Neurocritical Care最新文献

{"title":"Necessary Intensity of Monitoring After Elective Craniotomies: A Prediction Score for Postoperative Complications to Stratify Postoperative Monitoring.","authors":"Elena Kurz, Darius Kalasauskas, Dominik Wesp, Harald Krenzlin, Alicia Schulze, Melek Bulut, Thomas Kerz, Florian Ringel, Naureen Keric","doi":"10.1007/s12028-025-02242-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02242-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications requiring monitoring following elective craniotomies occur in ~ 2% of cases. Therefore, in most neurosurgical departments, an elective craniotomy is routinely followed by postoperative monitoring in an intensive or intermediate care unit. However, there is no systematic allocation to this procedure. Consequently, patients at risk are not monitored as a priority. The aim of this study was to develop a prediction score for the occurrence of postoperative complications after elective craniotomies and to redefine the monitoring algorithm.</p><p><strong>Methods: </strong>In this retrospective single-center analysis, all patients with elective craniotomy between 2018 and 2021 were included. Demographic data, diagnosis, location of the pathology (infratentorial/supratentorial), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), duration of surgery, blood loss, postoperative complications, and type and duration of monitoring were analyzed. The score was developed and validated internally to ensure its predictive reliability.</p><p><strong>Results: </strong>A total of 860 consecutive patients (376 male patients and 484 female patients) with a mean age of 60.6 years (range 19-93 years) were included. Forty-three patients experienced a postoperative adverse event that required monitoring. Independent predictors for postoperative complications were age (odds ratio [OR] 0.001, 95% confidence interval [CI] 1.0-1.04), CCI (OR 1.19, 95% CI 1.04-1.36), operative duration (OR 45.90, 95% CI 10.01-229.30), vestibular schwannoma as the treated pathology (OR 1.58, 95% CI 0.09-0.77), blood loss (OR 1.001, 95% CI 1.00-1.001), and ASA score (OR 1.1, 95% CI 1.01-1.2). The score was based on the most reliable characteristics and the calculated predictor error. The formula for score calculation is as follows: 1.3 age + 10 CCI + 65 1_{{vascular pathology = yes}} + 0.5 duration of surgery + 20.5 ASA score - 100. The discriminatory value for clinical outcomes achieved an area under the curve of 0.78 in validation data.</p><p><strong>Conclusions: </strong>This score provides a practical approach for individual risk assessment of patients undergoing elective craniotomy. Postoperative monitoring capacity can be optimally distributed, and fast-track pathways can be developed for low-risk patients to use this valuable resource effectively.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128351","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":"An Exploratory Analysis of Chemical and Mechanical VTE Prophylaxis in Patients with High Rebleeding Risk Traumatic Brain Injury.","authors":"Heather X Rhodes-Lyons, Adel Elkbuli, Sanjan Kumar, Nikita Nunes Espat, Sarah E Johnson, David L McClure, Antonio Pepe","doi":"10.1007/s12028-025-02283-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02283-4","url":null,"abstract":"<p><strong>Background: </strong>There is little research on venous thromboembolism (VTE) prophylaxis (PPX) timing of the higher rebleeding risk groups based on size and type of traumatic brain injury (TBI) due to exclusion from previous observational studies, which prohibits the facilitation of an evidence-based strategy. We aim to determine the effect of VTE PPX timing on the high rebleeding risk TBI population based on the modified Berne Norwood Criteria.</p><p><strong>Methods: </strong>This retrospective cohort study used the American College of Surgeons Trauma Quality Program Participant Use File from 2017 to 2022. The study population consisted of adult patients who received chemical or mechanical PPX with no missing times and had a blunt high rebleeding risk TBI stratified by a comorbid history of anticoagulation or bleeding disorder with excluded polytrauma. There was a total of 12 exposure groups based on VTE PPX timing with the outcomes of interest being intensive care unit (ICU) stay, ventilation days, and mortality.</p><p><strong>Results: </strong>A total of 13,016 patients were included in the exploratory analysis. Early initiation of chemical VTE PPX (within ≤ 24 h) was associated with a reduced likelihood of prolonged ICU stay and ventilation days, regardless of prior anticoagulation use or bleeding disorder. In contrast, inferior vena cava filter placement within the > 24-h to < 72-h window was associated with increased ICU and ventilation duration.</p><p><strong>Conclusions: </strong>This study highlights the benefits of initiating chemical VTE PPX within 24 h for patients wih high rebleeding risk TBI, demonstrating significant reductions in ICU stays and ventilation days without an increase in mortality rates. Additionally, although inferior vena cava filters are associated with longer ICU stays and increased ventilation days, this may reflect the greater severity and potential mortality risk of the conditions being treated.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120309","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":"Hemoglobin and Perihematomal Edema After Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.","authors":"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Sarah Marchina, David J Seiffge, David J Roh, Fernanda Carvalho Poyraz, Magdy H Selim","doi":"10.1007/s12028-025-02284-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02284-3","url":null,"abstract":"<p><strong>Background: </strong>Anemia is common after intracerebral hemorrhage (ICH). It has been attributed to inflammation and is associated with poor outcomes. We investigated whether this could be related to the effects of hemoglobin (Hb) on perihematomal edema (PHE).</p><p><strong>Methods: </strong>We performed an exploratory post hoc analysis of the Intracerebral Hemorrhage Deferoxamine (i-DEF) randomized controlled trial. We included participants with primary supratentorial ICH, available baseline Hb levels, and computed tomography scans at baseline and follow-up after 72-96 h. We investigated the association of Hb and anemia (as continuous and dichotomous exposures, respectively) with edema extension distance (EED) as the main continuous outcome at baseline and follow-up and as its interscan change using Spearman correlation and unadjusted and adjusted linear models. We examined absolute and relative PHE in ancillary analyses.</p><p><strong>Results: </strong>We analyzed data from 276 of 293 (94%) i-DEF participants. The median age was 61 (interquartile range [IQR] 52-70) years, and 39% of participants were female. The median Hb level was 14.1 (IQR 13-15.2) g/dL, and 41 participants (15%) were anemic. The median EED was 4.4 (IQR 3.5-5.3) mm at baseline and 6.4 (IQR 5.3-7.3) mm at follow-up. Hb was weakly inversely correlated with baseline (ρ =  - 0.12, p = 0.05) and follow-up EED (ρ =  - 0.11, p = 0.07) but not with interscan EED change (ρ =  - 0.01, p = 0.89). Linear models showed similar relationships of Hb with baseline and particularly follow-up EED but not with EED change. In ancillary analyses, absolute and relative PHE showed no clear correlation with Hb but maintained similar relationships with Hb in linear models as in the main analysis.</p><p><strong>Conclusions: </strong>We identified signals for an association of baseline Hb with PHE after ICH. These findings may warrant further exploration in larger cohorts.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier: NCT02175225.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120311","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":"In Response to \"Second Transcranial Doppler to Confirm Cerebral Circulatory Arrest\".","authors":"Tiffany Eatz, Yosdely Cabrera, Frank Cabrera, Mohan Kottapally, Amedeo Merenda, Ayham Alkhachroum, Jose G Romano, Sebastian Koch","doi":"10.1007/s12028-025-02286-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02286-1","url":null,"abstract":"","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":"144111426","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":"In Reply: Comment on \"Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage\".","authors":"Dag Ferner Netteland, Mads Aarhus, Else Charlotte Sandset, Angelika Sorteberg, Llewellyn Padayachy, Eirik Helseth, Reidar Brekken","doi":"10.1007/s12028-025-02279-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02279-0","url":null,"abstract":"","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":"144111425","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":"Second Transcranial Doppler to Confirm Cerebral Circulatory Arrest.","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Begoña Guardiola, Mariana Andrea Novo, Daniel Agustín Godoy","doi":"10.1007/s12028-025-02285-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02285-2","url":null,"abstract":"","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":"144111428","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":"Systolic Blood Pressure Reduction with Stability as a New Therapeutic Goal in Patients with Intracerebral Hemorrhage: Results of the Pooled Analysis of ATACH 2 and INTERACT 2 Trials.","authors":"Adnan I Qureshi, William Baskett, Renee H Martin, Pashmeen Lakhani, Ibrahim A Bhatti, Hijrah El Sabae, Fawaz Al-Mufti, Joao A Gomes, Ali Seifi, Alejandro A Rabinstein, Jose I Suarez, Thorsten Steiner, Chi-Ren Shyu, Craig S Anderson","doi":"10.1007/s12028-025-02277-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02277-2","url":null,"abstract":"<p><strong>Background: </strong>The American Heart Association/American Stroke Association recommends achieving systolic blood pressure (SBP) therapeutic targets within 60 min of initiating treatment for intracerebral hemorrhage (ICH), emphasizing avoidance of \"overshoot\" correction and SBP fluctuations. We evaluated the prognostic value of \"SBP reduction with stability,\" a novel end point combining controlled blood pressure reduction and maintenance, using data from two large multinational clinical trials.</p><p><strong>Methods: </strong>We analyzed patients with ICH from Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 and Intensive BP Reduction in Acute Cerebral Hemorrhage Trial 2 trials presenting with initial SBP 150-220 mm Hg. SBP reduction with stability was defined as achieving and maintaining SBP between 130 and 150 mm Hg within the first hour after randomization based on consecutive recordings. Outcomes included functional independence (modified Rankin scale 0-2) at 90 days and neurological deterioration within 24 h, adjusted for potential confounders.</p><p><strong>Results: </strong>Among 3,694 patients with ICH (2,781 patients from Intensive BP Reduction in Acute Cerebral Hemorrhage Trial 2 and 913 patients from Antihypertensive Treatment of Acute Cerebral Hemorrhage 2), 1,061 patients (28.7%) achieved SBP reduction with stability within 1 h. Patients had mean age 63.3 ± 12.9 years, baseline SBP 177.14 ± 18.28 mm Hg, and median hematoma volume of 10.78 mL (interquartile range 5.5-19.16). Achieving SBP reduction with stability significantly improved functional independence odds (odds ratio 1.38, 95% confidence interval 1.16-1.64) and reduced neurological deterioration odds (odds ratio 0.68, 95% confidence interval 0.53-0.88) after adjusting for initial SBP, Glasgow Coma Scale, age, sex, stroke history, hypertension, diabetes mellitus, study, ICH location, hematoma volume, and intraventricular hemorrhage presence.</p><p><strong>Conclusions: </strong>Only 30% of patients with mild-to-moderate ICH achieved SBP reduction with stability within the first hour. This achievement was associated with improved functional outcomes and reduced early neurological deterioration. These findings suggest that SBP reduction with stability represents a valuable therapeutic target for future clinical trials in ICH management.</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":"144111429","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":"Comment on \"Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage\".","authors":"Umaya Memon","doi":"10.1007/s12028-025-02280-7","DOIUrl":"https://doi.org/10.1007/s12028-025-02280-7","url":null,"abstract":"","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":"144111424","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":"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":"https://doi.org/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}