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Nitric Oxide-Based Treatment of Poor-Grade Patients After Severe Aneurysmal Subarachnoid Hemorrhage
ConclusionsEven in comatose/intubated patients, TCD-guided dual-compartment administration of NO donors probably could reverse macrospasm and seems to be feasible. The number of DCI was much lower than expected in this specific subgroup, indicating that this treatment possibly provides a positive impact on outcomes. A randomized trial should verify or falsify our results.
Source: Neurocritical Care - August 14, 2019 Category: Neurology Source Type: research

Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society
ConclusionsPrognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Vitamin K Antagonist (Phenprocoumon) and Subarachnoid Hemorrhage: A Single-Center, Matched-Pair Analysis
ConclusionPatients with phenprocoumon treatment at the time of SAH are significantly older, admission status is worse, and 30-day mortality rates are significantly higher compared to patients without anticoagulant treatment. However, outcome at 6  months did not differ to the matched-pair control group but seems to be strongly associated with the underlying cardiovascular disease. Treatment of these patients is challenging and should be performed on an interdisciplinary base in each individual case. Careful decision-making regarding discont inuation and bridging of anticoagulation and close observation is mandatory.
Source: Neurocritical Care - October 27, 2019 Category: Neurology Source Type: research

Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage
ConclusionsDysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment.
Source: Neurocritical Care - November 14, 2019 Category: Neurology Source Type: research

Beta-Blockade in Aneurysmal Subarachnoid Hemorrhage: a Systematic Review and Meta-Analysis
ConclusionsIn adult patients with aSAH, beta-blocker therapy is associated with a mortality benefit. Studies are generally of a low quality with considerable clinical heterogeneity. Prospective large interventional trials with patient centered outcomes are required to validate this finding.
Source: Neurocritical Care - January 27, 2020 Category: Neurology Source Type: research

Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome: MISTIE II and CLEAR III
ConclusionsConcomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome.Clinical Trial Registrationhttp://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.
Source: Neurocritical Care - February 4, 2020 Category: Neurology Source Type: research

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients
ConclusionThe available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH. Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to better inform clinicians of the best options ...
Source: Neurocritical Care - May 14, 2020 Category: Neurology Source Type: research

Efficacy of 4-Factor Prothrombin Complex Concentrates in Factor Xa Inhibitor-Associated Intracranial Bleeding
Conclusion4FPCC appears to be an effective and safe option for FXaI-associated ICB with outcomes comparable to andexanet alfa. A formal prospective evaluation of this strategy versus andexanet alpha including cost analysis is warranted.
Source: Neurocritical Care - May 18, 2020 Category: Neurology Source Type: research

Regular-Shaped Hematomas Predict a Favorable Outcome in Patients with Hypertensive Intracerebral Hemorrhage Following Stereotactic Minimally Invasive Surgery
ConclusionsPatients with regular-shaped hematomas exhibited more favorable outcomes. Irregular-shaped hematomas and postoperative residual hematoma volume predicted a poor outcome in patients with ICH following sMIS.
Source: Neurocritical Care - May 26, 2020 Category: Neurology Source Type: research

Rural –Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample
ConclusionsDespite current efforts to reduce disparity in stroke care, ICH patients hospitalized in rural hospitals had two times the odds of dying compared to those in urban hospitals. In addition, the ICH mortality gap between rural and urban centers is increasing. Further studies are needed to identify and reverse the causes of this disparity.
Source: Neurocritical Care - May 31, 2020 Category: Neurology Source Type: research

Determining Optimal Mean Arterial Pressure After Cardiac Arrest: A Systematic Review
AbstractThe use of cerebral autoregulation monitoring to identify patient-specific optimal mean arterial pressure (MAPOPT) has emerged as a technique to augment cerebral oxygen delivery in post-cardiac arrest patients. Our systematic review aims to determine (a) the average MAPOPT in these patients, (b) the feasibility of identifying MAPOPT, (c) the brain tissue oxygenation levels when MAP is  within proximity to the MAPOPT and (d) the relationship between neurological outcome and MAPOPT-targeted resuscitation strategies. We carried out this review in accordance with the PRISMA guidelines. We included all studies that use...
Source: Neurocritical Care - June 21, 2020 Category: Neurology Source Type: research

A Model for Prediction of In-Hospital Mortality in Patients with Subarachnoid Hemorrhage
ConclusionsIn addition to the conventional risk factors for in-hospital mortality, in our study, mortality was associated with the presence of coma at onset of the condition, the physiological variables assessed by means of the APACHE II scale within the first 24  h, and the total SOFA score on day 0. A simple prediction model of mortality was developed with novel parameters assessed on admission, which also assessed organ failure and did not require a previous etiological diagnosis.
Source: Neurocritical Care - July 14, 2020 Category: Neurology Source Type: research

Cerebral Microembolism in Intracerebral Hemorrhage: A Prospective Case –Control Study
ConclusionMicro-embolic signals occur in over one-third of patients with ICH. Further research is needed to identify the sources of cerebral microembolism and their relationship with small acute infarcts in ICH.
Source: Neurocritical Care - August 6, 2020 Category: Neurology Source Type: research

Use of a Novel Negative-Pressure Tent During Bedside Tracheostomy in COVID-19 Patients
ConclusionsIt is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
Source: Neurocritical Care - August 6, 2020 Category: Neurology Source Type: research

Liver Fibrosis and Perihematomal Edema Growth in Primary Intracerebral Hemorrhage
ConclusionsIn a multicenter cohort of patients with primary intracerebral hemorrhage, a liver fibrosis score was not associated with PHE volume or growth.
Source: Neurocritical Care - August 16, 2020 Category: Neurology Source Type: research

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