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Liezel Ulloque-Caamaño, Joulen Mo-Carrascal, Johana Maraby, Alexis Narvaez-Rojas, Loraine Quintana-Pajaro, Yancarlos Ramos-Villegas, Luis R Moscote-Salazar
Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations...
2019: Cirugia y Cirujanos
Caroline Der-Nigoghossian, Kimberly Levasseur-Franklin, Jason Makii
Optimal blood pressure management is controversial in neurocritically ill patients due to conflicting concerns of worsening ischemia with decreased blood pressure versus cerebral edema and increased intracranial pressure with elevated blood pressure. In addition, there is a lack of high-quality evidence regarding optimal blood pressure goals in patients with most of these conditions. This review summarizes guideline recommendations and examines the literature for blood pressure management in patients with ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury...
February 7, 2019: Pharmacotherapy
Hannah C Glass, Donna M Ferriero, David H Rowitch, Thomas K Shimotake
PURPOSE OF REVIEW: With the advent of therapeutic hypothermia for treatment of hypoxic ischemic encephalopathy, and improvements in neuroimaging and bedside neuromonitoring, a new era of neonatal brain-focused care has emerged in recent years. We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes...
January 31, 2019: Current Opinion in Pediatrics
Ericka L Fink, Sue R Beers, Amy J Houtrow, Rudolph Richichi, Cheryl Burns, Lesley Doughty, Roberto Ortiz-Aguayo, Catherine A Madurski, Cynthia Valenta, Maddie Chrisman, Lynn Golightly, Michelle Kiger, Cheryl Patrick, Amery Treble-Barna, Dorothy Pollon, Craig M Smith, Patrick Kochanek
OBJECTIVES: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN: Randomized controlled trial. SETTING: Three tertiary care PICUs in the United States. PATIENTS: Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours...
January 30, 2019: Pediatric Critical Care Medicine
Ancor Sanz-Garcia, Miriam Perez-Romero, Jesus Pastor, Rafael G Sola, Lorena Vega-Zelaya, Gema Vega, Fernando Monasterio, Carmen Torrecilla, Paloma Pulido, Guillermo J Ortega
Sedation of neurocritically ill patients is one of the most challenging situation in ICUs. Quantitative knowledge on the sedation effect on brain activity in that complex scenario could help to uncover new markers for sedation assessment. Hence, we aim to evaluate the existence of changes of diverse EEG-derived measures in deeply-sedated (RASS -Richmond Agitation-Sedation Scale- -4 and -5) neurocritically ill patients, and also whether sedation doses are related with those eventual changes. 
 Approach: We performed an observational prospective cohort study in the Intensive Care Unit of the Hospital de la Princesa...
January 31, 2019: Journal of Neural Engineering
Yu-Zhi Gao, Qiang Li, Chun-Shuang Wu, Shao-Yun Liu, Mao Zhang
OBJECTIVES: As a noninvasive method for evaluation of cerebral hemodynamics, the correct interpretation of transcranial Doppler or transcranial imaging (TCI) data remains a major challenge. We explored how to interpret the pulsatility index (PI) derived via TCI during evaluations of cerebral hemodynamics in posthemicraniectomy patients. METHODS: We included patients who underwent invasive arterial pressure and intracranial pressure (ICP) monitoring and simultaneous TCI examinations after hemicraniectomy...
January 30, 2019: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
(no author information available yet)
No abstract text is available yet for this article.
February 5, 2019: Chinese Medical Journal
Salia Farrokh, Sung-Min Cho, Jose I Suarez
PURPOSE OF REVIEW: To discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care. RECENT FINDINGS: Maintaining euvolemia with crystalloids seems to be the recommended fluid resuscitation for neurocritical care patients. Buffered crystalloids have been shown to reduce hyperchloremia in patients with subarachnoid hemorrhage without causing hyponatremia or hypo-osmolality. In addition, in patients with traumatic brain injury, buffered solutions reduce the incidence of hyperchloremic acidosis but are not associated with intracranial pressure (ICP) alteration...
January 22, 2019: Current Opinion in Critical Care
Olivier Opdenakker, Anna Vanstraelen, Veerle De Sloovere, Geert Meyfroidt
PURPOSE OF REVIEW: In this article, the specific and general indications for sedatives in the neurocritical care unit are discussed, together with an overview on current insights in sedative protocols for these patients. In addition, physiological effects of sedative agents on the central nervous system are reviewed. RECENT FINDINGS: In the general ICU population, a large body of evidence supports light protocolized sedation over indiscriminate deep sedation. Unfortunately, in patients with severe acute brain injury, the evidence from randomized controlled trials is scarce to nonexistent, and practice is supported by expert opinion, physiological studies and observational or small interventional trials...
January 21, 2019: Current Opinion in Critical Care
Fumiaki Oka, David Y Chung, Michiyasu Suzuki, Cenk Ayata
BACKGROUND: Delayed cerebral ischemia (DCI) is among the most dreaded complications following aneurysmal subarachnoid hemorrhage (SAH). Despite advances in neurocritical care, DCI remains a significant cause of morbidity and mortality, prolonged intensive care unit and hospital stay, and high healthcare costs. Large artery vasospasm has classically been thought to lead to DCI. However, recent failure of clinical trials targeting vasospasm to improve outcomes has underscored the disconnect between large artery vasospasm and DCI...
January 22, 2019: Neurocritical Care
Ciera L Patzke, Michael J Armahizer, Neeraj Badjatia, Melissa Motta
Background and Purpose: Current literature reports that half of critically ill patients are continued on broad-spectrum antibiotics beyond 72 hours despite no confirmed infection. The purpose of this retrospective study was to identify the incidence of and risk factors for prolonged empiric antimicrobial therapy (PEAT) in adult neurocritical care (NCC) patients treated for pneumonia, hypothesizing that NCC patients will have a higher incidence of PEAT. Methods: This is a retrospective chart review of adult NCC patients treated for pneumonia...
January 2019: Neurohospitalist
Katharina Maria Busl, Thomas P Bleck, Panayiotis N Varelas
Importance: Neurocritical care has grown into an organized specialty that may have consequences for patient care, outcomes, research, and neurointensive care (neuroICU) technology. Observations: Neurocritical care improves care and outcomes of the patients who are neurocritically ill, and neuroICUs positively affect the financial state of health care systems. The development of neurocritical care as a recognized subspecialty has fostered multidisciplinary research, neuromonitoring, and neurocritical care information technology, with advances and innovations in practice and progress...
January 22, 2019: JAMA Neurology
Casey C May, Beth L Erwin, Margaret Childress, Josh Cortopassi, Garrett Curtis, Tyson Kilpatrick, Jennifer Taylor, Bonnie Vance, Doug Wylie
Background: Previous reports note that in a mixed patient population, vancomycin doses >4 g/day are associated with increased rates of acute kidney injury (AKI). Objective: The objective of the study is to determine if vancomycin regimens >4 g/day are associated with a higher incidence of AKI in neurocritical care unit (NCCU) and trauma/burn Intensive Care Unit (TBICU) patients. Materials and Methods: This single-centered, retrospective study enrolled adult patients initiated on vancomycin in the NCCU and TBICU at an academic medical center during 2016...
October 2018: International Journal of Critical Illness and Injury Science
Francois Mathieu, Abdelhakim Khellaf, Eric Peter Thelin, Frederick Adam Zeiler
Thermal diffusion flowmetry (TDF) is an appealing candidate for monitoring of cerebral blood flow (CBF) in neurocritical-care patients as it provides absolute measurements with a high temporal resolution, potentially allowing for bedside intervention that could mitigate secondary injury. We performed a systematic review of TDF-regional(r)CBF measurements and their association with A) patient functional outcome B) other neurophysiological parameters C) imaging-based tissue outcomes. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth and the Cochrane Databases from inception to October 2018 and relevant conference proceedings published over the last 5 years...
January 14, 2019: Journal of Neurotrauma
Jose A Pineda, David D Limbrick
No abstract text is available yet for this article.
January 2019: Pediatric Critical Care Medicine
Charles R Wira, Tracy E Madsen, Bernard P Chang, Jason T Nomura, Evie Marcolini, Nina T Gentile, Kraftin E Schreyer, Lisa H Merck, Matthew Siket, Karen Greenberg, Christopher G Zammit, Edward C Jauch, M Fernanda Bellolio
Objectives: Neurovascular and neurocritical care emergencies constitute a leading cause of morbidity/mortality. There has been great evolution in this field, including but not limited to extended time-window therapeutic interventions for acute ischemic stroke. The intent of this article is to evaluate the goals and future direction of clinical rotations in neurovascular and neurocritical care for emergency medicine (EM) residents. Methods: A panel of 13 board-certified emergency physicians from the Society for Academic Emergency Medicine (SAEM) neurologic emergencies interest group (IG) convened in response to a call for publications-three with fellowship training/board certification in stroke and/or neurocritical care; five with advanced research degrees; three who have been authors on national practice guidelines; and six who have held clinical duties within neurology, neurosurgery, or neurocritical care...
December 2018: AEM education and training
Niyatee P Samudra, Soo M Park, Sara E Gray, Mohammed A Sebai, DaiWai M Olson
PURPOSE: To assess whether the collection and communication of intracranial pressure (ICP) values were standardized and reproducible. METHODS: Integrative review of clinical trials ( n = 357) reporting ICP as a variable. RESULTS: Only 24.1% of studies reported adequate data required for replication. Of the 357 reports, 342 provided information about the design, 274 discussed sampling strategy, 294 identified the ICP device type, 312 provided a unit of measure, 121 provided anatomical localization for measuring ICP, and 83 provided information about patient positioning...
December 2018: Journal of Nursing Measurement
Ivan R F da Silva, Luciano Gouvea, Carlos Bruno Nogueira, Victor Cravo, Bernardo B Liberato
Background: We analyzed the utilization of acute neurologic care during the 2016 Olympic and Paralympic Games in Rio de Janeiro. Methods: We conducted a retrospective analysis of data collected during the games. Results: Sixty-three neurologic evaluations were performed in patients from the Olympic Family (OF), 22 of these involving athletes from 19 countries. Traumatic brain injuries (TBIs) were the most frequent reason for assessment among athletes, some associated with polytrauma...
December 2018: Neurology. Clinical Practice
(no author information available yet)
Military neurosurgery has played an integral role in the development and innovation of neurosurgery and neurocritical care in treating battlefield injuries. It is of paramount importance to continue to train and prepare the next generation of military neurosurgeons. For the Army, this is currently primarily achieved through the military neurosurgery residency at the National Capital Consortium and through full-time out-service positions at the Veterans Affairs-Department of Defense partnerships with the University of Florida, the University of Texas-San Antonio, and Baylor University...
December 1, 2018: Neurosurgical Focus
Anine P Skibsted, Moshgan Amiri, Patrick M Fisher, Annette Sidaros, Melita Cacic Hribljan, Vibeke Andrée Larsen, Joan Lilja S Højgaard, Miki Nikolic, John Hauerberg, Martin E Fabricius, Gitte Moos Knudsen, Kirsten Møller, Daniel Kondziella
Aims and Objectives: To facilitate individualized assessment of unresponsive patients in the intensive care unit for signs of preserved consciousness after acute brain injury. Background: Physicians and neuroscientists are increasingly recognizing a disturbing dilemma: Brain-injured patients who appear entirely unresponsive at the bedside may show signs of covert consciousness when examined by functional MRI (fMRI) or electroencephalography (EEG). According to a recent meta-analysis, roughly 15% of behaviorally unresponsive brain-injured patients can participate in mental tasks by modifying their brain activity during EEG- or fMRI-based paradigms, suggesting that they are conscious and misdiagnosed...
2018: Frontiers in Neurology
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