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ICU NEURO

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143 papers 100 to 500 followers
https://www.readbyqxmd.com/read/28601130/neurobehavioral-management-of-traumatic-brain-injury-in-the-critical-care-setting-an-update
#1
REVIEW
Earl De Guzman, Andrea Ament
Traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI is a major cause of disability and mortality worldwide. Post-traumatic amnesia, or the interval from injury until the patient is oriented and able to form and later recall new memories, is an important index of TBI severity and functional outcome. This article will discuss the updates in the epidemiology, definition and classification, pathophysiology, diagnosis, and management of common acute neuropsychiatric sequelae of traumatic brain injury that the critical care specialist may encounter...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601131/detection-and-management-of-preexisting-cognitive-impairment-in-the-critical-care-unit
#2
REVIEW
Mark A Oldham, Walter Piddoubny, Ryan Peterson, Hochang B Lee
Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601132/acute-brain-failure-pathophysiology-diagnosis-management-and-sequelae-of-delirium
#3
REVIEW
José R Maldonado
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601135/novel-algorithms-for-the-prophylaxis-and-management-of-alcohol-withdrawal-syndromes-beyond-benzodiazepines
#4
REVIEW
José R Maldonado
Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601141/neuropsychiatric-aspects-of-infectious-diseases-an-update
#5
REVIEW
Sahil Munjal, Stephen J Ferrando, Zachary Freyberg
Among the critically ill, infectious diseases can play a significant role in the etiology of neuropsychiatric disturbances. All critical care physicians are familiar with delirium as a secondary complication of systemic infection. This article focuses on key infectious diseases that commonly and directly produce neuropsychiatric symptoms, including direct infection of the central nervous system, human immunodeficiency virus infection, and AIDS.
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28693567/protocol-based-invasive-intracranial-pressure-monitoring-in-acute-liver-failure-feasibility-safety-and-impact-on-management
#6
Venkatakrishna Rajajee, Robert J Fontana, Anthony J Courey, Parag G Patil
BACKGROUND: Acute liver failure (ALF) may result in elevated intracranial pressure (ICP). While invasive ICP monitoring (IICPM) may have a role in ALF management, these patients are typically coagulopathic and at risk for intracranial hemorrhage (ICH). Contemporary ICP monitoring techniques and coagulopathy reversal strategies may be associated with a lower risk of hemorrhage. Our objective was to evaluate the safety, feasibility, impact on clinical management and outcomes associated with protocol-directed use of IICPM in ALF...
July 11, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28640020/extubation-success-prediction-in-a-multicentric-cohort-of-patients-with-severe-brain-injury
#7
MULTICENTER STUDY
Karim Asehnoune, Philippe Seguin, Sigismond Lasocki, Antoine Roquilly, Adrien Delater, Antoine Gros, Florian Denou, Pierre-Joachim Mahé, Nicolas Nesseler, Dominique Demeure-Dit-Latte, Yoann Launey, Karim Lakhal, Bertrand Rozec, Yannick Mallédant, Véronique Sébille, Samir Jaber, Aurélie Le Thuaut, Fanny Feuillet, Raphaël Cinotti
BACKGROUND: Patients with brain injury are at high risk of extubation failure. METHODS: We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with brain injury. RESULTS: A total of 437 consecutive patients with brain injury were included, and 338 patients (77.3%) displayed successful extubation...
August 2017: Anesthesiology
https://www.readbyqxmd.com/read/28369295/cranial-imaging-before-lumbar-puncture-in-adults-with-community-acquired-meningitis-clinical-utility-and-adherence-to-the-infectious-diseases-society-of-america-guidelines
#8
Lucrecia Salazar, Rodrigo Hasbun
Background.: The Infectious Diseases Society of America (IDSA) guidelines delineate criteria for the use of computed tomography (CT) scan of the head before lumbar puncture (LP) in adults with community-acquired meningitis (CAM). There are limited data to document adherence to these guidelines and assess the clinical utility of brain imaging. Methods.: This was a retrospective analysis from January 2005 to January 2010 in Houston, Texas. Results...
June 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28234783/is-there-still-a-role-for-hypothermia-in-neurocritical-care
#9
Florian Frank, Gregor Broessner
PURPOSE OF REVIEW: Therapeutic hypothermia (i.e. induced body core temperature ≈ 33-35°C) in neurological patients with cerebrovascular disease and traumatic brain injury is a controversially discussed issue in the literature. In this review, we have included the most recently published research covering the use of therapeutic hypothermia and targeted temperature management in neurologic diseases and translated the results into a clinical decision support for the professional healthcare community...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28323720/neuroprognostication-after-cardiac-arrest-in-the-light-of-targeted-temperature-management
#10
Mauro Oddo, Hans Friberg
PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28480083/optic-nerve-sheath-diameter-as-a-bedside-assessment-for-elevated-intracranial-pressure
#11
Peter Williams
A previously fit and healthy 26-year-old lady with no significant medical history presented with a two-month history of headaches. The headaches were prolonged, generalised, and unusually severe for the patient. Examination revealed papilloedema. The patient's optic nerve sheath diameter was measured 3 mm posterior to the globe and found to be 7.5 mm. The patient subsequently had computed tomography scan of her brain that showed an optic nerve sheath diameter of 7.56 mm as measured 3 mm posterior to the globe...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/26044255/cardiac-arrest-resuscitation-and-reperfusion
#12
REVIEW
Kaustubha D Patil, Henry R Halperin, Lance B Becker
The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices...
June 5, 2015: Circulation Research
https://www.readbyqxmd.com/read/28250995/malignant-catatonia-warrants-early-psychiatric-critical-care-collaborative-management-two-cases-and-literature-review
#13
Julia Park, Josh Tan, Sylvia Krzeminski, Maryam Hazeghazam, Meghana Bandlamuri, Richard W Carlson
Malignant catatonia (MC) is a life-threatening manifestation which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with the Neuroleptic Malignant Syndrome (NMS). The subsequent diagnosis and definitive therapy of MC are typically delayed, which increases morbidity and mortality. We present two cases of MC and review recent literature of MC and NMS, illustrating factors which delay diagnosis and management...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28348899/abnormal-breathing-patterns-predict-extubation-failure-in-neurocritically-ill-patients
#14
Pragya Punj, Premkumar Nattanmai, Pravin George, Christopher R Newey
In neurologically injured patients, predictors for extubation success are not well defined. Abnormal breathing patterns may result from the underlying neurological injury. We present three patients with abnormal breathing patterns highlighting failure of successful extubation as a result of these neurologically driven breathing patterns. Recognizing abnormal breathing patterns may be predictive of extubation failure and thus need to be considered as part of extubation readiness.
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28267351/contemporary-imaging-of-cerebral-arteriovenous-malformations
#15
Eric Tranvinh, Jeremy J Heit, Lotfi Hacein-Bey, James Provenzale, Max Wintermark
OBJECTIVE: Brain arteriovenous malformation (AVM) rupture results in substantial morbidity and mortality. The goal of AVM treatment is eradication of the AVM, but the risk of treatment must be weighed against the risk of future hemorrhage. CONCLUSION: Imaging plays a vital role by providing the information necessary for AVM management. Here, we discuss the background, natural history, clinical presentation, and imaging of AVMs. In addition, we explain advances in techniques for imaging AVMs...
June 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28374472/a-prospective-outcome-study-observing-patients-with-severe-traumatic-brain-injury-over-10-15%C3%A2-years
#16
E Andersson, D Rackauskaite, E Svanborg, L Csajbók, M Öst, B Nellgård
BACKGROUND: Severe traumatic brain injury (sTBI) can be divided into primary and secondary injuries. Intensive care protocols focus on preventing secondary injuries. This prospective cohort study was initiated to investigate outcome, including mortality, in patients treated according to the Lund Concept after a sTBI covering 10-15 years post-trauma. METHODS: Patients were included during 2000-2004 when admitted to the neurointensive care unit, Sahlgrenska University Hospital...
May 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28342192/intravenous-versus-nonintravenous-benzodiazepines-for-the-cessation-of-seizures-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#17
Abdussalam Alshehri, Ahmad Abulaban, Rakan Bokhari, Suleiman Kojan, Majid Alsalamah, Mazen Ferwana, Mohammad Hassan Murad
BACKGROUND: The acquisition of intravenous (IV) access in the actively convulsing patient is difficult. This often delays the administration of the IV benzodiazepine (BDZ) necessary for seizure cessation. Delays in seizure cessation are associated with increased pharmacoresistance, increased risk of neuronal injury, worse patient outcomes, and increased morbidity. OBJECTIVE: The objective was to assess whether the delay imposed by IV access acquisition is justified by improved outcomes...
March 25, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28207600/advancements-in-the-critical-care-management-of-status-epilepticus
#18
Andrew Bauerschmidt, Andrew Martin, Jan Claassen
PURPOSE OF REVIEW: Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. RECENT FINDINGS: Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28207602/spreading-depolarization-monitoring-in-neurocritical-care-of-acute-brain-injury
#19
Jed A Hartings
PURPOSE OF REVIEW: Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential. RECENT FINDINGS: Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28203777/2017-infectious-diseases-society-of-america-s-clinical-practice-guidelines-for-healthcare-associated-ventriculitis-and-meningitis
#20
Allan R Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L Kaplan, W Michael Scheld, Diederik van de Beek, Thomas P Bleck, Hugh J L Garton, Joseph R Zunt
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society)...
February 14, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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