Neurocritical Care最新文献

{"title":"Response to Commentary by Dr. Lakhal and Dr. Lasocki.","authors":"Cappi Lay, Hae Young Baang","doi":"10.1007/s12028-025-02379-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02379-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252279","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":"Ongoing Debate on IV Milrinone for Cerebral Vasospasm: \"It Ain't Over 'Til It's Over\".","authors":"Karim Lakhal, Sigismond Lasocki","doi":"10.1007/s12028-025-02378-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02378-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252205","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":"Prioritization of Ethical Themes When Surrogates Object to Technology Removal After Brain Death Determination.","authors":"Elena Montag, Matthew P Kirschen, Pamela Nathanson, Wynne Morrison, Evan Fieldston, Jennifer K Walter","doi":"10.1007/s12028-025-02390-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02390-2","url":null,"abstract":"<p><p>As hospitals revise their policies for brain death/death by neurologic criteria (BD/DNC), they should provide transparent and clear plans for how to handle surrogate requests to continue technology after declaration of death. National guidelines provide little guidance in this matter, and individual institutions should make decisions grounded in an understanding of their local constraints and the ethical values at stake. Ethical arguments exist in favor of and opposed to allowing continuation of technologic support for families who object to BD/DNC. Prioritization of these ethical values influences how institutions handle objections to removal of technologic support after BD/DNC determination. A narrative review of the literature identified six ethical values relevant to institutional responses to surrogate objections: inappropriate treatment, distributive justice, BD/DNC as philosophical or legal death not biological death, dignity and respect, surrogate authority, and medical mistrust. We articulate three potential paths forward an institution can take and the relative prioritization of ethical values in each case. When developing or revising hospital policies on BD/DNC, hospitals must understand the ethical values in tension with any particular approach taken. Hospitals vary in the populations they care for and the resources at their disposal, which may impact prioritization of ethical principles at stake in these decisions. Although some ethical values may not be prioritized, institutions should design systems to honor them to the extent possible given the plurality of beliefs and experiences of the patients for whom we care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252259","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 Targets in Stroke Care: The Need for Prospective Validation Before Clinical Implementation.","authors":"Arnaldo Alves da Silva, Rogerio da Hora Passos, Mauricio Reis Pedrosa, João Manoel da Silva","doi":"10.1007/s12028-025-02388-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02388-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239241","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 in Stroke: Building a Framework, Conceptualizing Intervention Opportunities, and Identifying Practical Research Objectives.","authors":"David Z Rose, Alejandro A Rabinstein, May Kim-Tenser, Sergio D Bergese, Gabriel V Fontaine, Charles Kircher, Adnan I Qureshi","doi":"10.1007/s12028-025-02389-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02389-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239231","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":"Effects of 'Head Up' Prone Position on Transcranial Color Doppler-Based Estimators of Intracranial Pressure in Moderate to Severe Acute Respiratory Distress Syndrome Without Brain Injury: A Cross-Over, Longitudinal, Physiological Study.","authors":"Domenico Junior Brunetti, Francesca Leonardis, Francesca Frisardi, Mario Dauri, Cristian Deana, Raffaele Aspide, Gianmaria Cammarota, Luigi Pisani, Rossella Adorno, Roberto Polidoro, Marco Tiseo, Paola Giuseppina Sergi, Luigi Vetrugno, Luciana Mascia, Daniele Guerino Biasucci","doi":"10.1007/s12028-025-02240-1","DOIUrl":"10.1007/s12028-025-02240-1","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning is recommended in acute respiratory distress syndrome (ARDS) to ensure adequate gas exchange. However, it may lead to an increase in intracranial pressure (ICP), mostly due to a reduction of venous return from the brain. ICP can be noninvasively estimated with transcranial color-coded Doppler (TCCD) using methods based on the relationships between the pulsatility index (PI) and ICP or methods based on the estimate of cerebral perfusion pressure (eCPP) and estimate of ICP (eICP). This study was aimed at assessing the effects of a 30° reverse Trendelenburg ('head up') prone position on two noninvasive estimators of ICP (eICP and PI).</p><p><strong>Methods: </strong>This is a cross-over, longitudinal, physiological study conducted on a cohort of adult patients fulfilling Berlin definition criteria for moderate to severe ARDS without brain injury but with clinical indication to prone positioning. We registered TCCD parameters of cerebral hemodynamic and systemic hemodynamic parameters, blood gas exchange data, and respiratory mechanics parameters in a horizonal supine position, in a 30° semirecumbent supine position, in the standard prone position, and, finally, in the 30° 'head up' prone position, obtained by tilting the entire bed to a reverse Trendelenburg position. One-way repeated measures analysis of variance was used to analyze data.</p><p><strong>Results: </strong>In 20 patients included, switching from a supine position to the standard prone position resulted in a significant increase in mean ± SD PI (from 0.99 ± 0.22 to 1.29 ± 0.25, p < 0.01) and eICP (from 12.5 ± 3.8 to 17.5 ± 4.1, p < 0.01), whereas moving from this latter position to the 'head up' prone position resulted in a decrease in the mean ± SD PI (from 1.29 ± 0.25 to 1.0 ± 0.23, p < 0.01). Hemodynamic and respiratory mechanics parameters did not differ.</p><p><strong>Conclusions: </strong>The 30° 'head up' prone position may limit the increase in PI in moderate to severe ARDS without brain injury. As a noninvasive estimator of ICP, PI may allow detection of changes in ICP when moving from the 'head up' semirecumbent supine position to the standard prone position and from this latter position to the 'head up' prone position.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"446-457"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710779","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":"Clinical Consequences of Disproportionate Free Valproate Elevation in Critically Ill Adult Patients: A Multicenter Retrospective Cohort Study.","authors":"Andrew J Webb, David J Gagnon, Caitlin S Brown, Richard R Riker, Natasha D Lopez, Melanie Z Goodberlet, Michael J Schontz, Kaylee K Marino, Sahar F Zafar, Eric S Rosenthal","doi":"10.1007/s12028-025-02243-y","DOIUrl":"10.1007/s12028-025-02243-y","url":null,"abstract":"<p><strong>Background: </strong>Valproate has a narrow therapeutic index and unpredictable protein binding, and critically ill patients may experience unexpectedly elevated free concentrations. We sought to identify the clinical consequences and determinants of disproportionate free valproate concentration elevation in critically ill adults.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study conducted at two academic medical centers from December 2015 to December 2023. Adult patients admitted to an intensive care unit who were receiving valproate and had concurrent total and free valproate concentrations measured were eligible for inclusion. We examined whether valproate concentrations were independently associated with adverse effects (AEs), including thrombocytopenia, hepatotoxicity, hyperammonemia, and pancreatic injury. Secondarily, determinants of disproportionate free valproate elevation, defined as a free valproate concentration that was greater than expected and out of proportion to the total concentration (e.g., free valproate above reference range but total valproate below reference range), were also identified.</p><p><strong>Results: </strong>A total of 311 patients (mean age 58 [SD ± 17] years, 36% female, 31% non-White, and 29% on valproate prior to admission) with 550 concurrent free valproate and total valproate pairs were included. The median total valproate concentration was 46 μg/mL (interquartile range [IQR] 34-63), and the median free valproate concentration was 17 μg/mL (IQR 11-23); the median free fraction was 35% (IQR 25-63%). Disproportionate free valproate elevation was observed in 462 (84%) samples. Each 2.5-μg/mL increase in free valproate concentration was associated with thrombocytopenia (adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI] 1.05-1.26) and hepatotoxicity (aOR 1.11, 95% CI 1.05-1.18). Albumin concentration (aOR 0.17, 95% CI 0.08-0.36), blood urea nitrogen (aOR 1.36, 95% CI 1.09-1.70), and propofol exposure (aOR 3.06, 95% CI 1.38-6.79) were associated with disproportionate free valproate elevation.</p><p><strong>Conclusions: </strong>Elevated free valproate concentrations were associated with hepatotoxicity and thrombocytopenia; free valproate concentrations should be directly measured in critically ill patients because it is underrepresented by total valproate. Most critically ill patients are at risk, especially those with hypoalbuminemia, uremia, and propofol exposure.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"472-483"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710774","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":"Communicating with Families after Severe Acute Brain Injury.","authors":"Adeline L Goss, Claire J Creutzfeldt","doi":"10.1007/s12028-025-02252-x","DOIUrl":"10.1007/s12028-025-02252-x","url":null,"abstract":"<p><p>Communicating with patients and families after severe acute brain injury (SABI) is often considered an art, but the science of communication in SABI is advancing. Recent research demonstrates how surrogates perceive various styles of prognostic language in SABI, provides insight on factors that influence prognostic discordance between surrogate decision-makers and clinicians, and identifies sources of bias in prognostic communication and shared decision-making. In this article for Neurocritical Care's topical collection on palliative care, we review this latest research, offer strategies to approach difficult communication tasks with insufficient evidence to guide practice, and discuss ethical issues relevant to decision-making for this patient population.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"671-681"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045283","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":"Different Responses to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage.","authors":"Santiago Clocchiatti-Tuozzo, Cyprien A Rivier, Adnan I Qureshi, Daniela Renedo, Shufan Huo, Charles Matouk, Nils Petersen, Adam de Havenon, Kevin N Sheth, Alejandro A Rabinstein, Guido J Falcone, Maximiliano A Hawkes","doi":"10.1007/s12028-025-02269-2","DOIUrl":"10.1007/s12028-025-02269-2","url":null,"abstract":"<p><strong>Background: </strong>Intensive blood pressure (BP) reduction may benefit patients with acute intracerebral hemorrhage (ICH), but it is unknown if those benefits apply equally to patients with lobar and deep ICH. Our objective was to assess the impact of intensive BP reduction on hematoma expansion (HE), 90-day functional outcomes, and renal adverse events (RAEs) in patients with deep ICH compared with those with lobar ICH.</p><p><strong>Methods: </strong>This was an exploratory, post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) randomized clinical trial, which investigated the efficacy of intensive BP reduction (110-139 mm Hg systolic BP) versus standard (140-179 mm Hg systolic BP) reduction 4.5 h after acute spontaneous ICH. Our end points of interest were HE (> 6 mL increase in hematoma volume between baseline and 24 h), 90-day functional outcome (modified Rankin Scale score 0-3 vs. 4-6), and RAEs.</p><p><strong>Results: </strong>Of 1000 ATACH-2 participants, only 875 participants (87.5%) with complete neuroimaging data were included (778 [89%] deep and 97 [11%] lobar, mean age of 62 years, 62% male). Multivariable logistic regressions results showed that intensive BP reduction decreased the risk of HE (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.38-0.93; p = 0.024) and increased the risk of RAE (OR 2.42, 95% CI 1.29-4.72; p = 0.007) in deep ICH, whereas in lobar ICH results were nonsignificant for HE (OR 0.91, 95% CI 0.34-2.41; p = 0.9). Intensive BP reduction was not significantly associated with 90-day unfavorable functional outcome in either deep (OR 1.03, 95% CI 0.71-1.51; p = 0.9) or lobar (OR 0.97, 95% CI 0.31-2.95; p = 0.9) ICH.</p><p><strong>Conclusions: </strong>In this exploratory analysis of the ATACH-2 study, intensive BP reduction was associated with reduced risk of HE and increased risk of RAE in deep but not lobar ICH. These results emphasize the need for a better understanding of the biological differences in ICH, which may have therapeutic implications.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"607-615"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064169","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: Invasive and Noninvasive Intracranial Pressure Pulse Waveform in Neurocritical Care Patients with Different Cranium Integrity.","authors":"Shraddha Mainali","doi":"10.1007/s12028-025-02381-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02381-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207058","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}