Neurocritical Care最新文献

{"title":"Unsupervised Clustering in Neurocritical Care: A Systematic Review.","authors":"Jeanette Tas, Verena Rass, Bogdan-Andrei Ianosi, Anna Heidbreder, Melanie Bergmann, Raimund Helbok","doi":"10.1007/s12028-024-02140-w","DOIUrl":"https://doi.org/10.1007/s12028-024-02140-w","url":null,"abstract":"<p><p>Managing patients with acute brain injury in the neurocritical care (NCC) unit has become increasingly complex because of technological advances and increasing information derived from multiple data sources. Diverse data streams necessitate innovative approaches for clinicians to understand interactions between recorded variables. Unsupervised clustering integrates different data streams and could be supportive. Here, we provide a systematic review on the use of unsupervised clustering using NCC data. The primary objective was to provide an overview of clustering applications in NCC studies. As a secondary objective, we discuss considerations for future NCC studies. Databases (Medline, Scopus, Web of Science) were searched for unsupervised clustering in acute brain injury studies including traumatic brain injury (TBI), subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and hypoxic-ischemic brain injury published until  March 13th 2024. We performed the systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We identified 18 studies that used unsupervised clustering in NCC. Predominantly, studies focused on patients with TBI (12 of 18 studies). Multiple research questions used a variety of resource data, including demographics,  clinical- and monitoring data, of which intracranial pressure was most often included (8 of 18 studies). Studies also covered various clustering methods, both traditional methods (e.g., k-means) and advanced methods, which are able to retain the temporal aspect. Finally, unsupervised clustering identified novel phenotypes for clinical outcomes in 9 of 12 studies. Unsupervised clustering can be used to phenotype NCC patients, especially patients with TBI, in diverse disease stages and identify clusters that may be used for prognostication. Despite the need for validation studies, this methodology could help to improve outcome prediction models, diagnostics, and understanding of pathophysiology.Registration number: PROSPERO: CRD4202347097676.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676246","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":"Long-Term Outcomes After Severe Acute Brain Injury Requiring Mechanical Ventilation: Recovery Trajectories Among Patients and Mental Health Symptoms of Their Surrogate Decision Makers.","authors":"Natalie L Smith, Adrienne James, Nassim Matin, Christine T Fong, Monisha Sharma, Abhijit V Lele, Chiara Robba, Nicole Mazwi, Diana B Wiseman, Robert H Bonow, Erin K Kross, Claire J Creutzfeldt, James Town, Sarah Wahlster","doi":"10.1007/s12028-024-02164-2","DOIUrl":"https://doi.org/10.1007/s12028-024-02164-2","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcomes of patients with severe acute brain injury (SABI) and their surrogate decision makers (SDMs) are insufficiently explored.</p><p><strong>Methods: </strong>We conducted a prospective, single-center, observational study of patients with SABI who required mechanical ventilation between September and November 2021. Two telephonic interviews were conducted at 6-12 months and 18-24 months post SABI. Patients' functional outcomes at both time points were measured on the Glasgow Outcome Scale-Extended and categorized as dead (1), dependent (2-4), or independent (5-8). SDMs were interviewed at 18-24 months using validated screening tools for depression, anxiety, and posttraumatic stress disorder and qualitative questions about the hardest challenges during their recovery journey.</p><p><strong>Results: </strong>We included 103 patients (median age 58 years, 28% female, 77% White, 51% with stroke, 49% with traumatic brain injury); in-hospital mortality was 46%. At 6-12 months and 18-24 months, 34% and 36% were independent, respectively; the Glasgow Outcome Scale-Extended score improved ≥ 1 point for 32% between time points. Quality of life was perceived as acceptable for 47% of all survivors and 58% of independent patients by their SDMs. At 18-24 months, we reached 56 SDMs (median age 58 years, 71% female, 72% White). Symptoms of depression, anxiety, and posttraumatic stress disorder were reported in 18%, 30%, and 7%, respectively (23%, 34%, and 9% in the 35 SDMs of survivors and 10%, 24%, and 5% in the 21 SDMs to deceased patients). Main themes about challenges for patients and SDMs included extrinsic factors related to the health care system, and intrinsic factors related to the brain injury: difficulties in adapting to a new state, mental health symptoms, and social isolation.</p><p><strong>Conclusions: </strong>Mental health symptoms among SDMs of patients with SABI were frequent at 18-24 months, and the patients' quality of life was deemed unacceptable for 42% of SDMs to independent survivors. Our findings underscore the need for psychosocial support to SDMs, the importance of addressing modifiable barriers to patient and SDM well-being, and the need for more patient/family-centric outcome measures.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676238","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":"Neuroimaging Markers of Brain Reserve and Associations with Delirium in Patients with Intracerebral Hemorrhage.","authors":"Nathaniel B Rex, Carlin C Chuck, Hari G Dandapani, Helen Y Zhou, Thomas Y Yi, Scott A Collins, Harrison X Bai, Ani Eloyan, Richard N Jones, Jerrold L Boxerman, Timothy D Girard, Olga Boukrina, Michael E Reznik","doi":"10.1007/s12028-024-02148-2","DOIUrl":"https://doi.org/10.1007/s12028-024-02148-2","url":null,"abstract":"<p><strong>Background: </strong>Delirium occurs frequently in patients with stroke, but the role of preexisting neural substrates in delirium pathogenesis remains unclear. We sought to explore associations between acute and chronic neural substrates of delirium in patients with intracerebral hemorrhage (ICH).</p><p><strong>Methods: </strong>Using data from a single-center ICH registry, we identified consecutive patients with acute nontraumatic ICH and available magnetic resonance imaging scans. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were used to classify each patient as delirious or nondelirious during their hospitalization. Magnetic resonance imaging scans were processed and analyzed using semiautomated software, with volumetric measurement of acute ICH volume as well as white matter hyperintensity volume (WMHV) and gray and white matter volumes from the contralateral hemisphere. We tested associations between WMHV and incident delirium using multivariable regression models, and then determined the predictive accuracy of these neuroimaging models via area under the curve (AUC) analysis.</p><p><strong>Results: </strong>Of 139 patients in our cohort (mean [standard deviation] age 67.3 [17.3] years, 53% male), 58 (42%) patients experienced delirium. In our primary analyses, WMHV was significantly associated with delirium after adjusting for ICH features (odds ratio 1.56 per 10 cm³, 95% confidence interval 1.13-2.13), and this association was strengthened after further adjustment for segmented brain volume in patients with high-resolution scans (odds ratio 1.89 per 10 cm³, 95% confidence interval 1.24-2.86). Neuroimaging-based models predicted delirium with high accuracy (AUC 0.81), especially in patients with Glasgow Coma Scale score > 13 (AUC 0.85) and smaller ICH (AUC 0.91).</p><p><strong>Conclusions: </strong>Chronic white matter disease is independently associated with delirium in patients with acute ICH, and neuroimaging biomarkers may have utility in predicting delirium occurrence.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676243","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":"A Propensity Score-Weighted Analysis of Short-Term Corticosteroid Therapy for Refractory Pain Following Spontaneous Subarachnoid Hemorrhage.","authors":"Adam Kardon, Dowon Kim, Haoyu Ren, Matthew N Jaffa, Dina Elsaesser, Michael Armahizer, Katharina M Busl, Neeraj Badjatia, Gunjan Parikh, Prajwal Ciryam, J Marc Simard, Chixiang Chen, Nicholas A Morris","doi":"10.1007/s12028-024-02165-1","DOIUrl":"https://doi.org/10.1007/s12028-024-02165-1","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids are prescribed for refractory headache in patients with spontaneous subarachnoid hemorrhage (SAH) despite limited supporting evidence. We hypothesized that a short course of corticosteroids would reduce pain.</p><p><strong>Methods: </strong>We reviewed all patients who received corticosteroids for refractory headache following spontaneous SAH within our institutional database. Pain was measured by a numeric rating scale (NRS) every 2 h. The primary outcome was maximum daily NRS score; secondary outcomes were the mean daily NRS score and daily opioid consumption. Propensity scores were developed using potential predictors of corticosteroid use, including age, sex, pretreatment 24-h pain burden, and the number of analgesics being used to control pain. Inverse probability treatment weighting (IPTW) was used to balance baseline covariate distributions between patients receiving corticosteroids and control patients. Generalized estimating equations were used to analyze longitudinal NRS scores and oral morphine equivalents based on the weighted cohort.</p><p><strong>Results: </strong>A total of 213 patients were included. The mean age was 55 (SD 13) years, and 141 of 213 (66%) were female. Of 213 patients, 195 (92%) had a low clinical grade (i.e., Hunt-Hess grades 1-3). Seventy patients were prescribed corticosteroids on postbleed day 5 (SD 3.3) on average, with an average of 26 (SD 10) mg of dexamethasone over 48 h. Patients receiving corticosteroids and controls were well balanced on baseline predictors of treatment status. After IPTW, we found that corticosteroid therapy reduced the daily maximum pain NRS score by 0.59 (SE = 0.39, p = 0.12), 0.96 (SE = 0.42, p = 0.02), and 0.91 (SE = 0.46, p = 0.048) on days 1-3, respectively, after adjusting for control effects. The mean daily pain NRS score and daily opioid use were nonsignificantly reduced in the 3 days following corticosteroid initiation after adjusting for control effects.</p><p><strong>Conclusions: </strong>Short-term corticosteroids only slightly reduced maximum pain severity after spontaneous SAH. Other analgesic strategies are required to manage refractory pain in this population.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676216","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":"War and Neurologic Trauma.","authors":"Eelco F M Wijdicks","doi":"10.1007/s12028-024-02161-5","DOIUrl":"10.1007/s12028-024-02161-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624763","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":"Reply to the Comment on \"Efficacy of N-Methyl-D-Aspartate (NMDA) Receptor Antagonists in Treating Traumatic Brain Injury-Induced Brain Edema: A Systematic Review and Meta-Analysis of Animal Studies\".","authors":"Fernanda Cristina Poscai Ribeiro, Nadine Vieira de Oliveira, Gabriela Regonha Coral, Alcântara Ramos de Assis César, Moisés Willian Aparecido Gonçalves, Erika Said Abu Egal, Kleber Fernando Pereira","doi":"10.1007/s12028-024-02167-z","DOIUrl":"https://doi.org/10.1007/s12028-024-02167-z","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624760","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":"Anticoagulation in Acute Stroke: Early Claims and Later Doubts.","authors":"Eelco F M Wijdicks","doi":"10.1007/s12028-024-02160-6","DOIUrl":"https://doi.org/10.1007/s12028-024-02160-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624750","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":"Beyond the Pupil: On Cranial Nerves, Brainstem Reflexes, and its Implications.","authors":"Eelco F M Wijdicks","doi":"10.1007/s12028-024-02163-3","DOIUrl":"https://doi.org/10.1007/s12028-024-02163-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624752","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":"Commentary on \"Efficacy of N-Methyl-D-Aspartate (NMDA) Receptor Antagonists in Treating Traumatic Brain Injury-Induced Brain Edema: A Systematic Review and Meta-Analysis of Animal Studies\".","authors":"Ankur Kapoor, Rachana Mehta, Muhammed Shabil, Sanjit Sah","doi":"10.1007/s12028-024-02166-0","DOIUrl":"https://doi.org/10.1007/s12028-024-02166-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624754","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":"Extracerebral Normalization of ¹⁸F-FDG PET Imaging Combined with Behavioral CRS-R Scores Predict Recovery from Disorders of Consciousness.","authors":"Kun Guo, Guiyu Li, Zhiyong Quan, Yirong Wang, Junling Wang, Fei Kang, Jing Wang","doi":"10.1007/s12028-024-02142-8","DOIUrl":"https://doi.org/10.1007/s12028-024-02142-8","url":null,"abstract":"<p><strong>Background: </strong>Identifying patients likely to regain consciousness early on is a challenge. The assessment of consciousness levels and the prediction of wakefulness probabilities are facilitated by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET). This study aimed to develop a prognostic model for predicting 1-year postinjury outcomes in prolonged disorders of consciousness (DoC) using ¹⁸F-FDG PET alongside clinical behavioral scores.</p><p><strong>Methods: </strong>Eighty-seven patients with prolonged DoC newly diagnosed with behavioral Coma Recovery Scale-Revised (CRS-R) scores and ¹⁸F-FDG PET/computed tomography (18F-FDG PET/CT) scans were included. PET images were normalized by the cerebellum and extracerebral tissue, respectively. Images were divided into training and independent test sets at a ratio of 5:1. Image-based classification was conducted using the DenseNet121 network, whereas tabular-based deep learning was employed to train depth features extracted from imaging models and behavioral CRS-R scores. The performance of the models was assessed and compared using the McNemar test.</p><p><strong>Results: </strong>Among the 87 patients with DoC who received routine treatments, 52 patients showed recovery of consciousness, whereas 35 did not. The classification of the standardized uptake value ratio by extracerebral tissue model demonstrated a higher specificity and lower sensitivity in predicting consciousness recovery than the classification of the standardized uptake value ratio by cerebellum model. With area under the curve values of 0.751 ± 0.093 and 0.412 ± 0.104 on the test sets, respectively, the difference is not statistically significant (P = 0.73). The combination of standardized uptake value ratio by extracerebral tissue and computed tomography depth features with behavioral CRS-R scores yielded the highest classification accuracy, with area under the curve values of 0.950 ± 0.027 and 0.933 ± 0.015 on the training and test sets, respectively, outperforming any individual mode.</p><p><strong>Conclusions: </strong>In this preliminary study, a multimodal prognostic model based on ¹⁸F-FDG PET extracerebral normalization and behavioral CRS-R scores facilitated the prediction of recovery in DoC.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624758","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}