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https://www.readbyqxmd.com/read/29782388/glasgow-coma-scale-score-fluctuations-are-inversely-associated-with-a-nirs-based-index-of-cerebral-autoregulation-in-acutely-comatose-patients
#1
Ryan J Healy, Andres Zorrilla-Vaca, Wendy Ziai, Marek A Mirski, Charles W Hogue, Romergryko Geocadin, Batya Radzik, Caitlin Palmisano, Lucia Rivera-Lara
BACKGROUND: The Glasgow Coma Scale (GCS) is an essential coma scale in critical care for determining the neurological status of patients and for estimating their long-term prognosis. Similarly, cerebral autoregulation (CA) monitoring has shown to be an accurate technique for predicting clinical outcomes. However, little is known about the relationship between CA measurements and GCS scores among neurological critically ill patients. This study aimed to explore the association between noninvasive CA multimodal monitoring measurements and GCS scores...
May 18, 2018: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/29779815/use-of-standard-enteral-formula-versus-enteric-formula-with-prebiotic-content-in-nutrition-therapy-a-randomized-controlled-study-among-neuro-critical-care-patients
#2
Piril Tuncay, Fatma Arpaci, Mutlu Doganay, Deniz Erdem, Arzu Sahna, Hulya Ergun, Dilek Atabey
OBJECTIVE: To compare use of standard enteral formula versus enteric formula with prebiotic content in terms of nutrition therapy related outcomes among neurocritical care patients. METHODS: A total of 46 adult neurocritical care patients who received nutrition therapy with standard enteral formula (SEF group; n = 23) or enteral formula with prebiotic content (EFPC group; n = 23) during their hospitalization in intensive care unit (ICU) were included in this prospective randomized controlled study...
June 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29760928/aneurysmal-subarachnoid-hemorrhage-intensive-care-for-improving-neurological-outcome
#3
REVIEW
Tomoya Okazaki, Yasuhiro Kuroda
Background: Aneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29732476/critical-thresholds-for-intracranial-pressure-vary-over-time-in-non-craniectomised-traumatic-brain-injury-patients
#4
Basil Nourallah, Frederick A Zeiler, Leanne Calviello, Peter Smielewski, Marek Czosnyka, David K Menon
BACKGROUND: Intracranial pressure (ICP)- and cerebral perfusion pressure (CPP)-guided therapy is central to neurocritical care for traumatic brain injury (TBI) patients. We sought to identify time-dependent critical thresholds for mortality and unfavourable outcome for ICP and CPP in non-craniectomised TBI patients. METHODS: This is a retrospective cohort study of 355 patients with moderate-to-severe TBI who received ICP monitoring and were managed without decompressive craniectomy in a tertiary hospital neurocritical care unit...
May 7, 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29727362/effect-of-body-temperature-on-cerebral-autoregulation-in-acutely-comatose-neurocritically-ill-patients
#5
Krishma Adatia, Romergryko G Geocadin, Ryan Healy, Wendy Ziai, Luciano Ponce-Mejia, Mirinda Anderson-White, Dhaval Shah, Batya R Radzik, Caitlin Palmisano, Charles W Hogue, Charles Brown, Lucia Rivera-Lara
OBJECTIVES: Impaired cerebral autoregulation following neurologic injury is a predictor of poor clinical outcome. We aimed to assess the relationship between body temperature and cerebral autoregulation in comatose patients. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Neurocritical care unit of the Johns Hopkins Hospital. PATIENTS: Eighty-five acutely comatose patients (Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017...
May 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29713575/an-evaluation-of-complications-in-femoral-arterial-sheaths-maintained-post-neuroangiographic-procedures
#6
Zalan Khan, Premkumar Nattanamai, Premkumar Keerthivaas, Christopher R Newey
BACKGROUND: Digital subtraction angiography (DSA) is a frequently used technique in the neuro-diagnosis and treatment of cerebrovascular diseases. The routine use of femoral arterial sheaths (FAS) peri-procedurally has become standard. The maintenance of a FAS post-procedure may be warranted while awaiting the normalization of coagulopathy or to reaccess emergently. We retrospectively reviewed our stroke dataset to evaluate for complications associated with the prolonged use of FAS post-procedure...
February 26, 2018: Curēus
https://www.readbyqxmd.com/read/29708438/outcomes-of-protocolised-analgesia-and-sedation-in-a-neurocritical-care-unit
#7
Leana Mahmoud, Andrew R Zullo, Bradford B Thompson, Linda C Wendell
OBJECTIVES: Providing analgesia and sedation while allowing for neurological assessment is important in the neurocritical care unit (NCCU), yet data are limited about the effects of protocolised analgesia and sedation. We developed an analgesia-based sedation protocol and evaluated its effect on medication utilisation and costs in the NCCU. METHODS: We conducted a retrospective cohort study of patients who are mechanically ventilated and admitted to a 12-bed NCCU over four years...
April 30, 2018: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29686025/shorter-intensive-care-unit-stays-the-majority-of-post-intravenous-tpa-tissue-type-plasminogen-activator-symptomatic-hemorrhages-occur-within-12-hours-of-treatment
#8
Adam Chang, Edward J Llinas, Karen Chen, Rafael H Llinas, Elisabeth B Marsh
BACKGROUND AND PURPOSE: Symptomatic intracranial hemorrhage (sICH) is a life-threatening complication after treatment with intravenous tPA (tissue-type plasminogen activator) for acute stroke. Currently, patients are monitored for sICH in a neurocritical care unit or intensive care unit-like setting for 24 hours post-treatment-a costly and resource intensive practice. Because the half-life of tPA is much shorter than 24 hours, it is possible that the majority of patients do not require such intensive monitoring...
April 23, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29664874/traumatic-brain-injury-and-infectious-encephalopathy-in-children-from-four-resource-limited-settings-in-africa
#9
Ericka L Fink, Amelie von Saint Andre-von Arnim, Rashmi Kumar, Patrick T Wilson, Tigist Bacha, Abenezer Tirsit Aklilu, Tsegazeab Laeke Teklemariam, Shubhada Hooli, Lisine Tuyisenge, Easmon Otupiri, Anthony Fabio, John Gianakas, Patrick M Kochanek, Derek C Angus, Robert C Tasker
OBJECTIVES: To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. DESIGN: Prospective study. SETTING: Four hospitals in Sub-Saharan Africa. PATIENTS: Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29663282/the-frozen-brain-state-of-cryptococcus-gattii-a-globe-trotting-tropical-neurotropic-fungus
#10
Paul T Akins, Brian Jian
Initially reported in tropical regions, Cryptococcus gattii infection is now diagnosed globally. METHODS: case report; Literature review. Although initial reports described outbreaks of pulmonary and central nervous system (CNS) disease in tropical regions such as Australia and New Guinea, it is now clear that Cryptococcus gattii is a global, neurotropic pathogen. In contrast with C. neoformans, C. gattii patients are more likely to present with cryptococcomas in the brain and lungs and are often HIV negative...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29659050/continuous-electroencephalography-predicts-delayed-cerebral-ischemia-after-subarachnoid-hemorrhage-a-prospective-study-of-diagnostic-accuracy
#11
Eric S Rosenthal, Siddharth Biswal, Sahar F Zafar, Kathryn L O'Connor, Sophia Bechek, Apeksha V Shenoy, Emily J Boyle, Mouhsin M Shafi, Emily J Gilmore, Brandon P Foreman, Nicolas Gaspard, Thabele M Leslie-Mazwi, Jonathan Rosand, Daniel B Hoch, Cenk Ayata, Sydney S Cash, Andrew J Cole, Aman B Patel, M Brandon Westover
OBJECTIVE: Delayed cerebral ischemia (DCI) is a common, disabling complication of subarachnoid hemorrhage (SAH). Preventing DCI is a key focus of neurocritical care, but interventions carry risk and cannot be applied indiscriminately. While retrospective studies have identified continuous EEG (cEEG) measures associated with DCI, no study has characterized the accuracy of cEEG with sufficient rigor to justify using it to triage patients to interventions or clinical trials. We therefore prospectively assessed the accuracy of cEEG for predicting DCI, following the Standards for Reporting Diagnostic Accuracy Studies...
April 16, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29629983/impact-of-icu-structure-and-processes-of-care-on-outcomes-after-severe-traumatic-brain-injury-a-multicenter-cohort-study
#12
Victoria A McCredie, Aziz S Alali, Damon C Scales, Gordon D Rubenfeld, Brian H Cuthbertson, Avery B Nathens
OBJECTIVES: It is uncertain whether dedicated neurocritical care units are associated with improved outcomes for critically ill neurologically injured patients in the era of collaborative protocol-driven care. We examined the association between dedicated neurocritical care units and mortality and the effects of standardized management protocols for severe traumatic brain injury. DESIGN: We surveyed trauma medical directors from centers participating in the American College of Surgeons Trauma Quality Improvement Program to obtain information about ICU structure and processes of care...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29629931/magnetic-resonance-imaging-in-neurocritically-ill-patients-who-fails-and-how
#13
Joong-Goo Kim, Myung-Ah Ko, Han-Bin Lee, Sang-Beom Jeon
OBJECTIVES: Performing magnetic resonance imaging (MRI) in neurocritically ill patients is challenging because it often requires sedation and withholding care in the neurological intensive care unit. This study investigated the incidence of and reasons for failed or complicated MRI (MRI-FC) in such patients. METHODS: A consecutive series of 218 neurocritically ill patients who underwent brain MRI were retrospectively evaluated. Failed or complicated MRI included failure to obtain all ordered sequences, unscheduled sedative administration, decrease in oxygen saturation to less than 90%, hypotension (≥40-mm Hg decrease and/or use of inotropic agents), and cardiac or respiratory arrest...
April 6, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29621072/a-comprehensive-onboarding-and-orientation-plan-for-neurocritical-care-advanced-practice-providers
#14
Tamra M Langley, Jeremy Dority, Justin F Fraser, Kevin W Hatton
BACKGROUND: As the role of advanced practice providers (APPs) expands to include increasingly complex patient care within the intensive care unit, the educational needs of these providers must also be expanded. An onboarding process was designed for APPs in the neurocritical care service line. METHODS: Onboarding for new APPs revolved around 5 specific areas: candidate selection, proctor assignment, 3-phased orientation process, remediation, and mentorship. To ensure effective training for APPs, using the most time-conscious approach, the backbone of the process is a structured curriculum...
April 4, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/29611254/oxytocin-levels-in-saliva-correlate-better-than-plasma-levels-with-concentrations-in-the-cerebrospinal-fluid-of-patients-in-neurocritical-care
#15
Jan Martin, Simone M Kagerbauer, Jens Gempt, Armin Podtschaske, Alexander Hapfelmeier, Gerhard Schneider
In the converging fields of neuroendocrinology and behavioural neuroscience, the interaction between peripheral secretion and central release of oxytocin in humans has not yet been comprehensively assessed. As the human brain is not directly accessible and as the collection of human cerebrospinal fluid (CSF) usually requires invasive procedures, easier accessible compartments such as blood or saliva attract increasing attention. In this study, we prospectively determined oxytocin concentrations in the three compartments plasma, CSF and saliva of fifty critically ill patients with neurological and neurosurgical diseases...
April 3, 2018: Journal of Neuroendocrinology
https://www.readbyqxmd.com/read/29600909/spontaneous-occult-intracranial-hypotension-precipitating-life-threatening-cerebral-venous-thrombosis-case-report
#16
Avital Perry, Christopher S Graffeo, Waleed Brinjikji, William R Copeland, Alejandro A Rabinstein, Michael J Link
Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia...
March 30, 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29589329/tactical-neurocritical-care
#17
Julio A Chalela, Patrick E Britell
Neurocritical care is usually practiced in the comfort of an intensive care unit within a tertiary care medical center. Physicians deployed to the frontline with the US military or allied military are required to use their critical care skills and their neurocritical skills in austere environments with limited resources. Due to these factors, tactical critical care and tactical neurocritical care differ significantly from traditional critical care. Operational constraints, the tactical environment, and resource availability dictate that tactical neurocritical care be practiced within a well-defined, mission-constrained framework...
March 27, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29579816/systodiastolic-separation-expresses-cerebral-circulatory-arrest
#18
A Cacciatori, M Godino, R Mizraji
There is a situation before the cerebral circulatory cessation phase, the systodiastolic separation in transcranial Doppler (TCD), which may raise doubts to the operator technician who performs it. A total of 266 studies were performed in 188 neurocritical patients over a 9-year period: 88 cases (77%) corresponded to cerebral circulatory arrest (CCA) which accompanies brain death (BD); 9 (5%) presented the systodiastolic separation pattern. In 1 of those 9 there was persistence of cough reflex and spontaneous breathing; in 5, CCA was not reached; only 3 evolved to CCA...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29579815/utility-of-transcranial-doppler-in-the-coordination-of-transplants-10-years-of-experience
#19
A Cacciatori, M Godino, R Mizraji
Transcranial Doppler (TCD) integrated to multimodal neuromonitoring of neurocritical patients is a useful tool in the clinical follow-up. A retrospective and descriptive study of 194 patients who were admitted into the intensive care unit (ICU) was carried out from December 2007 to February 2017. We analyzed the distribution of study frequencies with respect to the pathologies that motivated them, the characteristics of patients who evolved to brain death (BD), and most frequent patterns of cerebral circulatory arrest...
March 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29579814/epidemiologic-and-evolutionary-profile-of-patients-with-subarachnoid-hemorrhage-with-glasgow-coma-scale-score-of-8-or-less-who-entered-the-follow-up-program-of-the-national-institute-of-donation-and-transplantation
#20
N Tommasino, M Saravia, A Rodriguez, R Mizraji
INTRODUCTION: The improvement in understanding the process that determines the death of an individual and his or her evolution toward brain death allows organization and planning of health policies, optimization of clinical activity and management of organ and tissue procurement processes for transplantation. OBJECTIVE: This study sought to analyze the epidemiological and evolutionary profile of patients with spontaneous subarachnoid hemorrhage (SAH) with a Glasgow Coma Scale score (GCS) ≤8 who entered follow-up in the Neurocritical Patient Monitoring Program (SPN) of Instituto Nacional de Donación y Trasplante (INDT), Uruguay...
March 2018: Transplantation Proceedings
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