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Neurocritical care

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By M KKhan Pediatric Intensivist
https://www.readbyqxmd.com/read/27940011/pediatric-intracranial-hypertension
#1
REVIEW
Shawn C Aylward, Rachel E Reem
Primary (idiopathic) intracranial hypertension has been considered to be a rare entity, but with no precise estimates of the pediatric incidence in the United States. There have been attempts to revise the criteria over the years and adapt the adult criteria for use in pediatrics. The clinical presentation varies with age, and symptoms tending to be less obvious in younger individuals. In the prepubertal population, incidentally discovered optic disc edema is relatively common. By far the most consistent symptom is headache; other symptoms include nausea, vomiting tinnitus, and diplopia...
January 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/24481284/management-of-raised-intracranial-pressure-and-hyperosmolar-therapy
#2
REVIEW
Allan H Ropper
The management of raised intracranial pressure is undergoing rapid change. The choice of medical treatments to reduce intracranial pressure varies between institutions and regions of the world. The mainstay of therapy, however, continues to be the infusion of a hyperosmolar solution to achieve an osmotic gradient to force the exit of water from the brain. This review introduces the basic concepts of raised intracranial pressure, summarises several recent studies that have challenged dogma in the field, and provides practical advice on hyperosmolar treatment, based on personal experience and a critical reading of the literature...
June 2014: Practical Neurology
https://www.readbyqxmd.com/read/23753247/hypertonic-saline-in-elevated-intracranial-pressure-past-present-and-future
#3
REVIEW
Salim Surani, Geoff Lockwood, Melissa Y Macias, Bharat Guntupalli, Joseph Varon
Hypertonic Saline (HS) has been a proven and effective therapy and a safe alternative to mannitol in patients with increase intracranial pressure (ICP). We hereby present a case of 25-year-old women with intracranial bleed secondary to right parietal arteriovenous malformation. Patient underwent surgery for evacuation of hematoma and resection of arteriovenous malformation. Post- operative course was complicated by recurrent episodes of elevated ICP. She received total of 17 doses of 23.4% HS and 30 doses of mannitol with good outcome...
January 2015: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/26426232/management-of-intracranial-pressure
#4
REVIEW
W David Freeman
PURPOSE OF REVIEW: Intracranial pressure (ICP) can be elevated in traumatic brain injury, large artery acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure. Raised ICP is also known as intracranial hypertension and is defined as a sustained ICP of greater than 20 mm Hg. RECENT FINDINGS: ICP must be measured through an invasive brain catheter, typically an external ventricular catheter that can drain CSF and measure ICP, or through an intraparenchymal ICP probe...
October 2015: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/26673840/effectiveness-of-pharmacological-therapies-for-intracranial-hypertension-in-children-with-severe-traumatic-brain-injury-results-from-an-automated-data-collection-system-time-synched-to-drug-administration
#5
Steven L Shein, Nikki M Ferguson, Patrick M Kochanek, Hülya Bayir, Robert S B Clark, Ericka L Fink, Elizabeth C Tyler-Kabara, Stephen R Wisniewski, Ye Tian, G K Balasubramani, Michael J Bell
OBJECTIVES: To describe acute cerebral hemodynamic effects of medications commonly used to treat intracranial hypertension in children with traumatic brain injury. Currently, data supporting the efficacy of these medications are insufficient. DESIGN: In this prospective observational study, intracranial hypertension (intracranial pressure ≥ 20 mm Hg for > 5 min) was treated by clinical protocol. Administration times of medications for intracranial hypertension (fentanyl, 3% hypertonic saline, mannitol, and pentobarbital) were prospectively recorded and synchronized with an automated database that collected intracranial pressure and cerebral perfusion pressure every 5 seconds...
March 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/26463914/the-evolution-of-the-clinical-use-of-osmotic-therapy-in-the-treatment-of-cerebral-edema
#6
Michael N Diringer
For almost a century, it has been known that hypertonic solutions shrink cerebral tissue. Early attempts used hypertonic solutions of ions (sodium, magnesium) and sugars (glucose, dextrose, sucrose), concentrated albumin, and, later, urea. These early attempts were largely abandoned because the effect was short lived and often followed by a period of rebound edema. This was a result, to a great extent, of the osmotic agent either being metabolized or crossing the cell membrane.Renewed interest in osmotic therapy came in the 1960s, with the introduction of intracranial pressure monitoring in head injury and the use of mannitol as an osmotic agent...
2016: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/27673506/sodium-bicarbonate-for-control-of-icp-a-systematic-review
#7
Frederick A Zeiler, Nicholas Sader, Michael West, Lawrence M Gillman
OBJECTIVE: Our goal was to perform a systematic review of the literature on the use of intravenous sodium bicarbonate for intracranial pressure (ICP) reduction in patients with neurologic illness. METHODS: Data sources: articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to April 2015), reference lists of relevant articles, and gray literature were searched. DATA EXTRACTION: 2 reviewers independently extracted data including population characteristics and treatment characteristics...
September 26, 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28342705/comparison-of-20-mannitol-and-3-hypertonic-saline-on-intracranial-pressure-and-systemic-hemodynamics
#8
Navdeep Sokhal, Girija Prasad Rath, Arvind Chaturvedi, Manmohan Singh, Hari Hara Dash
Mannitol and hypertonic saline (HS) are most commonly used hyperosmotic agents for intraoperative brain relaxation. We compared the changes in ICP and systemic hemodynamics after infusion of equiosmolar solutions of both agents in patients undergoing craniotomy for supratentorial tumors. Forty enrolled adults underwent a standard anesthetic induction. Apart from routine monitoring parameters, subdural ICP with Codmann catheter and cardiac indices by Vigileo monitor, were recorded. The patients were randomized to receive equiosmolar solutions of either 20% mannitol (5ml/kg) or 3% HS (5...
August 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28478873/the-use-of-mannitol-and-hypertonic-saline-therapies-in-patients-with-elevated-intracranial-pressure-a-review-of-the-evidence
#9
REVIEW
Briana Witherspoon, Nathan E Ashby
Patients with increased intracranial pressure generally require pharmacologic therapies and often more definitive treatments, such as surgical intervention. The overall goal of these interventions is to maintain or re-establish adequate cerebral blood flow and prevent herniation. Regardless of the cause of increased intracranial pressure, osmotherapy is considered the mainstay of medical therapy, and should be administered as soon as possible. This article reviews the history of hyperosmolar and hypertonic therapies, the Monro-Kellie hypothesis, and types of cerebral edema...
June 2017: Nursing Clinics of North America
https://www.readbyqxmd.com/read/28282553/challenges-in-the-treatment-of-convulsive-status-epilepticus
#10
REVIEW
Gaetano Zaccara, Gianfranco Giannasi, Roberto Oggioni, Eleonora Rosati, Luciana Tramacere, Pasquale Palumbo
Convulsive status epilepticus (CSE) is a medical emergency associated with high mortality and morbidity. The most recent definition of CSE is a convulsive seizure lasting more than 5min or consecutive seizures without recovery of consciousness. In adults, for the treatment of the early stages of CSE, diazepam, lorazepam or midazolam are the most common treatments, although the choice of agent seems less important than rapid treatment. Midazolam, when administered intramuscularly (best evidence), buccally, or nasally, is effective and safe in the pre-hospital setting...
April 2017: Seizure: the Journal of the British Epilepsy Association
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
#11
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/28249297/cerebrospinal-fluid-shunting-complications-in-children
#12
Brian W Hanak, Robert H Bonow, Carolyn A Harris, Samuel R Browd
Although cerebrospinal fluid (CSF) shunt placement is the most common procedure performed by pediatric neurosurgeons, shunts remain among the most failure-prone life-sustaining medical devices implanted in modern medical practice. This article provides an overview of the mechanisms of CSF shunt failure for the 3 most commonly employed definitive CSF shunts in the practice of pediatric neurosurgery: ventriculoperitoneal, ventriculopleural, and ventriculoatrial. The text has been partitioned into the broad modes of shunt failure: obstruction, infection, mechanical shunt failure, overdrainage, and distal catheter site-specific failures...
March 2, 2017: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28232464/question-2-should-thrombolytic-agents-be-used-in-children-presenting-with-acute-ischaemic-stroke
#13
Dhinesh Baskaran, Nahin Hussain
No abstract text is available yet for this article.
April 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28234810/seizure-detection-by-critical-care-providers-using-amplitude-integrated-electroencephalography-and-color-density-spectral-array-in-pediatric-cardiac-arrest-patients
#14
Geneviève Du Pont-Thibodeau, Sarah M Sanchez, Abbas F Jawad, Vinay M Nadkarni, Robert A Berg, Nicholas S Abend, Alexis A Topjian
OBJECTIVES: Determine the accuracy and confidence of critical care medicine providers to identify seizures using amplitude-integrated electroencephalography versus amplitude-integrated electroencephalography combined with color density spectral array electroencephalography (aEEG + CDSA). DESIGN: Tutorial and questionnaire. SETTING: PICU. SUBJECTS: Pediatric critical care providers (attendings, fellows, and nurses). INTERVENTIONS: A standardized powerpoint tutorial on amplitude-integrated electroencephalography and color density spectral array followed by classification of 100 amplitude-integrated electroencephalography images and 100 amplitude-integrated electroencephalography combined with color density spectral array as displaying seizures or not displaying seizures...
April 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28242531/recent-developments-in-the-management-of-patients-resuscitated-from-cardiac-arrest
#15
REVIEW
Jacob C Jentzer, Casey M Clements, Joseph G Murphy, R Scott Wright
Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28190433/seizures-in-the-critically-ill
#16
REVIEW
J Ch'ang, J Claassen
Critically ill patients with seizures are either admitted to the intensive care unit because of uncontrolled seizures requiring aggressive treatment or are admitted for other reasons and develop seizures secondarily. These patients may have multiorgan failure and severe metabolic and electrolyte disarrangements, and may require complex medication regimens and interventions. Seizures can be seen as a result of an acute systemic illness, a primary neurologic pathology, or a medication side-effect and can present in a wide array of symptoms from convulsive activity, subtle twitching, to lethargy...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187810/management-of-infections-associated-with-neurocritical-care
#17
REVIEW
L Rivera-Lara, W Ziai, P Nyquist
The reported incidence of hospital-acquired infections (HAIs) in the neurointensive care unit (NICU) ranges from 20% to 30%. HAIs in US hospitals cost between $28 and $45 billion per year in direct medical costs. These infections are associated with increased length of hospital stay and increased morbidity and mortality. Infection risk is increased in NICU patients due to medication side-effects, catheter and line placement, neurosurgical procedures, and acquired immune suppression secondary to steroid/barbiturate use and brain injury itself...
2017: Handbook of Clinical Neurology
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/28170143/prevalence-of-brain-injuries-and-recurrence-of-seizures-in-children-with-posttraumatic-seizures
#19
Mohamed K Badawy, Peter S Dayan, Michael G Tunik, Frances M Nadel, Kathleen A Lillis, Michelle Miskin, Dominic A Borgialli, Michael C Bachman, Shireen M Atabaki, John D Hoyle, James F Holmes, Nathan Kuppermann
OBJECTIVES: Computed tomography (CT) is often used in the emergency department (ED) evaluation of children with posttraumatic seizures (PTS); however, the frequency of traumatic brain injuries (TBIs) and short-term seizure recurrence is lacking. Our main objective was to evaluate the frequency of TBIs on CT and short-term seizure recurrence in children with PTS. We also aimed to determine the associations between the likelihood of TBI on CT with the timing of onset of PTS after the traumatic event and duration of PTS...
May 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28171804/hemodynamic-and-neuro-monitoring-for-neurocritically-ill-patients-an-international-survey-of-intensivists
#20
Sanjeev Sivakumar, Fabio S Taccone, Mohammed Rehman, Holly Hinson, Neeraj Naval, Christos Lazaridis
PURPOSE: To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). METHODS: Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. RESULTS: Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI...
June 2017: Journal of Critical Care
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