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ICU NEURO

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112 papers 25 to 100 followers
https://www.readbyqxmd.com/read/27870576/airway-management-strategies-for-brain-injured-patients-meeting-standard-criteria-to-consider-extubation-a-prospective-cohort-study
#1
Victoria A McCredie, Niall D Ferguson, Ruxandra L Pinto, Neill Kj Adhikari, Robert A Fowler, Martin G Chapman, Althea Burrell, Andrew J Baker, Deborah J Cook, Maureen O Meade, Damon C Scales
RATIONALE: Patients with acute brain injury are frequently capable of breathing spontaneously with minimal ventilatory support despite persistent neurological impairment. OBJECTIVES: We sought to describe factors associated with extubation timing, success and primary tracheostomy in these patients. METHODS: We conducted a prospective multicenter observational cohort study in three academic hospitals in Toronto, Canada. Consecutive brain-injured adults receiving mechanical ventilation for at least 24 hours in 3 ICUs were screened by study personnel daily for extubation consideration criteria...
November 21, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27848125/the-effect-of-positive-end-expiratory-pressure-on-intracranial-pressure-and-cerebral-hemodynamics
#2
Myles D Boone, Sayuri P Jinadasa, Ariel Mueller, Shahzad Shaefi, Ekkehard M Kasper, Khalid A Hanafy, Brian P O'Gara, Daniel S Talmor
BACKGROUND: Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. METHOD: Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015...
November 15, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27844464/the-safety-and-effectiveness-of-intravenous-lacosamide-for-refractory-status-epilepticus-in-the-critically-ill
#3
C R Newey, N M Le, C Ahrens, P Sahota, S Hantus
BACKGROUND: Status epilepticus (SE) often does not respond to initial treatment. A second-line agent with a less established safety and efficacy profile is then required. This study examined the safety of intravenous (IV) lacosamide (LCM) in a critically ill population and obtained an estimate of effectiveness in patients with refractory SE on continuous video EEG monitoring (cEEG). METHODS: Retrospective review of critically ill patients in SE on cEEG treated with IV LCM from June 2009 to April 2011...
November 14, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27837689/neurogenic-stunned-myocardium-in-subarachnoid-hemorrhage
#4
REVIEW
Ali Kerro, Timothy Woods, Jason J Chang
"Stunned myocardium," characterized by reversible left ventricular dysfunction, was first described via animal models using transient coronary artery occlusion. However, this phenomenon has also been noted with neurologic pathologies and collectively been labeled "neurogenic stunned myocardium" (NSM). Neurogenic stunned myocardium resulting from subarachnoid hemorrhage (SAH) is a challenging pathology due to its diagnostic uncertainty. Traditional diagnostic criteria for NSM after SAH focus on electrocardiographic and echocardiographic abnormalities and troponemia...
October 20, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27829714/seizures-just-the-tip-of-the-iceberg-critical-care-management-of-super-refractory-status-epilepticus
#5
REVIEW
Karen Ruby Lionel, Ajay Prasad Hrishi
Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 h or more after the onset of anesthetic therapy, including those cases where SE recurs on the reduction or withdrawal of anesthesia. Although SRSE is a rare clinical problem, it is associated with high mortality and morbidity rates. This article reviews the treatment approaches and the systemic complications commonly encountered in patients with SRSE. As evident in our search of literature, therapy for SRSE and its complications have been based on clinical reports and expert opinions since there is a lack of controlled and randomized trials...
October 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27828809/epidemiology-diagnosis-and-treatment-of-brain-abscesses
#6
Matthijs C Brouwer, Diederik van de Beek
PURPOSE OF REVIEW: This article describes the epidemiology, diagnosis, and treatment of brain abscesses focusing on studies published in the past 2 years. RECENT FINDINGS: In the recent literature, advances have been made in describing the disease, ancillary investigations, and treatment, mostly by combining previously available literature in meta-analyses. These studies identified Staphylococcus and Streptococcus species as the most frequent cause of brain abscess...
November 18, 2016: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/27828810/community-acquired-bacterial-meningitis
#7
Joost M Costerus, Matthijs C Brouwer, Merijn W Bijlsma, Diederik van de Beek
PURPOSE OF REVIEW: Bacterial meningitis is a medical emergency and is associated with a high disease burden. We reviewed recent progress in the management of patients with community-acquired bacterial meningitis. RECENT FINDINGS: The worldwide burden of disease of bacterial meningitis remains high, despite the decreasing incidence following introduction of routine vaccination campaigns. Delay in diagnosis and treatment remain major concerns in the management of acute bacterial meningitis...
November 8, 2016: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/27785516/effect-of-conscious-sedation-vs-general-anesthesia-on-early-neurological-improvement-among-patients-with-ischemic-stroke-undergoing-endovascular-thrombectomy-a-randomized-clinical-trial
#8
Silvia Schönenberger, Lorenz Uhlmann, Werner Hacke, Simon Schieber, Sibu Mundiyanapurath, Jan C Purrucker, Simon Nagel, Christina Klose, Johannes Pfaff, Martin Bendszus, Peter A Ringleb, Meinhard Kieser, Markus A Möhlenbruch, Julian Bösel
Importance: Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from randomized trials. Objective: To assess whether conscious sedation is superior to general anesthesia for early neurological improvement among patients receiving stroke thrombectomy. Design, Setting, and Participants: SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment), a single-center, randomized, parallel-group, open-label treatment trial with blinded outcome evaluation conducted at Heidelberg University Hospital in Germany (April 2014-February 2016) included 150 patients with acute ischemic stroke in the anterior circulation, higher National Institutes of Health Stroke Scale (NIHSS) score (>10), and isolated/combined occlusion at any level of the internal carotid or middle cerebral artery...
November 15, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27780653/clinical-mimics-an-emergency-medicine-focused-review-of-stroke-mimics
#9
Brit Long, Alex Koyfman
BACKGROUND: Stroke is a leading cause of death and disability and most commonly presents with focal neurologic deficit within a specific vascular distribution. Several other conditions may present in a similar manner. OBJECTIVES: This review provides emergency providers with an understanding of stroke mimics, use of thrombolytics in these mimics, and keys to differentiate true stroke from mimic. DISCUSSION: Stroke has significant morbidity and mortality, and the American Heart Association emphasizes rapid recognition and aggressive treatment for patients with possible stroke-like symptoms, including thrombolytics...
October 22, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27757914/risks-of-routinely-clamping-external-ventricular-drains-for-intrahospital-transport-in-neurocritically-ill-cerebrovascular-patients
#10
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
https://www.readbyqxmd.com/read/27776537/cerebrospinal-fluid-penetration-of-meropenem-in-neurocritical-care-patients-with-proven-or-suspected-ventriculitis-a-prospective-observational-study
#11
Ute Blassmann, Anka C Roehr, Otto R Frey, Cornelia Vetter-Kerkhoff, Niklas Thon, William Hope, Josef Briegel, Volker Huge
BACKGROUND: Ventriculitis is a complication of temporary intraventricular drains. The limited penetration of meropenem into the cerebrospinal fluid (CSF) is well known. However, ventricular CSF pharmacokinetic data in patients with ventriculitis are lacking. The aim of this study was to evaluate meropenem pharmacokinetics in the serum and CSF of neurocritical care patients with proven or suspected ventriculitis. METHODS: We conducted an observational pharmacokinetic study of neurocritical care patients with proven or suspected ventriculitis receiving meropenem...
October 24, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27766633/inadvertent-intrathecal-injections-and-best-practice-management
#12
H Liu, R Tariq, G L Liu, H Yan, A D Kaye
The intrathecal space has become an important anatomic site for medical intervention not only in anesthesia practice, but also in many other medical specialties. Undesired/inadvertent intrathecal injections (UII) are generally rare. There is tremendous variation in reported inadvertent administrations via an intrathecal route in the literature, mainly as individual cases and very small case-series reports. This review aims to identify potential sources of UII, its clinical presentations, and appropriate management...
October 21, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27749290/extubation-failure-in-brain-injured-patients-risk-factors-and-development-of-a-prediction-score-in-a-preliminary-prospective-cohort-study
#13
Thomas Godet, Russell Chabanne, Julien Marin, Sophie Kauffmann, Emmanuel Futier, Bruno Pereira, Jean-Michel Constantin
BACKGROUND: The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients. METHODS: One hundred and forty brain-injured patients were prospectively included after the first spontaneous breathing trial success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation...
October 3, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27741984/headache-in-the-emergency-department-avoiding-misdiagnosis-of-dangerous-secondary-causes
#14
Ramin R Tabatabai, Stuart P Swadron
There are a number of dangerous secondary causes of headaches that are life, limb, brain, or vision threatening that emergency physicians must consider in patients presenting with acute headache. Careful history and physical examination targeted at these important secondary causes of headache will help to avoid misdiagnosis in these patients. Patients with acute thunderclap headache have a differential diagnosis beyond subarachnoid hemorrhage. Considering the "context" of headache "PLUS" some other symptom or sign is one strategy to help focus the differential diagnosis...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741987/status-epilepticus-what-s-new
#15
Danya Khoujah, Michael K Abraham
The emergent evaluation and treatment of generalized convulsive status epilepticus presents challenges for emergency physicians. This disease is one of the few in which minutes can mean the difference between life and significant morbidity and mortality. It is imperative to use parallel processing and have multiple treatment options planned in advance, in case the current treatment is not successful. There is also benefit to exploring, or initiating, treatment algorithms to standardize the care for these critically ill patients...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741988/initial-diagnosis-and-management-of-coma
#16
Stephen J Traub, Eelco F Wijdicks
Coma represents a true medical emergency. Drug intoxications are a leading cause of coma; however, other metabolic disturbances and traumatic brain injury are also common causes. The general emergency department approach begins with stabilization of airway, breathing, and circulation, followed by a thorough physical examination to generate a limited differential diagnosis that is then refined by focused testing. Definitive treatment is ultimately disease-specific. This article presents an overview of the pathophysiology, causes, examination, and treatment of coma...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741991/diagnosis-of-acute-ischemic-stoke
#17
Lauren M Nentwich
Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741992/treatment-of-acute-ischemic-stroke
#18
Matthew S Siket
Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration-approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741993/diagnosis-and-management-of-acute-intracerebral-hemorrhage
#19
REVIEW
Andrea Morotti, Joshua N Goldstein
Intracerebral hemorrhage (ICH) is the deadliest type of stroke and up to half of patients die in hospital. Blood pressure management, coagulopathy reversal, and intracranial pressure control are the mainstays of acute ICH treatment. Prevention of hematoma expansion and minimally invasive hematoma evacuation are promising therapeutic strategies under investigation. This article provides an updated review on ICH diagnosis and management in the emergency department.
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741994/subarachnoid-hemorrhage
#20
Michael K Abraham, Wan-Tsu Wendy Chang
Aneurysmal subarachnoid hemorrhage (SAH) is a neurological emergency with high risk of neurological decline and death. Although the presentation of a thunderclap headache or the worst headache of a patient's life easily triggers the evaluation for SAH, subtle presentations are still missed. The gold standard for diagnostic evaluation of SAH remains noncontrast head computed tomography (CT) followed by lumbar puncture if the CT is negative for SAH. Management of patients with SAH follows standard resuscitation of critically ill patients with the emphasis on reducing risks of rebleeding and avoiding secondary brain injuries...
November 2016: Emergency Medicine Clinics of North America
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