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Resource Allocation: Stable Patients Remain Stable 12 –24 h Post-tPA
ConclusionsNew onset of neurologic deterioration is rare 12 –24 h after treatment of acute stroke. Stable patients with low NIHSS scores and no ICU needs may not require intensive monitoring greater than 12 h post-treatment.
Source: Neurocritical Care - December 8, 2019 Category: Neurology Source Type: research

Predictors of Ventricular Dysrhythmias in Neurology Intensive Care Unit Patients with Prolonged QTc
ConclusionsIn this group of patients with prolonged QTc in the Neuro ICU, we observed several episodes of non-sustained ventricular tachycardia and identified important risk factors associated with their occurrence. This knowledge is essential to inform clinical decisions.
Source: Neurocritical Care - April 16, 2020 Category: Neurology Source Type: research

Safety and Feasibility of a Novel Transnasal Cooling Device to Induce Normothermia in Febrile Cerebrovascular Patients
ConclusionsInducing normothermia with a novel transnasal TMD appears to be safe, feasible and not associated with significant shivering. A multicenter trial testing the ability of the CoolStat to maintain normothermia for 24  h is currently underway.
Source: Neurocritical Care - July 13, 2020 Category: Neurology Source Type: research

Clinicians ’ Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study
ConclusionsCaring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision making involving the family, taking into account patients ’ previously expressed values and preferences and incorporating these into bespoke care planning.
Source: Neurocritical Care - December 2, 2020 Category: Neurology Source Type: research

Role of Interleukin-1 Receptor-Like 1 (ST2) in Cerebrovascular Disease
AbstractFollowing both ischemic and hemorrhagic stroke, innate immune cells initiate a proinflammatory response that further exacerbate tissue injury in the acute phase, but these cells also play an important reparative role thereafter. Numerous cytokines and signaling pathways have been implicated in driving the deleterious proinflammatory response, but less is known about the mediators that connect the initial vascular injury to the systemic immune response and the relationship between proinflammatory and reparative immune responses. The Interleukin-33 (IL-33) and serum stimulation-2 (ST2) axis is an interleukin signalin...
Source: Neurocritical Care - July 6, 2021 Category: Neurology Source Type: research

The Effect of Hyperoxemia on Neurological Outcomes of Adult Patients: A Systematic Review and Meta-Analysis
AbstractHyperoxemia commonly occurs in clinical practice and is often left untreated. Many studies have shown increased mortality in patients with hyperoxemia, but data on neurological outcome in these patients are conflicting, despite worsened neurological outcome found in preclinical studies. To investigate the association between hyperoxemia and neurological outcome in adult patients, we performed a systematic review and meta-analysis of observational studies. We searched MEDLINE, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov from inception to May 2020 f...
Source: Neurocritical Care - January 31, 2022 Category: Neurology Source Type: research

Waveform Morphology as a Surrogate for ICP Monitoring: A Comparison Between an Invasive and a Noninvasive Method
ConclusionsThe new ICPni wave morphology monitor showed a good agreement with the standard invasive method and an acceptable discriminatory power to detect intracranial hypertension.Clinical trial registration Trial registration: NCT05121155.
Source: Neurocritical Care - March 24, 2022 Category: Neurology Source Type: research

Early Hyperchloremia is Independently Associated with Death or Disability in Patients with Intracerebral Hemorrhage
ConclusionsThe independent association between hyperchloremia and death or disability at 90  days suggests that avoidance of hyperchloremia may reduce the observed death or disability in patients with ICH.Clinical Trial RegistrationClinicalTrials.gov: NCT01176565.
Source: Neurocritical Care - May 5, 2022 Category: Neurology Source Type: research

A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients
ConclusionsIn this pilot study, the FMSE achieved a high sensitivity and specificity in detecting delirium. Follow-up validation studies in a larger more diverse cohort of neurocritical care patients will use score cutoffs of  ≥ 1 as “possible” delirium and ≥ 2 as “probable” delirium.
Source: Neurocritical Care - October 14, 2022 Category: Neurology Source Type: research

Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury
ConclusionsEarly low pulse pressure (<  20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection.
Source: Neurocritical Care - June 1, 2023 Category: Neurology Source Type: research

Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations
Abstract The effect of intracranial pressure (ICP) and the role of ICP monitoring are best studied in traumatic brain injury (TBI). However, a variety of acute neurologic illnesses e.g., subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, meningitis/encephalitis, and select metabolic disorders, e.g., liver failure and malignant, brain tumors can affect ICP. The purpose of this paper is to review the literature about ICP monitoring in conditions other than TBI and to provide recommendations how the technique may be used in patient management. A PubMed search between 1980 and September 2013 identifie...
Source: Neurocritical Care - September 11, 2014 Category: Neurology Source Type: research

Monitoring Biomarkers of Cellular Injury and Death in Acute Brain Injury
Conclusion Current studies vary significantly in patient selection, biosample collection/processing, and biomarker measurement protocols, thereby limiting the generalizability of overall results. Future large prospective studies with standardized treatment, biosample collection, and biomarker measurement and validation protocols are necessary to identify high-fidelity biomarkers in neurocritical care.
Source: Neurocritical Care - September 11, 2014 Category: Neurology Source Type: research

Complications Associated with Decompressive Craniectomy: A Systematic Review
Abstract Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all re...
Source: Neurocritical Care - June 2, 2015 Category: Neurology Source Type: research

Emergency Neurological Life Support: Intracerebral Hemorrhage
Abstract Intracerebral hemorrhage (ICH) is a subset of stroke due to bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, reversal of coagulopathy, and proper diagnosis. ICH was chosen as an Emergency Neurological Life Support protocol because intervention within the first critical hour may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently.
Source: Neurocritical Care - October 5, 2015 Category: Neurology Source Type: research

Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome
Conclusions Early deterioration of CA significantly correlates with unfavorable clinical outcome and severity of angiographic vasospasm. Dynamic CA measurements might represent an important tool in stratifying therapy guidelines in patients after SAH.
Source: Neurocritical Care - November 6, 2015 Category: Neurology Source Type: research

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