089/prognosis-at-6-and-12months-after-self-attempted-hanging
#11
Guillaume Gantois, Erika Parmentier-Decrucq, Thibault Duburcq, Raphaël Favory, Daniel Mathieu, Julien Poissy
INTRODUCTION: Patients surviving a self-attempted hanging have a total neurological recovery in 57-77% of cases at hospital discharge, but no long-term data are available. METHODS: In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2+3+4 (bad recovery) vs...
May 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28549644/maximizing-interhospital-transfer-resources-for-neurosurgical-patients
#12
Zane Schnurman, Robert Chin, Edward R Fishkin, Paul P Huang
BACKGROUND: Delays in patient transfers are associated with worse outcomes for some neurosurgical conditions. One of the primary causes of transfer delay is lack of neurosurgery ICU bed availability. In this study, we characterize the results of implementing an interhospital transfer protocol to reduce unnecessary transfers and improve bed availability. METHODS: A transfer protocol was implemented in July 2012 at the Bellevue Hospital Department of Neurosurgery that screened for and prevented transfer of low-risk patients that were unlikely to require specialized inpatient neurosurgical care...
May 23, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#13
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28544539/intensive-care-unit-admissions-and-ventilation-support-in-infants-with-bronchiolitis
#14
Ed Oakley, Vi Chong, Meredith Borland, Jocelyn Neutze, Natalie Phillips, David Krieser, Stuart Dalziel, Andrew Davidson, Susan Donath, Kim Jachno, Mike South, Amanda Fry, Franz E Babl
OBJECTIVES: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. DESIGN: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2-12 months old admitted with bronchiolitis. SETTING: Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011...
May 19, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28543642/bidirectional-superior-cavopulmonary-anastomosis-with-or-without-cardiopulmonary-bypass-a-randomized-study
#15
Sachin Talwar, Anish Gupta, Ashima Nehra, Neeti Makhija, Poonam Malhotra Kapoor, Vishnubhatla Sreenivas, Shiv Kumar Choudhary, Balram Airan
OBJECTIVES: This study aims to compare the bidirectional superior cavopulmonary anastomosis (BDG) with or without cardiopulmonary bypass (CPB). METHODS: 100 patients undergoing BDG were randomized into two groups: Off-CPB or on-CPB groups. All patients underwent near-infrared spectrophotometry (NIRS) and bispectral index (BIS) monitoring and pre- and postoperative serum 100 beta protein measurements (Sβ100) and neuro-cognitive evaluation. Postoperative intensive care unit (ICU) parameters were also studied...
May 21, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28534234/functional-outcome-of-patients-with-prolonged-hypoglycemic-encephalopathy
#16
Guillaume Barbara, Bruno Mégarbane, Laurent Argaud, Guillaume Louis, Nicolas Lerolle, Francis Schneider, Stéphane Gaudry, Nicolas Barbarot, Angéline Jamet, Hervé Outin, Sébastien Gibot, Pierre-Edouard Bollaert
BACKGROUND: Little is known about the causes, clinical course and long-term outcome of comatose patients with prolonged hypoglycemic encephalopathy. METHODS: In a multicenter retrospective study conducted in patients hospitalized from July 1, 2004, to July 1, 2014, we investigated functional long-term prognosis and identified prognosis factors of patients admitted in an intensive care unit (ICU) with prolonged neurological manifestations related to hypoglycemia...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28528969/limitation-of-life-sustaining-treatment-in-severe-trauma-in-the-elderly-after-admission-to-an-intensive-care-unit
#17
Y Peñasco, A González-Castro, J C Rodríguez Borregán, M Ortiz-Lasa, R Jáuregui Solórzano, M J Sánchez Arguiano, P Escudero Acha
OBJECTIVE: To analyze the factors associated to limitation of life-sustaining treatment (LLST) measures in elderly patients admitted to an intensive care unit (ICU) due to trauma. DESIGN: A retrospective, descriptive, observational study was carried out. SETTING: ICU. PATIENTS: A total of 149 patients aged 65 years or older admitted to the ICU due to trauma. Hospital mortality, the decision to limit life-sustaining treatment and the factors associated to these measures were analyzed...
May 18, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28528140/maternal-and-neonatal-outcomes-of-respiratory-failure-during-pregnancy
#18
Chen-Yiu Hung, Han-Chung Hu, Li-Chung Chiu, Chih-Hao Chang, Li-Fu Li, Chung-Chi Huang, Chuan-Chi Kao, Po-Jen Cheng, Kuo-Chin Kao
BACKGROUND: Obstetric patients comprise a limited portion of intensive care unit patients, but they often present with unfamiliar conditions and exhibit the potential for catastrophic deterioration. This study evaluated the maternal and neonatal outcomes of respiratory failure during pregnancy. METHODS: Information on 71 patients at >25 weeks gestation in the ICU with respiratory failure was recorded between 2009 and 2013. The characteristics and outcomes of mothers and fetuses were determined through a retrospective chart review and evaluated using Student's t test, chi-square test, and Fisher's exact test...
May 17, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28523031/myocardial-protection-with-glucose-insulin-potassium-infusion-during-adult-cardiac-surgery
#19
Suhail Ahmad, Rana Altaf Ahmad, Bilal Ahsan Qureshi, Mirza Ahmad Raza Baig
BACKGROUND & OBJECTIVE: Recent meta-analysis reports have called for more randomized trials to evaluate the effectiveness of GIK solution in patients of cardiac surgery. So this study was conducted to evaluate the effectiveness of Glucose-insulin-potassium (GIK) solutions in non-diabetic patients undergoing coronary artery bypass grafting. METHODS: A total number of one hundred and sixty (160) patients were randomized into two equal groups; GIK Group and non-GIK group...
March 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28506865/protocol-driven-neurological-prognostication-and-withdrawal-of-life-sustaining-therapy-after-cardiac-arrest-and-targeted-temperature-management
#20
Irina Dragancea, Matthew P Wise, Nawaf Al-Subaie, Julius Cranshaw, Hans Friberg, Guy Glover, Tommaso Pellis, Rebecca Rylance, Andrew Walden, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial...
May 12, 2017: Resuscitation
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