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Refractory ICP

Tara L Sacco, Jenna Gonillo Davis
Pharmacologic and nonpharmacologic interventions are available to treat patients who experience serious elevations in intracranial pressure (ICP). In some cases, patients may experience ICP that is refractory to treatment. Significant negative effects on cerebral blood flow, tissue oxygenation, and cerebral metabolism occur as a result of intracranial hypertension, leading to secondary brain injury. In part 2 of this series, nonpharmacologic interventions for ICP and ICP refractory to treatment are discussed...
March 2019: Dimensions of Critical Care Nursing: DCCN
Hai Wang, Youyi Ni, Jian Zheng, Zhaoya Huang, Detao Xiao, Tatsuo Aono
Two fusion methods were established for rapid determination of Pu in soil and sediment samples. The methods consisted of NH4 HSO4 or NH4 HF2 fusion procedures incorporated with procedures for CaF2 /LaF3 co-precipitation, extraction chromatography and SF-ICP-MS measurement. The fusion procedures were done on a portable hot plate instead of in a cumbersome muffle furnace and took only 15 min heating-up time from room temperature to 250 °C and 15 min fusion time at 250 °C. Chemical recoveries of Pu after completing the NH4 HSO4 and NH4 HF2 fusion methods for 0...
March 7, 2019: Analytica Chimica Acta
Thomas A van Essen, Hugo F den Boogert, Maryse C Cnossen, Godard C W de Ruiter, Iain Haitsma, Suzanne Polinder, Ewout W Steyerberg, David Menon, Andrew I R Maas, Hester F Lingsma, Wilco C Peul
BACKGROUND: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. METHODS: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP)...
December 19, 2018: Acta Neurochirurgica
Kaihui Zhang, Min Gao, Guangyu Wang, Yingying Shi, Xiaoying Li, Yvqiang Lv, Guangye Zhang, Zhongtao Gai, Yi Liu
Methylmalonic acidemia (MMA) is a typical type of organic acidemia caused by defects in methylmalonyl-CoA mutase or adenosyl-cobalamin synthesis. Hydrocephalus (HC), results from an imbalance between production and absorption of cerebrospinal fluid (CSF), causeing enlarged cerebral ventricles and increased intracranial pressure, is a condition that requires urgent clinical decision-making. MMA without treatment could result in brain damage. However, HC in MMA was rarely reported. In this study, 147 MMA were identified from 9117 high risk children by gas chromatography mass spectrometry (GC/MS) for organic acidurias screening in urine samples and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for amino acids detection in blood samples...
December 19, 2018: Metabolic Brain Disease
Matthew A Koenig
PURPOSE OF REVIEW: This article reviews the management of cerebral edema, elevated intracranial pressure (ICP), and cerebral herniation syndromes in neurocritical care. RECENT FINDINGS: While corticosteroids may be effective in reducing vasogenic edema around brain tumors, they are contraindicated in traumatic cerebral edema. Mannitol and hypertonic saline use should be tailored to patient characteristics including intravascular volume status. In patients with traumatic brain injury who are comatose, elevated ICP should be managed with an algorithmic, multitiered treatment protocol to maintain an ICP of 22 mm Hg or less...
December 2018: Continuum: Lifelong Learning in Neurology
Nidhi Ravishankar, Rolla Nuoman, Krishna Amuluru, Mohammad El-Ghanem, Venkatraman Thulasi, Neha S Dangayach, Kiwon Lee, Fawaz Al-Mufti
Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence for evaluation and management of medically refractory ICP in SAH. The role of standard management strategies such as head elevation, hyperventilation, mannitol and hypertonic saline as well as lesser known management such as sodium bicarbonate, indomethacin, tromethamine, decompressive craniectomy, decompressive laparotomy, hypothermia, and barbiturate coma are reviewed...
December 4, 2018: Journal of Intensive Care Medicine
Hsun Shuan Wang, Yajun Ruan, Lia Banie, Kai Cui, Ning Kang, Dongyi Peng, Tianshu Liu, Tianyu Wang, Bohan Wang, Guifang Wang, Alan W Shindel, Guiting Lin, Tom F Lue
BACKGROUND: Erectile dysfunction (ED) caused by pelvic neurovascular injury (PNVI) is often refractory to treatment. In many cases, erectogenic therapy is administered in a delayed fashion. AIM: To evaluate penile hemodynamic effects and histologic changes associated with delayed low-intensity extracorporeal shock wave therapy (Li-ESWT) after PNVI ED in a rat model. We visualized images using immunofluorescence and 3-dimensional imaging of solvent-cleared organs (3DISCO), a novel imaging technique...
November 30, 2018: Journal of Sexual Medicine
Joseph Donnelly, Marek Czosnyka, Hadie Adams, Danilo Cardim, Angelos G Kolias, Frederick A Zeiler, Andrea Lavinio, Marcel Aries, Chiara Robba, Peter Smielewski, Peter J A Hutchinson, David K Menon, John D Pickard, Karol P Budohoski
BACKGROUND: Intracranial pressure (ICP) is a clinically important variable after severe traumatic brain injury (TBI) and has been monitored, along with clinical outcome, for over 25 yr in Addenbrooke's hospital, Cambridge, United Kingdom. This time period has also seen changes in management strategies with the implementation of protocolled specialist neurocritical care, expansion of neuromonitoring techniques, and adjustments of clinical treatment targets. OBJECTIVE: To describe the changes in intracranial monitoring variables over the past 25 yr...
November 23, 2018: Neurosurgery
Altaf Ali Laghari, Muhammad Ehsan Bari, Muhammad Waqas, Syed Ijlal Ahmed, Karim Rizwan Nathani, Wardah Moazzam
Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors. Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015-December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected...
October 2018: Asian Journal of Neurosurgery
Georgia G Tsaousi, Lorenzo Marocchi, Paola G Sergi, Chryssa Pourzitaki, Antonio Santoro, Federico Bilotta
INTRODUCTION: Decompressive craniectomy (DC) to control refractory intracranial hypertension in patients with traumatic brain injury (TBI), has been listed as possible but controversial therapeutic approach in the latest version of TBI management guidelines. This study aimed to perform a systematic review and meta-analysis on efficacy and safety of DC compared to standard care in TBI patients. EVIDENCE ACQUISITION: A database search from 2011 to 2017 was conducted to identify studies pertinent to DC compared to standard care after TBI...
October 23, 2018: Journal of Neurosurgical Sciences
Lelio Guida, Fabio Mazzoleni, Alberto Bozzetti, Erik Sganzerla, Carlo Giussani
BACKGROUND: We present a case of almost complete bifrontal dural ossification after decompressive craniectomy for severe traumatic brain injury. CASE DESCRIPTION: A 6-year-old boy was brought to the emergency room after a severe traumatic brain injury (Glasgow Coma Scale/Score 7). Due to rapidly increasing intracranial pressure values (>20 mm Hg) refractory to conservative therapy and in the absence of focal lesions justifying the neurological status, a bicoronal decompressive craniectomy was performed...
December 2018: World Neurosurgery
Sarang Koushik, Narjeet Khurmi, Richard Helmers
No abstract text is available yet for this article.
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Patrick Reid, Irene Say, Smit Shah, Sneha Tolia, Shashank Musku, Charles Prestigiacomo, Chirag D Gandhi
BACKGROUND: Decompressive hemicraniectomy to control medically refractory intracranial hypertension and cerebral edema and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, the critical specifications of the bone flap size necessary to control the intracranial pressure (ICP) and provide improved patient outcomes is unknown. We assessed the effect of craniectomy size on the outcomes in surgical decompression for traumatic brain injury. METHODS: From 2003 to 2011, 58 cases of decompressive hemicraniectomy were performed for evacuation of hematoma and treatment of refractory ICP in adult patients with traumatic brain injury...
November 2018: World Neurosurgery
Michel Roethlisberger, Lara Gut, Daniel Walter Zumofen, Urs Fisch, Oliver Boss, Nicolai Maldaner, Davide Marco Croci, Ethan Taub, Natascia Corti, Jan-Karl Burkhardt, Raphael Guzman, Oliver Bozinov, Luigi Mariani
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population...
July 2018: Neurosurgical Focus
Rathin Pujari, Peter J Hutchinson, Angelos G Kolias
Traumatic brain injury (TBI) remains a leading cause of mortality and disability worldwide. Surgical intervention is one of the main pillars of TBI management. The mainstay of treatment for substantial intracranial hematomas is surgical evacuation. In addition, patients with TBI may have brain swelling and increased intracranial pressure. If the latter is refractory to medical management, surgical interventions can be helpful. In this review we seek to outline the major tenets of the surgical management of TBI...
October 2018: Journal of Neurosurgical Sciences
Jiajie Gu, Haoping Huang, Yuejun Huang, Haitao Sun, Hongwu Xu
Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases...
June 15, 2018: Neurosurgical Review
Sivashakthi Kanagalingam, Prem S Subramanian
PURPOSE OF REVIEW: This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. RECENT FINDINGS: A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial-IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone...
May 28, 2018: Current Treatment Options in Neurology
Jussiane Souza Silva, Alessandra Schneider Henn, Valderi Luiz Dressler, Paola Azevedo Mello, Erico Marlon Moraes Flores
A comprehensive study was developed showing the feasibility of determination of rare earth elements (REE) in low concentration in crude oil by using direct sampling electrothermal vaporization system coupled to inductively coupled plasma mass spectrometry (ETV-ICP-MS). The effect of organic modifier on the REE signal was evaluated and the use of 6 mg of citric acid allowed calibration using aqueous reference solutions (selected pyrolysis and vaporization temperatures were 700 and 2200 °C, respectively). Because of the facility of REE in forming refractory compounds inside the graphite furnace during the heating step, the use of a modifier gas (Freon R-12, 3...
June 5, 2018: Analytical Chemistry
Tara L Sacco, Samantha A Delibert
Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed...
May 2018: Dimensions of Critical Care Nursing: DCCN
Casey J Allen, Daniel J Baldor, Mena M Hanna, Nicholas Namias, M Ross Bullock, Jonathan R Jagid, Kenneth G Proctor
After traumatic brain injury, decompressive craniectomy (DC) is a second-tier, late therapy for refractory intracranial hypertension. We hypothesize that early DC, based on CT evidence of intracranial hypertension, improves intracranial pressure (ICP) and cerebral perfusion pressure (CPP). From September 2008 to January 2015, 286 traumatic brain injury patients requiring invasive ICP monitoring at a single Level I trauma center were reviewed. DC and non-DC patients were propensity score matched 1:1, based on demographics, hemodynamics, injury severity score (ISS), Glasgow Coma Scale (GCS), transfusion requirements, and need for vasopressor therapy...
March 1, 2018: American Surgeon
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