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https://www.readbyqxmd.com/read/29351145/recent-evidence-on-early-mobilization-in-critical-ill-patients
#1
Kristina Fuest, Stefan J Schaller
PURPOSE OF REVIEW: To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. RECENT FINDINGS: Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients...
January 17, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29350603/decision-tree-analysis-in-subarachnoid-hemorrhage-prediction-of-outcome-parameters-during-the-course-of-aneurysmal-subarachnoid-hemorrhage-using-decision-tree-analysis
#2
Isabel Charlotte Hostettler, Carl Muroi, Johannes Konstantin Richter, Josef Schmid, Marian Christoph Neidert, Martin Seule, Oliver Boss, Athina Pangalu, Menno Robbert Germans, Emanuela Keller
OBJECTIVE The aim of this study was to create prediction models for outcome parameters by decision tree analysis based on clinical and laboratory data in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS The database consisted of clinical and laboratory parameters of 548 patients with aSAH who were admitted to the Neurocritical Care Unit, University Hospital Zurich. To examine the model performance, the cohort was randomly divided into a derivation cohort (60% [n = 329]; training data set) and a validation cohort (40% [n = 219]; test data set)...
January 19, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29329548/the-cost-of-a-pediatric-neurocritical-care-program-for-traumatic-brain-injury-a-retrospective-cohort-study
#3
Steven W Howard, Zidong Zhang, Paula Buchanan, Stephanie L Bernell, Christine Williams, Lindsey Pearson, Michael Huetsch, Jeff Gill, Jose A Pineda
BACKGROUND: Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics...
January 12, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29310574/traumatic-brain-injury-tbi-outcomes-in-an-lmic-tertiary-care-centre-and-performance-of-trauma-scores
#4
Samitha Samanamalee, Ponsuge Chathurani Sigera, Ambepitiyawaduge Pubudu De Silva, Kaushila Thilakasiri, Aasiyah Rashan, Saman Wadanambi, Kosala Saroj Amarasiri Jayasinghe, Arjen M Dondorp, Rashan Haniffa
BACKGROUND: This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. METHODS: Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited...
January 8, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29303797/lack-of-early-improvement-predicts-poor-outcome-following-acute-intracerebral-hemorrhage
#5
Vignan Yogendrakumar, Eric E Smith, Andrew M Demchuk, Richard I Aviv, David Rodriguez-Luna, Carlos A Molina, Yolanda Silva Blas, Imanuel Dzialowski, Adam Kobayashi, Jean-Martin Boulanger, Cheemun Lum, Gord Gubitz, Vasantha Padma, Jayanta Roy, Carlos S Kase, Rohit Bhatia, Myzoon Ali, Patrick Lyden, Michael D Hill, Dar Dowlatshahi
OBJECTIVES: There are limited data as to what degree of early neurologic change best relates to outcome in acute intracerebral hemorrhage. We aimed to derive and validate a threshold for early postintracerebral hemorrhage change that best predicts 90-day outcomes. DESIGN: Derivation: retrospective analysis of collated clinical stroke trial data (Virtual International Stroke Trials Archive). VALIDATION: retrospective analysis of a prospective multicenter cohort study (Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign [PREDICT])...
January 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29298527/a-narrative-review-of-the-clinical-application-of-pressure-reactiviy-indices-in-the-neurocritical-care-unit
#6
Stephen Copplestone, Jessie Welbourne
Pressure reactivity indices are used in clinical research as a surrogate marker of the ability of the cerebrovasculature to maintain cerebral autoregulation. The use of pressure reactivity indices in patients with neurological injury represents a potential to move away from population-based physiological targets used in guidelines to individualized physiological targets. The aim of this review is to describe the underlying principles and development of pressure reactivity indices, alongside a critique of how they have been used in clinical research, including their limitations...
January 4, 2018: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29288291/transfusion-of-blood-products-in-the-neurocritical-care-unit-an-exploration-of-rationing-and-futility
#7
Deepa P Malaiyandi, Galen V Henderson, Michael A Rubin
Rationing is the allocation of scarce resources, which in healthcare necessarily requires withholding potentially beneficial treatments from some individuals. While it often entails a negative connotation, rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important, because it not only affects individual lives, but also reflects society's most important values. At the core of any rationing, decision is how much a limited resource may benefit a patient, which can be particularly difficult to determine in the practice of neurocritical care, as prognosis is often uncertain...
December 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29262441/imaging-in-neurocritical-care-practice
#8
Craig Williamson, Larry Morgan, Joshua P Klein
The use of neuroimaging in conjunction with serial neurological examinations is a core component of modern neurocritical care practice. Although there is a growing role for other neuromonitoring techniques, the ability to quickly and accurately interpret images in the context of a patient's clinical status arguably remains the indispensable skill for neurocritical care practitioners. Due to its rapid acquisition time and excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and signs of elevated intracranial pressure, computed tomography (CT) remains the most useful neuroimaging technique for intensive care unit (ICU) patients...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29247499/cardiac-output-changes-after-osmotic-therapy-in-neurosurgical-and-neurocritical-care-patients-a-systematic-review-of-the-clinical-literature
#9
Georgia Tsaousi, Elisabetta Stazi, Marco Cinicola, Federico Bilotta
AIM: Osmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic hemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHOD: A database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting...
December 16, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29214398/monisha-kumar-joshua-m-levine-james-schuster-w-andrew-kofke-eds-neurocritical-care-management-of-the-neurosurgical-patient-elsevier-2017-558%C3%A2-pp-300-tables-450-illustrations-isbn-978-0-323-32-106-8-e-isbn-9780323322225
#10
https://www.readbyqxmd.com/read/29211186/epidemiology-of-acute-kidney-injury-and-chronic-kidney-disease-in-the-intensive-care-unit
#11
Darwin Tejera, Fernanda Varela, Daniela Acosta, Stephanie Figueroa, Sebastián Benencio, Cristina Verdaguer, Mauricio Bertullo, Federico Verga, Mario Cancela
OBJECTIVE: To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. METHODS: A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis...
November 30, 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29209266/current-opportunities-for-clinical-monitoring-of-axonal-pathology-in-traumatic-brain-injury
#12
REVIEW
Parmenion P Tsitsopoulos, Sami Abu Hamdeh, Niklas Marklund
Traumatic brain injury (TBI) is a multidimensional and highly complex disease commonly resulting in widespread injury to axons, due to rapid inertial acceleration/deceleration forces transmitted to the brain during impact. Axonal injury leads to brain network dysfunction, significantly contributing to cognitive and functional impairments frequently observed in TBI survivors. Diffuse axonal injury (DAI) is a clinical entity suggested by impaired level of consciousness and coma on clinical examination and characterized by widespread injury to the hemispheric white matter tracts, the corpus callosum and the brain stem...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29204033/white-matter-changes-in-corpus-callosum-in-a-patient-with-idiopathic-normal-pressure-hydrocephalus
#13
Naresh Mullaguri, Anusha Battineni, Christopher R Newey, Premkumar Nattanmai
Idiopathic normal pressure hydrocephalus (INPH) is characterized by the clinical triad of gait and cognitive dysfunction and urinary incontinence. Ventriculoperitoneal (VP) shunting is often required for treatment. Review of literature shows few case reports discussing benign magnetic resonance imaging (MRI) T2 hyperintense changes in the corpus callosum of NPH patients after shunting due to mechanical compression of the middle and posterior regions of the body against falx cerebri leading to ischemic demyelination...
October 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29180981/cerebral-microdialysis-monitoring-to-improve-individualized-neurointensive-care-therapy-an-update-of-recent-clinical-data
#14
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/29174722/functional-progression-of-patients-with-neurological-diseases-in-a-tertiary-paediatric-intensive-care-unit-our-experience
#15
P Madurga Revilla, J López Pisón, P Samper Villagrasa, J P García Íñiguez, R Garcés Gómez, M Domínguez Cajal, I Gil Hernández
INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS)...
November 23, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/29119023/improvement-in-quality-metrics-outcomes-and-patient-and-family-satisfaction-in-a-neurosciences-intensive-care-unit-after-creation-of-a-dedicated-neurocritical-care-team
#16
Yaw Sarpong, Premkumar Nattanmai, Ginger Schelp, Robert Bell, Keerthivaas Premkumar, Erin Stapleton, Ashley McCormick, Christopher R Newey
Introduction: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods: This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/29113858/differences-in-blood-pressure-by-measurement-technique-in-neurocritically-ill-patients-a-technological-assessment
#17
Abhijit V Lele, Daren Wilson, Prabhakar Chalise, Jules Nazzaro, Vijay Krishnamoorthy, Monica S Vavilala
Blood pressure data may vary by measurement technique. We performed a technological assessment of differences in blood pressure measurement between non-invasive blood pressure (NIBP) and invasive arterial blood pressure (ABP) in neurocritically ill patients. After IRB approval, a prospective observational study was performed to study differences in systolic blood pressure (SBP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) values measured by NIBP arm, ABP at level of the phlebostatic axis (ABP heart) and ABP at level of the external auditory meatus (ABP brain) at 30 and 45-degree head of bed elevation (HOB) using repeated measure analysis of covariance and correlation coefficients...
January 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29107635/predictors-of-need-for-critical-care-support-adverse-events-and-outcome-after-stroke-thrombolysis
#18
Panagiotis Papamichalis, Spyridon Karagiannis, Efthimios Dardiotis, Achilleas Chovas, Dimitrios Papadopoulos, Tilemachos Zafeiridis, Dimitris Babalis, Georgios Paraforos, Vasiliki Zisopoulou, Apostolia-Lemonia Skoura, Ioannis Staikos, Konstantinos Bouliaris, Michail Papamichalis, Georgios Hadjigeorgiou, Apostolos Komnos
BACKGROUND: Results from trials and international registries exhibit heterogeneity regarding safety, efficacy, markers of prognosis, and markers of the need for critical care support after intravenous thrombolysis (IVT) for strokes. The purpose of our study was to indentify such markers after performance of comparisons among patients who received thrombolysis in our intensive care unit. MATERIALS AND METHODS: Our study included 124 patients who received IVT in accordance with international criteria...
October 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29103844/prediction-of-potential-for-organ-donation-after-circulatory-death-in-neurocritical-patients
#19
Guixing Xu, Zhiyong Guo, Wenhua Liang, Erye Xin, Bin Liu, Ye Xu, Zhongqin Luan, Paul Michael Schroder, Martí Manyalich, Dicken Shiu-Chung Ko, Xiaoshun He
BACKGROUND: The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. METHODS: In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China...
September 30, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29095167/feasibility-of-early-motor-assisted-upper-extremity-cycle-ergometry-in-critically-ill-neurological-patients-with-upper-extremity-weakness-and-variable-cognitive-status-a-case-series
#20
S Deluzio, I Vora, S Kumble, E K Zink, R D Stevens, M N Bahouth
Upper extremity paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper extremity coordination after neurological injury. However, it is difficult to integrate upper extremity interventions into very early rehabilitation of critically ill neurological patients due to patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper extremity cycling in critically ill neurological patients with bilateral or unilateral paresis...
October 31, 2017: American Journal of Physical Medicine & Rehabilitation
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