Neurocritical Care最新文献

{"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}

{"title":"Intrathecal Nicardipine-Time to Treat the Symptom?","authors":"Ofer Sadan, Feras Akbik","doi":"10.1007/s12028-024-02176-y","DOIUrl":"10.1007/s12028-024-02176-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"341-342"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882366","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":"Development of a Quality Indicator Set for the Optimal Acute Management of Moderate to Severe Traumatic Brain Injury in the Australian Context.","authors":"Toby Jeffcote, Camila R Battistuzzo, Rebecca Roach, Catherine Bell, Cino Bendinelli, Stephen Rashford, Ron Jithoo, Belinda J Gabbe, Oliver Flower, Gerard O'Reilly, Lewis T Campbell, D James Cooper, Zsolt J Balogh, Andrew A Udy","doi":"10.1007/s12028-024-02107-x","DOIUrl":"10.1007/s12028-024-02107-x","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which is a prospective cohort study that aims to identify and promote optimal clinical management of msTBI in Australia.</p><p><strong>Methods: </strong>A preliminary set of 45 quality indicators was developed based on available evidence. An advisory committee of established experts in the field refined the initial indicator set in terms of content coverage, proportional representation, contamination, and supporting evidence. The refined indicator set was then distributed to a wider Delphi panel for assessment of each indicator in terms of validity, measurement feasibility, variability, and action feasibility. Inclusion in the final indicator set was contingent on prespecified inclusion scoring.</p><p><strong>Results: </strong>The indicator set was structured according to the care pathway of msTBI and included prehospital, emergency department, neurosurgical, intensive care, and rehabilitation indicators. Measurement domains included structure indicators, logistic indicators, and clinical management indicators. The Delphi panel consisted of 44 participants (84% physician, 12% nursing, and 4% primary research) with a median of 15 years of practice. Of the 47 indicators included in the second round of the Delphi, 32 indicators were approved by the Delphi group.</p><p><strong>Conclusions: </strong>This study identified a set of 32 quality indicators that can be used to structure data collection to drive quality improvement in the clinical management of msTBI. They will also be used to guide feedback to PRECISION-TBI's participating sites.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"485-494"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140632","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":"Feasibility Study of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage with Large Hematoma: a Comparison with Craniotomy Using Propensity Score Matching Analysis.","authors":"Min Cui, XiaoYong Tang, WeiMing Xiong, YongBing Deng, Qiang Yang","doi":"10.1007/s12028-024-02085-0","DOIUrl":"10.1007/s12028-024-02085-0","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracerebral hemorrhage (ICH) with large hematomas is commonly treated with craniotomy combined with decompressive craniectomy, procedures that involve huge trauma and require subsequent cranioplasty. Recently, endoscopic surgery has shown significant promise in treating ICH, but its feasibility for large hematomas remains uncertain. Therefore, this study aims to compare endoscopic surgery with craniotomy and to evaluate the efficacy and safety of endoscopic surgery in treating large hematomas ICH.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data from patients with spontaneous supratentorial ICH and hematoma volumes exceeding 50 mL who underwent either endoscopic surgery or craniotomy. Propensity score matching analysis was employed to reduce selection bias. The efficacy and safety of endoscopic surgery were evaluated by analyzing blood loss, postoperative edema, mortality rate, complications, and the Glasgow Outcome Scale (GOS) at 6-month follow-up.</p><p><strong>Results: </strong>A total of 113 cases that met the criteria were collected, with 65 in the endoscopic surgery group and 48 in the craniotomy group. After propensity score matching, each group contained 34 cases. The mean hematoma volume was 64.84 ± 11.02 mL in the endoscopy group and 66.57 ± 12.77 mL in the craniotomy group (p = 0.554). Hematoma evacuation rates were 93.27% in the endoscopy group and 89.34% in the craniotomy group (p = 0.141). The endoscopy group exhibited lower blood loss, shorter surgical time, and reduced postoperative edema volume at 24 h compared to the craniotomy group. The rate of pulmonary infection was slightly lower in the endoscopy group compared to the craniotomy group (70.59% vs. 91.18%, p = 0.031), but there were no statistically significant differences in overall complications and mortality rate between the two groups. GOS scores were similar in both groups at the 6-month follow-up.</p><p><strong>Conclusions: </strong>Endoscopic surgery is safe and feasible for treating spontaneous supratentorial ICH with large hematomas, demonstrating efficacy similar to that of craniotomy with decompressive craniectomy.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"512-520"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081123","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":"Peer-Delivered Interventions for Caregivers in the ICU with a Focus on Severe Acute Brain Injury: A Scoping Review.","authors":"Mira Reichman, Victoria A Grunberg, Alexander M Presciutti, Katherine T Foster, Ana-Maria Vranceanu, Claire J Creutzfeldt","doi":"10.1007/s12028-024-02115-x","DOIUrl":"10.1007/s12028-024-02115-x","url":null,"abstract":"<p><p>Approximately 50% of family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units experience clinically significant anxiety, depression, and posttraumatic stress. Peer-delivered interventions may be a sustainable way to provide social connection, emotional support, and evidence-based coping skills for family caregivers of patients with SABI to improve their mental health and well-being. The aim of this scoping review was to examine existing peer-delivered interventions for family caregivers of adult patients with SABI admitted to neurocritical and other critical care units. We set broad inclusion criteria and identified ten examples of peer-delivered interventions for family caregivers of adult patients with critical illness, of which only two were tailored to the needs of caregivers for patients who had experienced SABI. Our results indicated that (1) very few examples of peer-delivered interventions for this population exist, (2) all existing examples are professional-led (e.g., nurse-led) multifamily support groups, and (3) existing interventions demonstrate mixed results. Future research is needed to develop and evaluate peer-delivered interventions, including testing different models of peer-delivered interventions (e.g., one-to-one peer mentorship), programs that provide skills and support to caregivers after discharge, and skills-based formats that are tailored to the unique needs of SABI caregivers.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"690-700"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146030","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":"Impact of Aphasia on Brain Activation to Motor Commands in Patients with Acute Intracerebral Hemorrhage.","authors":"Samuel D Jacobson, Vedant Kansara, Stephanie Assuras, Qi Shen, Lucie Kruger, Jerina Carmona, You Lim Song, Lizbeth Cespedes, Mariam Yazdi, Angela Velazquez, Ian Gonzales, Satoshi Egawa, E Sander Connolly, Shivani Ghoshal, David Roh, Sachin Agarwal, Soojin Park, Jan Claassen","doi":"10.1007/s12028-024-02086-z","DOIUrl":"10.1007/s12028-024-02086-z","url":null,"abstract":"<p><strong>Background: </strong>Brain activation to motor commands is seen in 15% of clinically unresponsive patients with acute brain injury. This state called cognitive motor dissociation (CMD) is detectable by electroencephalogram (EEG) or functional magnetic resonance imaging, predicts long-term recovery, and is recommended by recent guidelines to support prognostication. However, false negative CMD results are a particular concern, and occult aphasia in clinically unresponsive patients may be a major factor. This study aimed to quantify the impact of aphasia on CMD testing.</p><p><strong>Methods: </strong>We prospectively studied 61 intensive care unit patients admitted with acute primary intracerebral hemorrhage (ICH) who had behavioral evidence of command following or were able to mimic motor commands. All patients underwent an EEG-based motor command paradigm used to detect CMD and comprehensive aphasia assessments. Logistic regression was used to identify predictors of brain activation, including aphasia types and associations with recovery of independence (Glasgow Outcome Scale-Extended score ≥ 4).</p><p><strong>Results: </strong>Of 61 patients, 50 completed aphasia and the EEG-based motor command paradigm. A total of 72% (n = 36) were diagnosed with aphasia. Patients with impaired comprehension (i.e., receptive or global aphasia) were less likely to show brain activation than those with intact comprehension (odds ratio [OR] 0.23 [95% confidence interval 0.05-0.89], p = 0.04). Brain activation was independently associated with Glasgow Outcome Scale-Extended ≥ 4 by 12 months (OR 2.4 [95% confidence interval 1.2-5.0], p = 0.01) accounting for the Functional Outcome in Patients with Primary ICH score (OR1.3 [95% confidence interval 1.0-1.8], p = 0.01).</p><p><strong>Conclusions: </strong>Brain activation to motor commands is four times less likely for patients with primary ICH with impaired comprehension. False negative results due to occult receptive aphasia need to be considered when interpreting CMD testing. Early detection of brain activation may help predict long-term recovery in conscious patients with ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"587-594"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976214","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":"Which Intravenous Isotonic Fluid Offers Better Outcomes for Patients with a Brain Injury?","authors":"Akshitkumar M Mistry","doi":"10.1007/s12028-024-02139-3","DOIUrl":"10.1007/s12028-024-02139-3","url":null,"abstract":"<p><p>Administering intravenous fluids is a common therapy for critically ill patients. Isotonic crystalloid solutions, such as saline or balanced solutions, are frequently used for intravenous fluid therapy. The choice between saline or a balanced crystalloid has been a significant question in critical care medicine. Recent large randomized controlled trials (RCTs) have investigated whether balanced crystalloids yield better outcomes in general or specific critical care populations, and many of them have confirmed this hypothesis. Although the broad eligibility criteria of these RCTs suggest applicability to neurocritical care patients, it is important to discuss whether using balanced crystalloids, as opposed to saline, would benefit patients who primarily have neurological disorders or diseases. This review considers the relevance of this question, weighs the pros and cons of the two fluid types, examines available data, and anticipates results from ongoing RCTs to guide clinicians in selecting the optimal fluid for patients with brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"715-721"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392039","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":"10.1007/s12028-024-02166-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"737-738"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","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}