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Neurocritical patient

Nophanan Chaikittisilpa, Abhijit V Lele, Vivian H Lyons, Bala G Nair, Shu-Fang Newman, Patricia A Blissitt, Monica S Vavilala
BACKGROUND: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients. METHODS: We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center...
October 18, 2016: Neurocritical Care
Angela Sánchez-Guerrero, Gemma Mur-Bonet, Marian Vidal-Jorge, Darío Gándara-Sabatini, Ivette Chocrón, Esteban Cordero, Maria-Antonia Poca, Katharine Mullen, Juan Sahuquillo
Cerebral microdialysis is widely used in neurocritical care units. The goal of this study was to establish the reference interval for the interstitial fluid concentrations of energy metabolites and glycerol by using the extrapolation to zero-flow methodology in anesthetized patients and by constant perfusion at 0.3 µL/min in awake patients. A CMA-71 probe was implanted during surgery in normal white matter of patients with posterior fossa or supratentorial lesions, and the perfusion flow rate was randomized to 0...
October 14, 2016: Journal of Cerebral Blood Flow and Metabolism
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
Rani Ameena Bashir, Liza Espinoza, Sakeer Vayalthrikkovil, Jeffrey Buchhalter, Leigh Irvine, Luis Bello-Espinosa, Khorshid Mohammad
BACKGROUND: We report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program. METHODS: Neonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider...
August 3, 2016: Pediatric Neurology
Hadie Adams, Angelos G Kolias, Peter J Hutchinson
The general consensus to optimize the care for severe TBI patients is management at specialized neurotrauma centers with neurosurgical and neurocritical care support and the use of guidelines-based standardized protocols. Over the last decade, significant efforts have been made to define neurotrauma treatment guidelines. However, it is important to recognize the heterogeneity of TBI and that the "one-size-fits-all approach" may not always be appropriate for these patients. Knowledge synthesis activities in neurotrauma are important to define future research agendas...
October 2016: Neurosurgery Clinics of North America
Beatrice Borsellino, Marcus J Schultz, Marcelo Gama de Abreu, Chiara Robba, Federico Bilotta
INTRODUCTION: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers...
October 2016: Expert Review of Respiratory Medicine
Eelco F M Wijdicks
Historically, neurologists were not involved in the day-to-day management of critically ill patients with bulbar poliomyelitis, but some were. The major contributions of 3 neurologists-W. Ritchie Russell, A.B. Baker, and Fred Plum-in the respiratory management of poliomyelitis have not been recognized. Russell's work was instrumental in identifying multiple types of poliomyelitis defined by their respiratory needs, and he advised treatment that varied from simple postural drainage to use of respirators. He participated in the development of the Radcliffe respiratory pump...
September 13, 2016: Neurology
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane English
BACKGROUND: Sedation is an important consideration in the care of the neurocritically ill patient. It provides anxiety and relief, facilitates procedures and nursing tasks, and minimizes intolerance of mechanical ventilation. Alpha-2 agonists such as dexmedetomidine and clonidine have been shown to be an effective alternative in the general critical care population by reducing duration of mechanical ventilation and length of stay in the intensive care unit (ICU), as compared to traditional sedative agents such as propofol or benzodiazepines...
2016: Systematic Reviews
Sophie Samuel, Suhas Bajgur, Jude P Savarraj, Huimahn A Choi
Publications regarding early initiating venous thromboembolism (VTE) prophylaxis have been available since the early 1990s. These recommendations became available in current guidelines on and after 2012. The purpose of this study is to review the practice change in reducing the incidence of VTE in brain injury patients from 2008 to 2014. This was a single-center, retrospective, observational, cohort study. Data was extracted from our data base that included patients over 100 kg from January 2008 to August 2014...
September 7, 2016: Journal of Thrombosis and Thrombolysis
Gerald A Dienel, Douglas L Rothman, Carl-Henrik Nordström
Cerebral microdialysis is a widely used clinical tool for monitoring extracellular concentrations of selected metabolites after brain injury and to guide neurocritical care. Extracellular glucose levels and lactate/pyruvate ratios have high diagnostic value because they can detect hypoglycemia and deficits in oxidative metabolism, respectively. In addition, patterns of metabolite concentrations can distinguish between ischemia and mitochondrial dysfunction, and are helpful to choose and evaluate therapy. Increased intracranial pressure can be life-threatening after brain injury, and hypertonic solutions are commonly used for pressure reduction...
September 7, 2016: Journal of Cerebral Blood Flow and Metabolism
DonRaphael Wynn, Donald McCorquodale, Angela Peters, Kelsey Juster-Switlyk, Gordon Smith, Safdar Ansari
A woman aged 77 years was transferred to our neurocritical care unit for evaluation and treatment of rapidly progressive motor weakness and encephalopathy. Examination revealed an ability to follow simple commands only and abnormal movements, including myoclonus, tongue and orofacial dyskinesias, and opsoclonus. Imaging study findings were initially unremarkable, but when repeated, they demonstrated enhancement of the cauda equina nerve roots, trigeminal nerve, and pachymeninges. Cerebrospinal fluid examination revealed mildly elevated white blood cell count and protein levels...
September 6, 2016: JAMA Neurology
Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Fernando Mendes Paschoal, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu
Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation...
August 8, 2016: World Journal of Hepatology
Ivan Rocha Ferreira da Silva, Gabriel Rodriguez de Freitas
BACKGROUND: Fever is commonly observed in patients who have had aneurysmal subarachnoid hemorrhage (SAH), and it has been associated with the occurrence of delayed cerebral ischemia and worse outcomes in previous studies. Frequently, fever is not the result of bacterial infections, and distinction between infection-related fever and fever secondary to brain injury (also referred as central fever) can be challenging. OBJECTIVES: The current study aimed to identify risk factors on admission for the development of central fever in patients with SAH...
August 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
James L Stone, Julian E Bailes, Ahmed N Hassan, Brian Sindelar, Vimal Patel, John Fino
Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring...
August 2, 2016: Neurocritical Care
Federico Bilotta, Chiara Robba, Antonio Santoro, Roberto Delfini, Giovanni Rosa, Luciano Agati
Contrast-enhanced ultrasonography (CEU) is a non-invasive imaging technique that provides real-time, bedside information on changes in global and segmental organ perfusion. Currently, there is a lack of data concerning changes in the distribution of segmental brain perfusion in acute ischemic stroke treated by decompressive craniectomy. The aim of our case series was to assess the role of CEU after decompressive craniectomy in patients with acute ischemic stroke. CEU was performed in 12 patients at baseline and after any one of the following interventions was performed as dictated by the patient's clinical condition: vasoactive drug administration (in order to achieve cerebral perfusion pressure ≥70 mm Hg and mean arterial pressure <100 mm Hg for management of arterial blood pressure) and mild hyperventilation (carbon dioxide arterial pressure = 30-35 mm Hg)...
November 2016: Ultrasound in Medicine & Biology
Christopher D Smyser, Emily W Y Tam, Taeun Chang, Janet S Soul, Steven P Miller, Hannah C Glass
BACKGROUND: Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. OBJECTIVES: To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic...
October 2016: Pediatric Neurology
Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Eduardo Bossone, Raffaele Calabrò
Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler (TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old...
July 26, 2016: World Journal of Cardiology
Fawaz Al-Mufti, Elie Dancour, Krishna Amuluru, Charles Prestigiacomo, Stephan A Mayer, E Sander Connolly, Jan Claassen, Joshua Z Willey, Philip M Meyers
Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care)...
July 19, 2016: Journal of Intensive Care Medicine
Günther Herzer, Udo Illievich, Wolfgang G Voelckel, Helmut Trimmel
OBJECTIVES: The task force Neuroanaesthesia of the Austrian Society of Anaesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is aiming to develop and provide recommendations in order to improve neurocritical care in Austria. Thus, a survey on neurocritical care concepts in Austria regarding intensive care of subarachnoid haemorrhage (SAH) and severe traumatic brain injury (TBI) was performed to assess the current status. METHODS: An online internet questionnaire comprising 59 items on current concepts of SAH and TBI critical care was sent to 117 anaesthesiology departments...
September 2016: Wiener Klinische Wochenschrift
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