Neurocritical Care最新文献

{"title":"Paroxysmal Cortical Slowing Predicts Posttraumatic Epilepsy After Severe Traumatic Brain Injury.","authors":"Yonatan Serlin, Hamza Imtiaz, Mark A Maclean, Matthew W Pease, David O Okonkwo, Ava M Puccio, Shawn Eagle, James F Castellano, Sara K Inati, Alon Friedman","doi":"10.1007/s12028-025-02282-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02282-5","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to evaluate whether paroxysmal slow wave events (PSWEs) identified in early electroencephalography (EEG) predict posttraumatic epilepsy (PTE) and disability outcomes following severe traumatic brain injury (sTBI).</p><p><strong>Methods: </strong>A retrospective case-control study included 45 patients with sTBI (17 with PTE and 28 without PTE) matched by age and Glasgow coma scale. Clinical and EEG data were analyzed. Logistic regression and leave-one-out cross-validation (LOOCV) assessed PTE risk and disability. The area under the curve (AUC) measured accuracy.</p><p><strong>Results: </strong>Patients with PTE had longer time in PSWEs (P = 0.04) and lower median power frequency (MPF) of PSWEs (P = 0.02) on initial EEGs, along with increased time in PSWEs between initial and follow-up EEGs (P = 0.03). Lower MPF was associated with increased PTE risk (odds ratio 5.88; P = 0.04). Multivariate regression identified hemicraniectomy, time in PSWEs, and MPF as PTE predictors (AUC 0.87; P < 0.0001), maintaining strong LOOCV performance (AUC 0.83; P < 0.0001, accuracy 80%). Longer time in PSWEs was observed in patients with severe disability at the 3-, 6-, and 12-month follow-ups compared with moderate-to-good recovery (P = 0.012, 0.006, and 0.04, respectively).</p><p><strong>Conclusions: </strong>PSWEs predict PTE development and are more prevalent among patients with worse disability after sTBI. Quantitative PSWE analysis may guide preventive and therapeutic strategies for PTE.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111427","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 Cognitive Status Scale: A Preliminary Investigation of Psychometric Properties in a Clinically Referred Pediatric Critical Care Sample.","authors":"Trevor A Hall, Susanne W Duvall, Lauren Demers, Natalia Rich-Wimmer, Cydni N Williams","doi":"10.1007/s12028-025-02281-6","DOIUrl":"10.1007/s12028-025-02281-6","url":null,"abstract":"<p><strong>Background: </strong>Cognitive morbidities persist after pediatric critical care. However, a significant gap exists related to measuring cognitive outcomes in this patient population due to heterogeneity in presentations and objective measures. This study's purpose was to develop a psychometrically sound coding system to summarize clinically generated and performance-based neuropsychological outcomes to be used for research.</p><p><strong>Methods: </strong>The work was conducted in two stages: (1) Cognitive Status Scale (CSS) development and (2) a retrospective pilot test in a clinically referred sample of post-critical-care youth aged 6-19 years (N = 110) to explore preliminary psychometric properties of the CSS.</p><p><strong>Results: </strong>Principal components analysis supported the CSS structure (capturing 59% of the total explained variance). Internal consistency (α = 0.82) and interrater reliability (r = 0.92) were good. Within the full sample, criterion-related validity was demonstrated as the CSS total composite score from long-term evaluation and was significantly correlated with abbreviated performance-based cognitive outcomes from the acute recovery phase (Neurocognitive Index, r = 0.74). Divergent validity was shown via significant differences on the CSS total composite score between known clinical groups (≥ 3 Functional Status Scale [FFS] change = 30.23 vs. ≤ 2 FFS change = 50.94, t = 4.10, p ≤ 0.001, d = 0.91) and across CSS clinical indicators (F_3,106 = 8.4495, p =  < 0.001, η² = 0.194). Bivariate correlations showed a significant association in the expected direction between the CSS total composite score and the Functional Status Scale total score (r =  - 0.44, p ≤ 0.001), as well as a significant association in the expected direction between the CSS total composite score and the Behavior Rating Inventory of Executive Function, Second Edition General Executive Composite (r =  - 0.29, p = 0.010).</p><p><strong>Conclusions: </strong>Primary evidence shows the CSS to be a reliable and valid measure for summarizing a clinically administered battery of cognitive assessments. Easy-to-generate metrics of performance-based cognition are essential to progress the state of the science germane to cognitive outcomes post pediatric critical care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079254","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 Regarding \"The Role of Ultrasonographic Assessment of Optic Nerve Sheath Diameter in Prediction of Sepsis-Associated Encephalopathy: Prospective Observational Study\".","authors":"Sherif M S Mowafy, Hany Bauiomy, Neveen A Kohaf, Shereen E Abd Ellatif","doi":"10.1007/s12028-025-02276-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02276-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972953","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":"Factors that Might Influence Optic Nerve Sheath Diameter in Sepsis-Associated Encephalopathy.","authors":"Indu Kapoor, Hemanshu Prabhakar, Charu Mahajan","doi":"10.1007/s12028-025-02275-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02275-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983242","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":"Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study.","authors":"Sourav Burman, Rajendra Singh Chouhan, Niraj Kumar, Charu Mahajan","doi":"10.1007/s12028-025-02274-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02274-5","url":null,"abstract":"<p><strong>Background: </strong>Most of the sedative and analgesic drugs used in patients with head injury cause a dose-dependent decrease in blood pressure, which may further worsen secondary neurologic injury. The sympathomimetic profile of ketamine, along with its neuroprotectant effect, can have a beneficial effect in these patients.</p><p><strong>Methods: </strong>A total of 60 adult patients with severe traumatic brain injury were randomized to receive either ketamine infusion at 3 mg/kg/h or normal saline. The study drugs were given by infusion while intracranial pressure (ICP) monitoring was going on. Systemic hemodynamics, arterial blood gas values, ICP, cerebral perfusion pressure (CPP), and jugular venous oxygen saturation were monitored. At the end of 3 months, neurological outcome was recorded by an independent observer using the Glasgow Outcome Scale-Extended.</p><p><strong>Results: </strong>Baseline values of hemodynamic parameters were comparable in the two groups. In the initial 4-6 h, patients in the ketamine group had a significantly higher level of blood pressure and CPP than patients in the control group, but the effect was not sustained after 6 h. Similarly, a significant reduction in ICP was observed only for a brief period, between the fourth and sixth hours. Vasopressors were more often used in the control group (13 [43.3%] vs. 5 [16.6%]; p = 0.02). There was no difference in the neurological outcome at 3 months in both groups.</p><p><strong>Conclusions: </strong>There was no significant improvement in neurological outcome with ketamine infusion in patients with severe traumatic brain injury. There was a trend toward better CPP and lower ICP; however, the difference was statistically insignificant. Trial registered at Central Trial Registry of India (CTRI/2018/09/015729) at https://ctri.nic.in/Clinicaltrials/.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982652","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":"Evaluating the Machine Learning Models in Predicting Intensive Care Unit Discharge for Neurosurgical Patients Undergoing Craniotomy: A Big Data Analysis.","authors":"Taghi Khaniyev, Efecan Cekic, Muhammet Abdullah Koc, Ilke Dogan, Sahin Hanalioglu","doi":"10.1007/s12028-025-02246-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02246-9","url":null,"abstract":"<p><strong>Background: </strong>Predicting intensive care unit (ICU) discharge for neurosurgical patients is crucial for optimizing bed sources, reducing costs, and improving outcomes. Our study aims to develop and validate machine learning (ML) models to predict ICU discharge within 24 h for patients undergoing craniotomy.</p><p><strong>Methods: </strong>The 2,742 patients undergoing craniotomy were identified from Medical Information Mart for Intensive Care dataset using diagnosis-related group and International Classification of Diseases codes. Demographic, clinical, laboratory, and radiological data were collected and preprocessed. Textual clinical examinations were converted into numerical scales. Data were split into training (70%), validation (15%), and test (15%) sets. Four ML models, logistic regression (LR), decision tree, random forest, and neural network (NN), were trained and evaluated. Model performance was assessed using area under the receiver operating characteristic curve (AUC), average precision (AP), accuracy, and F1 scores. Shapley Additive Explanations (SHAP) were used to analyze importance of features. Statistical analyses were performed using R (version 4.2.1) and ML analyses with Python (version 3.8), using scikit-learn, tensorflow, and shap packages.</p><p><strong>Results: </strong>Cohort included 2,742 patients (mean age 58.2 years; first and third quartiles 47-70 years), with 53.4% being male (n = 1,464). Total ICU stay was 15,645 bed days (mean length of stay 4.7 days), and total hospital stay was 32,008 bed days (mean length of stay 10.8 days). Random forest demonstrated highest performance (AUC 0.831, AP 0.561, accuracy 0.827, F1-score 0.339) on test set. NN achieved an AUC of 0.824, with an AP, accuracy, and F1-score of 0.558, 0.830, and 0.383, respectively. LR achieved an AUC of 0.821 and an accuracy of 0.829. The decision tree model showed lowest performance (AUC 0.813, accuracy 0.822). Key predictors of SHAP analysis included Glasgow Coma Scale, respiratory-related parameters (i.e., tidal volume, respiratory effort), intracranial pressure, arterial pH, and Richmond Agitation-Sedation Scale.</p><p><strong>Conclusions: </strong>Random forest and NN predict ICU discharge well, whereas LR is interpretable but less accurate. Numeric conversion of clinical data improved performance. This study offers framework for predictions using clinical, radiological, and demographic features, with SHAP enhancing transparency.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012593","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":"Blood Pressure Variability After Acute Ischemic Stroke and Intracerebral Hemorrhage: Refining Its Definition, Intervention Opportunities, and Research Directions.","authors":"David Z Rose, Alejandro A Rabinstein, May Kim-Tenser, Sergio D Bergese, Gabriel V Fontaine, Charles Kircher, Adnan I Qureshi","doi":"10.1007/s12028-025-02263-8","DOIUrl":"https://doi.org/10.1007/s12028-025-02263-8","url":null,"abstract":"<p><p>Increased blood pressure variability (BPV) in the acute phases of cerebrovascular emergencies, such as acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), has been shown to result in worsened outcomes. Although several studies have reported this association, no consensus exists for specific BPV targets or a consistent, unified definition of BPV in AIS or ICH. Therefore, we convened the Blood Pressure Variability in Cerebrovascular Emergencies Consortia, consisting of a multidisciplinary group of experts in stroke, neurocritical care, perioperative medicine, emergency medicine, and clinical pharmacy to assess the clinical impact of BPV and to develop a working consensus on defining BPV, identifying interventions to mitigate negative outcomes from increased BPV, and laying the groundwork for BPV research concepts in the future. First, the Consortia proposed bifurcating systolic BPV (SBPV) into two distinct periods-SBPV₁ and SBPV₂. SBPV₁ involves hyperacute management, when rapid and smooth blood pressure control is crucial. SBPV₂, the plateauing phase, consists of a more gradual, maintenance-therapy slope. For both periods, enabling a \"smooth\" (SBPV₁) and \"sustained\" (SBPV₂) trajectory is likely ideal, but more phase-specific research is required to validate this concept. Secondly, Consortia proposed to calculate BPV by subtracting maximum and minimum systolic blood pressure over subsequent measurements because it represents the most clinically feasible option among many proposed equations in the literature. Third, for ICH, the Consortia preferred intravenous antihypertensive medication to reach BPV goals as fast, safe, and efficiently as possible, consistent with American Heart Association/American Stroke Association guidelines recommending \"treatment regimens that limit BPV and achieve smooth, sustained blood pressure control.\" For AIS, guidelines do not yet address BPV, but Consortia members proposed an algorithm with distinct SBPV goals based on time (as a function of stroke acuity), arterial subtype (large, medium, and small vessel), thrombolytic and/or thrombectomy status, and presenting SBP. As the understanding of BPV evolves, future research may build on and/or refine concepts proposed by this Consortia.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036628","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":"Treatment Effect of Early Intravenous Milrinone for Cerebral Vasospasm or Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage.","authors":"Hae-Young Baang, Alexandra S Reynolds, Neha S Dangayach, Emily J Gilmore, Jennifer A Kim, Cappi Lay","doi":"10.1007/s12028-025-02260-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02260-x","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the effect of intravenous (IV) milrinone as first-line therapy for cerebral vasospasm (CVS) or delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>A retrospective study was performed on consecutive patients with aSAH from 2017 to 2022. We assessed the association of IV milrinone treatment with outcomes graded with modified Rankin Scale score at 6 months. We compared the use of alternative therapies for CVS or DCI between patients who received IV milrinone and those who did not. All statistical analyses were performed using STATA 18.0 (StataCorp, College Station, TX).</p><p><strong>Results: </strong>Of 336 patients, 130 (39%) developed CVS or DCI. Seventy-three patients received IV milrinone and 57 patients did not. Among symptomatic patients, 59% showed improvement in symptoms after milrinone was started. Twenty percent of patients in the milrinone group required vasopressor therapy, whereas 84% of patients were treated with vasopressors in the nonmilrinone group (p < 0.01). Thirty one percent of patients receiving milrinone and 56% of patients in the non-milrinone group received endovascular therapy (p = 0.02). Univariate analysis showed milrinone was likely associated with good outcome (odds ratio [OR] 2.12 [95% confidence interval [CI] 0.97-4.63]; p = 0.06). Propensity score matching analysis confirmed an association between milrinone and good outcome (coefficient 0.30, standard error 0.13 [95% confidence interval [CI] 0.05-0.55]; p = 0.02).</p><p><strong>Conclusions: </strong>Our study showed several potential benefits of early IV milrinone therapy for patients with aSAH with CVS or DCI. Patients who received IV milrinone had better outcome and required vasopressor or endovascular therapy less often. Limitations of the study included several protocol deviations, incomplete documentation of drug effect, and inconsistent assessment of CVS resolution. Early IV milrinone improved outcomes and reduced the use of other therapies to treat CVS and DCI. These results need confirmation in a large clinical trial with stratification of patients by clinical severity, indication, and optimized protocols.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028659","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":"Intravenous Milrinone: Are We There yet?","authors":"Ofer Sadan, Feras Akbik","doi":"10.1007/s12028-025-02262-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02262-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020339","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 Impact of Paroxysmal Sympathetic Hyperactivity on Prognosis in Patients with Severe Intracerebral Hemorrhage.","authors":"Fan Yang, Guang Feng, Bingsha Han, Jingzhou Li, Jinsong Chen","doi":"10.1007/s12028-025-02258-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02258-5","url":null,"abstract":"<p><strong>Background: </strong>Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodes of excessive sympathetic activity and is associated with poor outcomes in brain injuries, yet its impact on severe intracerebral hemorrhage (ICH) remains unclear. This study investigates the association between PSH and clinical outcomes in patients with severe ICH.</p><p><strong>Methods: </strong>We conducted a prospective observational cohort study of patients with severe ICH from January 2018 to December 2022. Severe ICH was defined as ICH with a Glasgow Coma Scale score ≤ 8 on admission, indicating significant neurological impairment. Patients were assessed for PSH using the PSH-Assessment Measure, and categorized into probable, possible, and unlikely PSH groups. Propensity score matching was used to adjust for baseline differences among three groups. The primary outcome was the 90-day mortality rate. Secondary outcomes included a favorable functional outcome at 90 days, defined by a modified Rankin Scale score of 0-2. Statistical analyses were performed using Cox proportional hazards regression and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>After propensity score matching, 177 patients (59 in each group) were analyzed. The 90-day mortality rate was significantly higher (P < 0.01) in the probable PSH group (67.8%), compared with possible (47.5%) and unlikely PSH groups (35.6%). The Kaplan-Meier survival curve further illustrates a significantly increased risk of 90-day mortality in the probable PSH group (Log rank test P < 0.01). Multivariate Cox proportional hazards regression analysis confirmed that, after adjusting for confounders, the presence of probable PSH (hazard ratio 3.86, 95% confidence interval 2.17-6.87; P < 0.01) was independently associated with a higher risk of 90-day mortality. Functional outcomes at 90 days were poorer in the probable PSH group.</p><p><strong>Conclusions: </strong>Probable PSH is significantly associated with worse outcomes in severe ICH, underscoring the importance of early recognition and targeted management strategies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064187","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}