Neurocritical Care最新文献

{"title":"Seizure Characteristics and EEG Features in Intoxication Type and Energy Deficiency Neurometabolic Disorders in the Pediatric Intensive Care Unit: Single-Center Experience Over 10 Years.","authors":"Kuntal Sen, Dana Harrar, Nicole Pariseau, Karis Tucker, Julia Keenan, Anqing Zhang, Andrea Gropman","doi":"10.1007/s12028-024-02073-4","DOIUrl":"10.1007/s12028-024-02073-4","url":null,"abstract":"<p><strong>Background: </strong>Acute metabolic crises in inborn errors of metabolism (such as urea cycle disorders, organic acidemia, maple syrup urine disease, and mitochondrial disorders) are neurological emergencies requiring management in the pediatric intensive care unit (PICU). There is a paucity of data pertaining to electroencephalograms (EEG) characteristics in this cohort. We hypothesized that the incidence of background abnormalities and seizures in this cohort would be high. Neuromonitoring data from our center's PICU over 10 years are presented in this article.</p><p><strong>Methods: </strong>Data were collected by retrospective chart review for patients with the aforementioned disorders who were admitted to the PICU at our institution because of metabolic/neurologic symptoms from 2008 to 2018. Descriptive statistics (χ² test or Fisher's exact test) were used to study the association between EEG parameters and outcomes.</p><p><strong>Results: </strong>Our cohort included 40 unique patients (8 with urea cycle disorder, 7 with organic acidemia, 3 with maple syrup urine disease, and 22 with mitochondrial disease) with 153 admissions. Presenting symptoms included altered mentation (36%), seizures (41%), focal weakness (5%), and emesis (28%). Continuous EEG was ordered in 34% (n = 52) of admissions. Twenty-three admissions were complicated by seizures, including eight manifesting as status epilepticus (seven nonconvulsive and one convulsive). Asymmetry and focal slowing on EEG were associated with seizures. Moderate background slowing or worse was noted in 75% of EEGs. Among those patients monitored on EEG, 4 (8%) died, 3 (6%) experienced a worsening of their Pediatric Cerebral Performance Category (PCPC) score as compared to admission, and 44 (86%) had no change (or improvement) in their PCPC score during admission.</p><p><strong>Conclusions: </strong>This study shows a high incidence of clinical and subclinical seizures during metabolic crisis in patients with inborn errors of metabolism. EEG background features were associated with risk of seizures as well as discharge outcomes. This is the largest study to date to investigate EEG features and risk of seizures in patients with neurometabolic disorders admitted to the PICU. These data may be used to inform neuromonitoring protocols to improve mortality and morbidity in inborn errors of metabolism.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"562-572"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976233","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":"10.1007/s12028-024-02167-z","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"739-740"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","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":"Predictive Hypoxemic Threshold for Tolerating the Apnea Test While Assessing Death by Neurological Criteria.","authors":"Daniel Aviram, Daniel Hikri, Michal Aharon, Amir Galoz, Yael Lichter, Noam Goder, Asaph Nini, Nimrod Adi, Dekel Stavi","doi":"10.1007/s12028-024-02105-z","DOIUrl":"10.1007/s12028-024-02105-z","url":null,"abstract":"<p><strong>Background: </strong>The apnea test (AT) plays a vital role in diagnosing brain death by evaluating the absence of spontaneous respiratory activity. It entails disconnecting the patient from mechanical ventilation to raise the CO₂ partial pressure and lower the pH. Occasionally, the AT is aborted because of safety concerns, such as hypoxemia and hemodynamic instability, to prevent worsening conditions. However, the exact oxygen partial pressure level needed before commencing AT, indicating an inability to tolerate the test, is still uncertain. This study seeks to determine pre-AT oxygen levels linked with a heightened risk of test failure.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving patients suspected of having brain death at the Tel Aviv Medical Center from 2010 to 2022. The primary outcome was defined as an arterial partial O₂ pressure (PaO₂) level of 60 mmHg or lower at the conclusion of the AT. This threshold is significant because it marks the point at which the saturation curve deflects, potentially leading to rapid deterioration in the patient's oxygen saturation.</p><p><strong>Results: </strong>Among the 70 patients who underwent AT, 7 patients met the primary diagnostic criteria. Patients with a PaO₂ ≤ 60 mmHg at the conclusion of the AT exhibited a significantly lower initial median PaO₂ of 243.7 mmHg compared with those with higher pre-AT PaO₂ levels of 374.8 mmHg (interquartile range 104.65-307.00 and interquartile range 267.8-444.9 respectively, P value = 0.0041). Pre-AT PaO₂ levels demonstrated good discriminatory ability for low PaO₂ levels according to the receiver operating characteristic (ROC) curve, with an area under the curve of 0.76 (95% confidence interval 0.52-0.99).</p><p><strong>Conclusions: </strong>PaO₂ values at the conclusion of the AT are closely associated with PaO₂ values at the beginning of the test. Establishing a cutoff value of approximately 300 mmHg PaO₂ at the onset of AT may assist in avoiding saturation drops below 90%.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"450-456"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation Intensity in Patients with Moderate to Severe Traumatic Brain Injury in the Intensive Care Unit: A TRACK-TBI Cohort Study.","authors":"Rianne G F Dolmans, Jason Barber, Brandon Foreman, Nancy R Temkin, David O Okonkwo, Claudia S Robertson, Geoffrey T Manley, Eric S Rosenthal","doi":"10.1007/s12028-024-02054-7","DOIUrl":"10.1007/s12028-024-02054-7","url":null,"abstract":"<p><strong>Background: </strong>Interventions to reduce intracranial pressure (ICP) in patients with traumatic brain injury (TBI) are multimodal but variable, including sedation-dosing strategies. This article quantifies the different sedation intensities administered in patients with moderate to severe TBI (msTBI) using the therapy intensity level (TIL) across different intensive care units (ICUs), including the use of additional ICP-lowering therapies.</p><p><strong>Methods: </strong>Within the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, we performed a retrospective analysis of adult patients with msTBI admitted to an ICU for a least 5 days from seven US level 1 trauma centers who received invasive ICP monitoring and intravenous sedation. Sedation intensity was classified prospectively as one of three ordinal levels as part of the validated TIL score, which were collected at least once a day.</p><p><strong>Results: </strong>A total of 127 patients met inclusion criteria (mean age 41.6 ± 17.7 years; 20% female). The median Injury Severity Score was 27 (interquartile range 17-33), with a median admission Glasgow Coma Score of 3 (interquartile range 3-7); 104 patients had severe TBI (82%), and 23 patients had moderate TBI (18%). The sedation intensity score was highest on the first ICU day (2.69 ± 1.78), independent of patient severity. Time to reaching each sedation intensity level varied by site. Sedation level I was reached within 24 h for all sites, but sedation levels II and III were reached variably between days 1 and 3. Sedation level III was never reached by two of seven sites. The total TIL score was highest on the first ICU day, with a modest decrease for each subsequent ICU day, but there was high site-specific practice-pattern variation.</p><p><strong>Conclusions: </strong>Intensity of sedation and other therapies for elevated ICP for patients with msTBI demonstrate large practice-pattern variation across level 1 trauma centers within the TRACK-TBI cohort study, independent of patient severity. Optimizing sedation strategies using patient-specific physiologic and pathoanatomic information may optimize patient outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"551-561"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976232","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":"Brain Ultrasound for External Ventricular Drain Catheter Localization and Intrathecal Antibiotic Administration: Overcoming Transport Challenges.","authors":"Gabriel Machado Naus Dos Santos, Marcus Arthur Pereira, Fernanda Alves, Juliana Caldas","doi":"10.1007/s12028-024-02110-2","DOIUrl":"10.1007/s12028-024-02110-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"730-732"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140630","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":"Lower Perceived Social Support During Hospitalization by Close Family Members may have Significant Associations with Psychological Distress 1 Month After Cardiac Arrest.","authors":"Mina Yuan, Isabella M Tincher, Danielle A Rojas, Bhanvi Sachdeva, Sabine Abukhadra, Christine E DeForge, Kristin Flanary, Bernard P Chang, Sachin Agarwal","doi":"10.1007/s12028-024-02131-x","DOIUrl":"10.1007/s12028-024-02131-x","url":null,"abstract":"<p><strong>Background: </strong>The perception of having poor social support is associated with worse symptoms of psychological distress in close family members of critically ill patients, yet this has never been tested after cardiac arrest.</p><p><strong>Methods: </strong>Close family members of consecutive patients with cardiac arrest hospitalized at an academic tertiary care center participated in a prospective study. The validated Multidimensional Scale of Perceived Social Support (MSPSS) cued to index hospitalization was administered before discharge. Multivariate linear regressions estimated the associations between the total MSPSS score and total scores on the Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder 2-item (GAD-2), and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), assessed 1 month after cardiac arrest.</p><p><strong>Results: </strong>In 102 participants (mean age 52 ± 15 years, 70% female, 21% Black, 33% Hispanic) with complete data, the prevalence of depression, generalized anxiety, and probable posttraumatic stress disorder at a median duration of 28.5 days (interquartile range 10-63 days) from cardiac arrest was 61%, 34%, and 13%, respectively. A lower MSPSS score was significantly associated with higher PHQ-8 scores (β =  - 0.11 [95% confidence interval - 0.04 to - 0.18]; p < 0.01), even after adjusting for family members' age, sex, prior psychiatric condition, and witnessing of cardiopulmonary resuscitation and patient's discharge disposition (β =  - 0.11 [95% confidence interval - 0.02 to - 0.15]; p < 0.01). Similarly, significant inverse associations of total MSPSS scores were seen with 1-month GAD-2 and PCL-5 scores.</p><p><strong>Conclusions: </strong>Poor social support during hospitalization, as perceived by close family members of cardiac arrest survivors, is associated with worse depressive symptoms at 1 month. Temporal changes in social networks and psychological distress warrant further investigation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"440-449"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308206","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 Case of Guillain-Barré Syndrome and Repurposing cEEG to Enable Communication in Total Locked-in Syndrome.","authors":"Thomas J Pisano, Joshua M Levine","doi":"10.1007/s12028-024-02171-3","DOIUrl":"10.1007/s12028-024-02171-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"726-729"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770699","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":"Decompressive Craniectomy with or Without Dural Closure: Systematic Review and Meta-analysis.","authors":"Henrique L Lepine, Gabriel Semione, Raphael G Povoa, Gustavo de Oliveira Almeida, David Abraham, Eberval G Figueiredo","doi":"10.1007/s12028-024-02081-4","DOIUrl":"10.1007/s12028-024-02081-4","url":null,"abstract":"<p><p>Decompressive craniectomy is used to alleviate intracranial pressure in cases of traumatic brain injury and stroke by removing part of the skull to allow brain expansion. Traditionally, this procedure is followed by a watertight dural suture, although evidence supporting this method is not strong. This meta-analysis examines the feasibility of the open-dura (OD) approach versus the traditional closed-dura (CD) technique with watertight suturing. A systematic review and comparative meta-analysis were conducted on OD and CD dural closure techniques. Medline, Embase, and Cochrane were searched for relevant trials. The primary end point was the rate of complications, with specific analyses for infection and cerebrospinal fluid (CSF) leaks. Mortality, poor neurological outcomes, and operation duration were also assessed. Odds ratios with 95% confidence intervals (CIs) were calculated using a random-effects model. Following a comprehensive search, 930 studies were screened, from which four studies and a total of 368 patients were ultimately selected. The primary outcome analysis showed a reduced likelihood of complications in the OD group when compared with the CD group (368 patients, odds ratio 0.54 [95% CI 0.32-0.90]; I² = 17%; p < 0.05). Specific analysis of infections and CSF leaks did not show statistically significant results, as well as the evaluation of the mortality rates and poor neurological outcome differences between groups. Assessment of operation duration, however, demonstrated a significant difference between techniques, with a mean reduction of 52.50 min favoring the OD approach (mean difference - 52.50 [95% CI - 92.13 to - 12.87]; I² = 96%). This study supports the viability of decompressive craniectomy without the conventional time-spending watertight duraplasty closure, exhibiting no differences in the rate of infections or CSF leaks. Furthermore, this approach has been associated with improved rates of complications and faster surgery, which are important aspects of this technique, particularly in its potential to reduce both costs and procedure length.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"635-643"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902479","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":"Elevated Blood Pressure and Culprit Aneurysm Rebleeding During the Unsecured Period of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.","authors":"Luke A Terrett, Jessica Reszel, Sara Ameri, Alexis F Turgeon, Lauralyn McIntyre, Shane W English","doi":"10.1007/s12028-024-02138-4","DOIUrl":"10.1007/s12028-024-02138-4","url":null,"abstract":"<p><p>In aneurysmal subarachnoid hemorrhage, rebleeding prior to securing the culprit aneurysm leads to significant morbidity and mortality. Elevated blood pressure has been identified as a possible risk factor. In this systematic review, we evaluated the association between elevated blood pressure and aneurysm rebleeding during the unsecured period. We searched MEDLINE, Embase + Embase Classic, and CENTRAL, from inception to March 8th, 2024. We included studies of adults with aneurysmal subarachnoid hemorrhage reporting at least one blood pressure measurement during the unsecured period and a measure of association with rebleeding. Results were stratified by blood pressure thresholds, effect measure, and adjustment for confounding. Separate meta-analyses were performed for each of these groups. Our search identified 5,209 citations. After screening, 15 studies were included in our review. All studies were observational in design and at moderate or high risk of bias. Meta-analysis of the unadjusted results produced mixed findings across the systolic blood pressure (SBP) thresholds: SBP > 140 mm Hg, unadjusted odds ratio (uOR) 1.03 (95% confidence interval [CI] 0.55-1.93; I² = 66%); SBP > 160 mm Hg, uOR 3.35 (95% CI 1.44-7.81; I² = 83%); SBP > 180 mm Hg, uOR 1.52 (95% CI 0.40-5.81; I² = 89%); and SBP > 200 mm Hg, uOR 7.99 (95% CI 3.60-17.72; I² = 0%). Meta-analysis of adjusted results was only possible at an SBP > 160 mm Hg; adjusted hazard ratio 1.13 (95% CI 0.98-1.31; I² = 0%). The overall quality of evidence as assessed by the Grading of Recommendations, Assessment, Development, and Evaluations tool was rated as very low. Based on very low quality evidence, our systematic review failed to determine whether there is an association between elevated blood pressure during the unsecured period and increased risk of culprit aneurysm rebleeding.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"351-362"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470850","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":"Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Are Old Data Enough to Justify Its Current Treatment Regimen?","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Daniel Agustín Godoy","doi":"10.1007/s12028-024-02182-0","DOIUrl":"10.1007/s12028-024-02182-0","url":null,"abstract":"<p><p>Nimodipine, a dihydropyridine L-type calcium channel antagonist, constitutes one of the mainstays of care to prevent delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage (aSAH) because it has been associated with a reduction in infarction rates and improvement in functional outcomes despite not significantly preventing angiographic vasospasm. Although it is a widely accepted treatment, controversies surrounding the current regimen of nimodipine in patients with aSAH exist. Still, there is a wide space open for randomized controlled trials or alternative study designs comparing different routes of administration, dosing, and timing of nimodipine treatment regimen in patients with aSAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"334-340"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847016","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}