Neurocritical Care最新文献

{"title":"In vivo Testing of the Pressio Intracranial Pressure Monitor.","authors":"Laurent Gergelé, Jérémy Mallard, Clément Magand, Kevin Lagarde, Russel Chabanne, Jérôme Morel, Jean François Payen, Yoann Launey","doi":"10.1007/s12028-025-02303-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02303-3","url":null,"abstract":"<p><strong>Background: </strong>Measuring reliable intracranial pressure (ICP) is critical for patients with acute brain injuries. The aim of this study was to evaluate zero drift of the intraparenchymal strain gauge Pressio transducer (Sophysa, Orsay, France) in clinical conditions.</p><p><strong>Methods: </strong>A prospective observational multicenter study was conducted in four French intensive care units of university hospitals. Patients with acute brain injuries were included if they needed ICP measurement using the Pressio transducer. The zero drift was measured at the explantation of the sensor. ICP-related adverse events were also collected.</p><p><strong>Results: </strong>Between January 1, 2018, and March 31, 2020, 235 patients were included in this study for a monitoring time of 2,180 days. The zero drift assessment was determined in 223 transducers (95%). The median duration of ICP monitoring was 8 days (interquartile range [IQR] 4 to 13 days). The median zero drift was 1 mm Hg (IQR 1 to 3 mm Hg), and a weak correlation was observed between the duration of ICP monitoring and zero drift (ρ = 0.141; P = 0.0357), which lacks clinical significance. Zero drifts higher than 5 mm Hg were found in 10% of transducers. Four patients (1.8%) had ICP-related hematomas, with no clinical impact, and none had ICP-related brain infection. Failures or technical dysfunctions of the monitoring were found in six patients (2.6%).</p><p><strong>Conclusions: </strong>The Pressio catheter from the Sophysa system exhibited a minor zero drift after a median monitoring period of 8 days. The transducer's precision was comparable to that of other ICP devices using strain gauge technology.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336758","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":"Ability of a Composite Brain Magnetic Resonance Imaging Score to Predict Neurologic Outcomes in Survivors of Out-Of-Hospital Cardiac Arrest.","authors":"Thuhien Nguyen, Nicolas Poilvert, Victor Lin, Hope Opara, Nassim Matin, Arielle P Davis, Breana L Taylor, Catherine R Counts, Penelope Chung Thomas, Monisha Sharma, James A Town, Sarah Wahlster, Nicholas J Johnson","doi":"10.1007/s12028-025-02295-0","DOIUrl":"10.1007/s12028-025-02295-0","url":null,"abstract":"<p><strong>Background: </strong>Brain magnetic resonance imaging (MRI) has been investigated as a neuroprognostication (NP) test after out-of-hospital cardiac arrest (OHCA); however, most studies have focused on predicting poor neurologic outcomes or death.</p><p><strong>Methods: </strong>We examined the ability of a composite brain MRI score (\"NP score\") to predict neurologic outcomes in an OHCA cohort (2017-2023) who underwent brain MRI within 2-7 days post arrest and survived to hospital discharge. NP scores (range 0-214) were calculated from diffusion weighted imaging and fluid attenuated inversion recovery signals in prespecified neuroanatomical regions. We categorized neurologic outcomes as \"independent\" (Cerebral Performance Categories [CPC] 1-2), \"dependent\" (CPC 3), and \"vegetative state\" (CPC 4). We conducted correlation analyses and used computational modeling for probabilities to identify transition points between the outcome categories.</p><p><strong>Results: </strong>Forty-two OHCA survivors were included (median age 47 years; 74% male, 43% shockable rhythm; 88% underwent targeted temperature management). At hospital discharge, 50% (n = 21) had recovered to independent, 24% (n = 10) were dependent, and 26% (n = 11) remained in a vegetative state. MRIs were obtained at a median of 4 days post arrest, (interquartile range 3-5). NP scores (range 0-136, median 11.5, interquartile range 0-41.5, intraclass correlation coefficient 0.89) strongly correlated with CPC (r_s = 0.69, p < 0.001) and were significantly different between CPC groups (p < 0.001); thresholds of 15 and 54 were identified as transition points between independent-dependent and dependent-vegetative state, respectively. Among survivors with bilaterally intact somatosensory evoked potentials, median NP scores were 0, 29, 68.5 for independent, dependent, and vegetative state patients, respectively.</p><p><strong>Conclusions: </strong>Quantitative brain MRI-based scoring may predict neurologic outcomes at discharge among OHCA survivors. External validation in larger prospective multicenter cohorts, assessment of long-term outcomes, and examination of the score in deceased patients are needed to establish the prognostic value and address concerns about generalizability.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333609","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":"Contextualizing India's Medicolegal Controversies Related to Brain Death/Death by Neurologic Criteria: Regulation, Religion, and Resource Allocation.","authors":"Ariane Lewis, Kapil Zirpe","doi":"10.1007/s12028-025-02300-6","DOIUrl":"10.1007/s12028-025-02300-6","url":null,"abstract":"<p><p>Brain death/death by neurologic criteria (BD/DNC) is accepted as legal death throughout much of the world. The World Brain Death Project and a subsequent review of the literature through 2023 highlighted several medicolegal controversies related to BD/DNC in Canada, the United Kingdom, and the United States but did not discuss medicolegal controversies related to BD/DNC in low- and middle-income countries, such as India. Although the Transplantation of Human Organs Act of 1994 acknowledged BD/DNC as death in India, BD/DNC evaluations are not always completed when BD/DNC is suspected. This has been attributed to lack of awareness/acceptance by medical professionals, lack of public awareness/acceptance of BD/DNC, communication challenges, fear, time limitations, and the inclusion of BD/DNC in organ donation law (but not general law). There has been a gradual rise in the number of donations after BD/DNC (a correlate for the number of BD/DNC determinations) in southern and western states, but the number of donations after BD/DNC has decreased in the southwestern state of Kerala in the setting of recent medicolegal controversies. This article reviews the history of BD/DNC determination in India as a whole, then describes the recent medicolegal controversies related to BD/DNC in the state of Kerala. Finally, these controversies are contextualized relative to the aforementioned controversies in high-income countries. Three key international themes of medicolegal controversies related to BD/DNC are regulation, religion, and resource allocation. The global neurocritical care community must advocate for consistency and accuracy in BD/DNC determination and collaborate with legal and policy experts to develop means to mitigate these challenges through revisions to the law, standardization of practice and policies, education, and communication.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333610","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":"Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients.","authors":"Essamedin M Negm, Hossam Tharwat Ali, Hanaa A Nofal, Ahmed Mosallem, Ashraf Elsayed Ahmed, Ahmed Ali Morsy, Tamer S Elserafy, Marwan Elgohary, Khaled Mohamed Altaher, Sherif Sharaf El Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen","doi":"10.1007/s12028-025-02302-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02302-4","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a recognized cause of global mortality in intensive care units. Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).</p><p><strong>Methods: </strong>An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICP_FVd), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 μg/kg/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).</p><p><strong>Results: </strong>Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICP_FVd medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICP_FVd showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (P value = 0.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (P value = 0.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (P values = 0.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (P value < 0.001 for each).</p><p><strong>Conclusions: </strong>The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. Further studies with large sample sizes and longer duration of administration and follow-up are needed to expand the current findings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326304","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 Intracranial Hypotension.","authors":"Yu Chang, Po-Chia Cheng, Jung-Shun Lee, Ming-Tsung Chuang","doi":"10.1007/s12028-025-02298-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02298-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258539","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 Machine Learning Model to Predict Treatment Effect Associated with Targeted Temperature Management After Cardiac Arrest.","authors":"Jocelyn Hsu, Han Kim, Kirby Gong, Carl Harris, Tej D Azad, Robert D Stevens","doi":"10.1007/s12028-025-02299-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02299-w","url":null,"abstract":"<p><strong>Background: </strong>Targeted temperature management (TTM) has been associated with neurological recovery among comatose survivors of cardiac arrest. The aim of this study is to determine whether models leveraging acute phase multimodal data after intensive care unit admission (hyperacute phase) can predict short-term outcome after TTM.</p><p><strong>Methods: </strong>Clinical, physiologic, and laboratory data in the hyperacute phase were analyzed from adult patients receiving TTM after cardiac arrest. Primary end points were survival and favorable neurological outcome. Three machine learning algorithms were trained: generalized linear models, random forest, and gradient boosting. Models with optimal features from forward selection were tenfold cross-validated and resampled 10 times.</p><p><strong>Results: </strong>The generalized linear model performed best, with an area under the receiver operating characteristic curve ± standard deviation of 0.86 ± 0.04 for the prediction of survival and 0.85 ± 0.03 for the prediction of favorable neurological outcome. Features most predictive of both end points included lower serum chloride concentration, higher serum pH, and greater neutrophil counts.</p><p><strong>Conclusions: </strong>We found that in patients receiving TTM after cardiac arrest, short-term outcomes can be accurately determined using machine learning applied to data routinely collected in the first 12 h after intensive care unit admission. With validation, hyperacute prediction could enable personalized decision-making in the postcardiac arrest setting.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258538","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":"Characterizing Stressors and Coping Strategies Among Caregivers of Patients with Severe Acute Brain Injury by Level of Distress.","authors":"Katherine J Meurer, Alexander M Presciutti, Sarah M Bannon, Rina Kubota, Nithyashri Baskaran, Jisoo Kim, Qiang Zhang, Mira Reichman, Nathan S Fishbein, Kaitlyn Lichstein, Melissa Motta, Susanne Muehlschlegel, Michael E Reznik, Matthew N Jaffa, Claire J Creutzfeldt, Corey R Fehnel, Amanda D Tomlinson, Craig A Williamson, Ana-Maria Vranceanu, David Y Hwang","doi":"10.1007/s12028-025-02294-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02294-1","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of patients with severe acute brain injury (SABI) who commit to tracheostomy and/or percutaneous endoscopic/surgical gastrostomy for the patient often develop chronic emotional distress. To inform future interventions to mitigate this distress, we characterized the stressors and coping strategies of caregivers of patients with SABI with varying levels of emotional distress during the acute and postacute stages of treatment.</p><p><strong>Methods: </strong>We conducted semistructured interviews with family caregivers of patients with SABI around the time of neurological intensive care unit discharge (T1) and at 2-month follow-up (T2). All caregivers included in this current study completed the Hospital Anxiety and Depression Scale at T1 and/or T2. We then stratified transcripts by caregiver distress level, characterizing caregivers who scored > 11 on at least one Hospital Anxiety and Depression Scale subscale as \"high distress\" and ≤ 11 as \"low distress.\" We conducted deductive, conceptual content analysis to compare perceived stressors and coping strategies employed at both time points.</p><p><strong>Results: </strong>Caregivers in both strata reported many similar stressors at each time point, including ongoing uncertainty. However, there were also differences in stressors by level of distress and time point of assessment. At T1, high-distress caregivers reported pronounced stress related to navigating the health care system and communicating with providers, staff, and the patient. At T2, high-distress caregivers noted heightened difficulty with transitioning to long-term caregiving, co-occurring complex emotions, and communication with family and friends. Conversely, low-distress caregivers focused on challenges with team-based medical decision making at T2. Clear differences in coping strategies also emerged, such that high-distress caregivers relied primarily on avoidance at both points, whereas low-distress caregivers incorporated more problem-solving and self-care strategies.</p><p><strong>Conclusions: </strong>Psychosocial interventions for caregivers of patients with SABI are needed to reduce emotional distress. Skills should be applied to relevant topics based on time since neurological intensive care unit discharge and distress level. Skills should focus on reducing avoidance, promoting active coping, and targeting the perceived stressors specific to high-distress versus low-distress caregivers revealed here.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248806","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":"Is There a Place for Cerebrospinal Fluid External Lumbar Drainage in Posttraumatic Intracranial Hypertension? Pros, Cons, and Uncertainties.","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Chiara Robba, Daniel Agustín Godoy","doi":"10.1007/s12028-025-02297-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02297-y","url":null,"abstract":"<p><p>Although different single-center series have shown the beneficial effects of cerebrospinal fluid external lumbar drainage in intracranial pressure control in patients with traumatic brain injury presenting with refractory intracranial hypertension, benefits must be balanced with potential life-threatening complications. In this article, we discuss the pros and cons and the uncertainties related to the use of cerebrospinal fluid external lumbar drainage in patients with traumatic brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226056","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":"KidsBrainIT: Visualization of the Impact of Cerebral Perfusion Pressure Insult Intensity and Duration on Childhood Brain Trauma Outcome.","authors":"Bavo Kempen, Bart Depreitere, Ian Piper, Maria Poca, Stefan Mircea Iencean, Mireia Garcia, James Weitz, Gayathri Subramanian, Roddy O'Kane, Julian Zipfel, Arta Barzdina, Stefano Pezzato, Patricia A Jones, Tsz-Yan Milly Lo","doi":"10.1007/s12028-025-02296-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02296-z","url":null,"abstract":"<p><strong>Background: </strong>Cerebral perfusion pressure (CPP) dose-response on post-traumatic brain injury (TBI) outcome in children remains unknown. This project aimed to produce the first pediatric post-TBI CPP dose-response visualization plot from the international multicenter KidsBrainIT data set.</p><p><strong>Methods: </strong>Fully anonymized prospectively collected routine minute-by-minute intracranial pressure (ICP), mean arterial blood pressure, and CPP time series data from 104 pediatric patients with TBI were categorized into CPP intensity duration episodes, albeit CPP above or below a range of thresholds. These episodes were then correlated with the 6-month modified Glasgow Outcome Score (GOS) and depicted in 3D color-coded CPP dose-response plots. Additionally, the effects of cerebrovascular reactivity patterns and ICP were examined.</p><p><strong>Results: </strong>Our pediatric CPP dose-response plots resembled the previously published adult CPP dose-response plots: on the CPP pressure time plots, an exponential \"black\" transition curve separated CPP episodes associated with poor (\"red,\" GOS < 4) and good (\"blue\") outcome. Lower and higher ends of CPP intensity were only tolerated for shorter durations. A \"safe\" CPP zone (56-89 mm Hg) was identified for childhood TBI with active cerebrovascular reactivity pattern and ICP < 20 mm Hg. Passive cerebrovascular reactivity pattern reduced the area of safe CPP doses. ICP levels > 20 mm Hg were associated with worse outcome, irrespective of CPP dose.</p><p><strong>Conclusions: </strong>The pediatric CPP dose-response on poor outcome was visualized successfully for the first time. Because the \"critical\" lower CPP limit exceeds the current recommended minimum CPP target for pediatric TBI treatments, there is an urgent need to validate childhood CPP dose-response to provide evidence-based CPP clinical targets in the future.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216337","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 Stroke Alert that Wasn't: Lessons Learned from Meningitis-Associated Vasospasm.","authors":"Julian L Moran, Erika J Sigman, Catherine S W Albin","doi":"10.1007/s12028-025-02291-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02291-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208953","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}