Neurocritical Care最新文献

{"title":"Epidemiological Patterns and Variability in Acute Brain Injury: A Multicenter Registry Analysis in South Korea's Neurocritical Care Units.","authors":"Heewon Jeong, So Hee Park, Yoon-Hee Choo, Dong-Wan Kang, Yong Soo Kim, Bosco Seong Kyu Yang, Huimahn Alex Choi, Sung-Min Cho, Eun Jin Ha, Jiwoong Oh, Han-Gil Jeong","doi":"10.1007/s12028-025-02313-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02313-1","url":null,"abstract":"<p><strong>Background: </strong>Specialized neurocritical care (NCC) improves outcomes in acute brain injury (ABI), but significant variability exists in practices across and hospitals within South Korea's developing national NCC system. This study aims to assess clinical variability among patients with ABI across six tertiary NCC units (NCCUs) in South Korea and evaluate center-specific effects on clinical outcomes.</p><p><strong>Methods: </strong>A multicenter registry of patients with ABI admitted to NCCUs between April 2023 and April 2024 was analyzed. A descriptive analysis was conducted to evaluate demographic, clinical, and treatment characteristics across centers. Variability across centers was quantified using the average standardized mean difference (SMD) for key variables. Mixed-effects and fixed-effects models compared center-specific effects on 6- and 12-month functional outcomes (utility-weighted modified Rankin scale [mRS] score), in-hospital mortality, length of NCCU stay, and tracheostomy rates.</p><p><strong>Results: </strong>Among 1,125 patients, 202 (18.2%) had aneurysmal subarachnoid hemorrhage, 478 (42.5%) had intracerebral hemorrhage, and 442 (39.3%) had traumatic brain injury. The median Glasgow Coma Scale (GCS) score was 13 (interquartile range 7-15). Notable differences (SMD > 0.2) were observed in premorbid mRS scores, initial clinical severity (e.g., GCS, pupillary response), treatment practices (e.g. intracranial pressure monitoring, vasospasm prophylaxis), and outcomes (e.g., 6-month mRS score). Hospital-specific effects did not significantly influence most outcomes; mixed-effects models showed no significant improvement in model fit for 6-month mRS scores (P = 0.78), in-hospital mortality (P = 0.99), length of NCCU stay (P = 0.12), and tracheostomy rates (P = 0.11), except for the 12-month mRS score (P = 0.01).</p><p><strong>Conclusions: </strong>Significant variability exists among patients with ABI across NCCUs in South Korea. Despite these differences, center-specific effects did not significantly influence key clinical outcomes closely related to NCCU care, suggesting that variability in outcomes may be more attributable to patient-level factors.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Monitoring After Elective Intracranial Surgery in a Postanesthesia Care Unit is Safe, Efficient, and Cost-Effective.","authors":"Arthur Wagner, Alexander Quiring, Anna Do, Markus Heim, Gerhard Schneider, Bernhard Meyer","doi":"10.1007/s12028-025-02323-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02323-z","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates whether monitoring patients in the postanesthesia care unit (PACU) after elective intracranial surgery is as safe and effective as intensive care unit (ICU) monitoring, focusing on postoperative complications and resource use.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a tertiary academic hospital, analyzing patients who underwent elective craniotomies from March 2013 to September 2023. Patients were allocated to PACU or ICU monitoring based on preoperative risk assessment and intraoperative events. Outcomes measured included complication rates, revision surgeries within 72 h, transfers from PACU to ICU, and ICU resource use.</p><p><strong>Results: </strong>A total of 5638 consecutive patients (mean age 54 years, 56% female) were analyzed, of whom 96.0% were monitored in the PACU, whereas 3.7% required ICU admission due to high-risk conditions or intraoperative events. The early complication rate in PACU-monitored patients was 17.1%, with most complications occurring within the first 13.2 h (SD 17.0) post surgery. Revision surgery was required in 4.6% of cases, and transfers from the PACU to the ICU occurred in 1.9%. PACU monitoring reduced ICU use by 94.4% compared to an all-ICU strategy, with no compromise in safety or outcomes.</p><p><strong>Conclusions: </strong>PACU-based monitoring is a safe and efficient alternative to ICU care for elective craniotomy patients, offering comparable complication rates and outcomes. This approach significantly reduces ICU demand, providing a cost-effective strategy that optimizes critical care resources while maintaining patient safety.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Discriminative Ability of ROTEM for Delayed Cerebral Ischemia and Poor Outcome Following Aneurysmal Subarachnoid Hemorrhage.","authors":"M A Tjerkstra, H Labib, B A Coert, R Post, W P Vandertop, D Verbaan, N P Juffermans","doi":"10.1007/s12028-025-02309-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02309-x","url":null,"abstract":"<p><strong>Background: </strong>The prediction of delayed cerebral ischemia (DCI) and poor clinical outcome following aneurysmal subarachnoid hemorrhage (aSAH) is an unmet clinical need to improve on stratification of patients. DCI and poor clinical outcome following aSAH have been associated with hypercoagulability as detected by viscoelastic testing. This study assesses temporal alterations in rotational thromboelastography (ROTEM) coagulation profiles and the discriminative ability of ROTEM parameters for DCI and poor clinical outcome following aSAH.</p><p><strong>Methods: </strong>ROTEM parameters were measured on admission, days 3-5, and days 9-11 after aSAH and compared between patients with and without DCI, radiological DCI, and poor 6-month clinical outcome as per modified Rankin Scale scores 4-6. Receiver operating characteristic curve analyses were used to calculate areas under the curve (AUCs) and determine cutoff values with a sensitivity > 90% for (radiological) DCI and with a specificity > 90% for poor outcome.</p><p><strong>Results: </strong>Of 160 included patients with aSAH, 31 (19%) had DCI, 16 (10%) had radiological DCI, and 68 (44%) had poor outcome at 6 months. DCI, radiological DCI, and poor clinical outcome were associated with hypercoagulability. The ROTEM parameter with the best discriminative ability for radiological DCI was INTEM clotting time (AUC 0.75) on admission day, with an optimal cutoff value of < 146 s (sensitivity 92%, specificity 47%). For poor outcome, this was increased clot strength by FIBTEM amplitude at 10 minutes (A10, AUC 0.85) on days 3-5, with an optimal cutoff value > 27 mm (specificity 94%, sensitivity 49%).</p><p><strong>Conclusions: </strong>In this study, ROTEM parameters indicative of increased coagulation had good predictive ability for poor clinical outcome. If independently validated, ROTEM parameters might have the potential to stratify patients with aSAH who may benefit from anticoagulant treatment in future trials with the aim to improve clinical outcome.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume of Aneurysmal Subarachnoid Hemorrhage and Cognitive Outcomes.","authors":"Elena Sagues, Navami Shenoy, Alex Van Dam, Lidia Diaz, Andres Gudino, Carlos Dier, Domenica Cifuentes, Ruben Calle, Linder Wendt, Kathleen Dlouhy, Mario Zanaty, Santiago Ortega-Gutierrez, Natalia Garcia-Casares, Edgar A Samaniego","doi":"10.1007/s12028-025-02326-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02326-w","url":null,"abstract":"<p><strong>Background: </strong>The modified Fisher score is commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to estimate hemorrhage burden and support early prognostication, although its accuracy in predicting cognitive outcomes remains limited. This study compares the predictive value of the subjective asessment of aSAH volume through the modified Fisher score with an objetive volumetric quantification in prognosticating cognitive outcomes.</p><p><strong>Methods: </strong>This retrospective observational study included patients with aSAH between 2009 and 2024 and good functional recovery (modified Rankin score ≤ 2) at least 6 months after aSAH. Cognitive outcomes were assessed using Montreal Cognitive Assessment scores normalized to population data, with poor outcomes defined as Montreal Cognitive Assessment scores < 25th percentile for normative data. A semiautomated method was used to quantify hemorrhage volume from presentation on computed tomography scans. Logistic regression, receiver operating characteristic curves, and mediation analyses were conducted to evaluate the potential relationship between aSAH volume, clinical variables, and cognitive outcomes.</p><p><strong>Results: </strong>A total of 142 patients with aSAH were included in the study, with 30% of patients (43/142) experiencing poor cognitive outcomes. The objective quantification of hemorrhage volume demonstrated a superior predictive performance compared with the modified Fisher score in determining poor cognitive outcomes (area under the curve 0.75 vs. 0.66, p = 0.037). An aSAH volume cutoff of 24 mL yielded a sensitivity of 72% and a specificity of 60% in predicting poor cognitive outcomes. Mediation analysis revealed partial mediation by vasospasm in the relationship between hemorrhage volume and poor cognitive outcomes.</p><p><strong>Conclusions: </strong>There is a high rate of cognitive impairment among survivors with aSAH with good functional recovery. Volume quantification outperformed the modified Fisher score in predicting cognitive outcomes after aSAH. aSAH volumes more than 24 mL are linked to worse outcomes, with vasospasm contributing to this association.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Ischemic Preconditioning to Prevent Delayed Cerebral Ischemia Due to Vasospasm in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage.","authors":"Carolin Albrecht, Teresa Silvestri, Maria Wostrack, Christian Maegerlein, Insa Janssen, Jan Martin, Bernhard Meyer, Arthur Wagner, Jens Gempt","doi":"10.1007/s12028-025-02324-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02324-y","url":null,"abstract":"<p><strong>Background: </strong>Remote ischemic preconditioning (RIPC) has shown potential in reducing vasospasm-induced secondary ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Research suggests RIPC may help the brain adapt to periods of reduced blood flow, thereby reducing the risk of cerebral infarction secondary to delayed cerebral ischemia. This study aimed to analyze the possible impact of RIPC in patients with vasospasm following aSAH.</p><p><strong>Methods: </strong>We performed a prospective, randomized, controlled, and rater-masked trial at our high-volume neurovascular center. Patients treated for aSAH between November 2019 and September 2023 were randomly allocated to either the control or RIPC intervention group. The RIPC intervention involved three upper arm blood pressure cuff inflations (20 mm Hg above systolic pressure) for 5 min, followed by 5 min of reperfusion, administered for 10 consecutive days within the initial 14 days after aSAH. The primary end point was postinterventional computed tomography to identify new cerebral infarction areas.</p><p><strong>Results: </strong>Among 60 patients (29 in the intervention group, 31 in the control group) the entire cohort averaged 62.0 years, with no significant age difference between groups (p = 0.41). RIPC did not significantly affect the initial occurrence of symptomatic vasospasms or the incidence of cerebral infarctions (RIPC 24.1% vs. control 16.1%, p = 0.44). No significant difference was found between the two groups with respect to incidence of new neurological symptoms (p = > 0.99) or in-hospital mortality (p = 0.5).</p><p><strong>Conclusions: </strong>Remote ischemic preconditioning does not appear to influence the occurrence of vasospasms or the development of new infarcts on computed tomography. Larger studies are needed to further explore whether RIPC may have a role in specific high-risk subgroups or clinical settings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Cerebrospinal Compensatory Zones Using a Noninvasive Approach.","authors":"Sérgio Brasil, Marek Czosnyka, Wellingson S Paiva, Gustavo Frigieri","doi":"10.1007/s12028-025-02320-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02320-2","url":null,"abstract":"<p><strong>Background: </strong>Intracranial compliance (ICC) reflects the balance among intracranial volume components. Recent technological advances enable continuous, noninvasive assessment of ICC in neurocritical care settings. In this study, we aimed to correlate noninvasive ICC parameters derived from intracranial pressure (ICP) waveform morphology with the established amplitude-pressure index (RAP index), which is calculated using invasive ICP monitoring.</p><p><strong>Methods: </strong>Patients with traumatic brain injury underwent ventricular ICP monitoring. Simultaneously, ICP values and waveform characteristics were recorded using an external skull microdynamics sensor (brain4care) that provides surrogate waveform parameters, including the P2/P1 ratio and time-to-peak (TTP). The RAP index was calculated using dedicated software based on ICP values and pulse amplitude and was used to categorize patients into three groups: (1) adequate ICC, (2) compromised ICC, and (3) exhausted ICC. Noninvasive parameters (P2/P1 ratio and TTP) were then analyzed in relation to RAP index groupings.</p><p><strong>Results: </strong>A total of 61 patients were included. Group 1 (adequate ICC) had a median ICP of 12.3 ± 5.4 mm Hg, a P2/P1 ratio of 1.06 ± 0.3, and a TTP of 0.18 ± 0.09 s. Group 2 (compromised ICC) had a median ICP of 13 ± 6.4 mm Hg, a P2/P1 ratio of 1.15 ± 0.32, and a TTP of 0.23 ± 0.07 s. Group 3 (exhausted ICC) had a median ICP of 19.45 ± 5.9 mm Hg, a P2/P1 ratio of 1.31 ± 0.26, and a TTP of 0.25 ± 0.05 s. Regression analysis revealed a statistically significant association between the noninvasive parameters and RAP index-based ICC classification (p < 0.0001).</p><p><strong>Conclusions: </strong>This study demonstrates a significant correlation between the RAP index and noninvasive ICP waveform-derived parameters, such as the P2/P1 ratio and TTP. These findings suggest that such noninvasive measures may serve as reliable indicators of ICC status. The critical ICP cut-off per RAP was 19.45 mmHg, below the current threshold for therapy escalation according to TBI guidelines. Although further prospective validation is required, this approach has the potential to facilitate earlier intervention before ICC deterioration and enable noninvasive monitoring, possibly improving outcomes in neurocritical care.</p><p><strong>Trial registration: </strong>NCT03144219. Registered 15 June 2017, http://www.</p><p><strong>Clinicaltrials: </strong>gov/NCT03144219 .</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier: NCT03144219.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The Pupillary Light-Off Reflex in Acute Disorders of Consciousness\".","authors":"Aabir Imran, Aaila Haider","doi":"10.1007/s12028-025-02317-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02317-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Blood Pressure Variability is Associated with More Time Spent Outside Personalized Limits of Cerebral Autoregulation in Postpartum Preeclampsia.","authors":"Michael Kirschner, Helen Woolcock Martinez, Noora Haghighi, Whitney A Booker, Randolph Marshall, Natalie A Bello, Nils Petersen, Eliza C Miller","doi":"10.1007/s12028-025-02316-y","DOIUrl":"10.1007/s12028-025-02316-y","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is associated with altered cerebral autoregulation (CA) and cerebrovascular injury, including intracranial hemorrhage and cerebral oedema, which are major causes of postpartum maternal mortality. Impaired autoregulation increases susceptibility to cerebral hypoperfusion or hyperperfusion. Preeclampsia is also associated with sympathetic hyperreactivity resulting in increased blood pressure variability (BPV). We investigated whether higher BPV in postpartum patients with preeclampsia correlated with more time spent outside the personalized limits of CA.</p><p><strong>Methods: </strong>This is a preliminary analysis of observational data collected through the Protecting Maternal Brains from Injury and Stroke study (ClinicalTrials.gov identifier: NCT05726279), an ongoing, nonrandomized, nonmasked pilot clinical trial that includes observational and interventional arms. Eligible patients were admitted for treatment of severe preeclampsia within 6 weeks after delivery. We continuously measured mean arterial blood pressure (MAP) using finger plethysmography and regional oxygen saturation with near infrared spectroscopy for up to 24 h. We calculated BPV as the standard deviation of MAP over the monitoring period. We correlated change in regional oxygen saturation with change in MAP to generate individual autoregulatory curves. The upper and lower MAPs, where curves crossed a correlation coefficient of ≥ 0.3, were considered limits of CA. We computed a Pearson correlation (R value) between BPV and percentage of time outside limits of CA.</p><p><strong>Results: </strong>We analyzed data from 19 participants, all of whom were in the observational arm of the trial. The median monitoring time was 16.0 h (interquartile range 5.7-19.5). Higher BPV correlated with more time spent outside limits of CA (R = 0.71, p < 0.001), including above the upper limit (R = 0.56, p = 0.012) but not below the lower limit (R = 0.31, p = 0.200).</p><p><strong>Conclusions: </strong>Higher BPV in postpartum patients with preeclampsia correlated with more time outside the personalized limits of CA. High BPV may identify patients at higher cerebrovascular risk. Future studies should correlate BPV with maternal outcomes in preeclampsia.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor for: \"The Pupillary Light-Off Reflex in Acute Disorders of Consciousness\".","authors":"Daniel Kondziella, Sarah Gharabaghi Stückler, Merlin D Larson","doi":"10.1007/s12028-025-02318-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02318-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Glibenclamide in Improving Cerebral Edema and Neurological Outcomes in Stroke: a GRADE-Evaluated Systematic Review and Meta-analysis with Subgroup Analysis.","authors":"Hazem E Mohammed, Mohamed E Haseeb, Zeyad Bady, Mohamed Nasser, Mostafa Meshref","doi":"10.1007/s12028-025-02311-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02311-3","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a significant cause of morbidity and mortality worldwide, with cerebral edema being a major complication. Glibenclamide, a SUR1-TRPM4 channel inhibitor, has been proposed to reduce cerebral edema, but its clinical efficacy remains uncertain. This meta-analysis aimed to evaluate the efficacy and safety of glibenclamide in patients with stroke, including acute ischemic stroke, acute subarachnoid hemorrhage, and intracerebral hemorrhage.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus up to January 2025. The primary efficacy outcomes included excellent (modified Rankin Scale [mRS] score 0-1) and good (mRS score 0-2) functional outcomes at 90 days. Safety outcomes included the incidence of hypoglycemia and decompressive craniectomy. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Ten and eight randomized controlled trials (RCTs) were included in our qualitative and quantitative analysis, respectively, encompassing 1,691 participants aged 18 to 85. No significant difference was observed between the glibenclamide and control groups regarding excellent functional outcome (risk ratio [RR] 1.10, 95% confidence interval [CI] 0.92-1.32, P = 0.29) and good functional outcome (RR 1.07, 95% CI 0.96-1.18, P = 0.22). Safety analysis revealed no significant increase in serious adverse events (RR 1.11, 95% CI 1.00-1.23, P = 0.06). Notably, hypoglycemia incidence after sensitivity analysis was higher in the glibenclamide group (RR 4.56, 95% CI 2.07-10.03, P = 0.0002).</p><p><strong>Conclusions: </strong>Glibenclamide did not significantly improve functional outcomes or reduce mortality in stroke patients but was associated with a higher incidence of hypoglycemia. Further well-designed RCTs are needed to clarify its therapeutic role and optimize safety protocols.</p><p><strong>Clinical trial registration: </strong>PROSPERO registration number: CRD420251008350.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}