Neurocritical Care最新文献

{"title":"Diagnostic and Prognostic Value of Sonographic Optic Nerve Sheath Diameter in Patients with Ischemic Stroke or Hypertensive Intracerebral Hemorrhage.","authors":"Hisham Alasar, Abdallah Kandeel, Mohamed Hamdi, Alshaimaa M Aboul Fotooh, Farid Amin, Mohamed Abdeltawab, Mahmoud Kenawy","doi":"10.1007/s12028-026-02697-8","DOIUrl":"https://doi.org/10.1007/s12028-026-02697-8","url":null,"abstract":"<p><strong>Background: </strong>Elevated intracranial pressure (ICP) is a critical complication in nontraumatic brain injury, yet invasive monitoring carries significant risks, and noninvasive alternatives remain undervalidated. Optic nerve sheath diameter (ONSD) ultrasonography represents a promising bedside technique, but data in nontraumatic populations are limited. This study evaluated the diagnostic and prognostic value of ONSD in neurocritical patients with ischemic stroke or hypertensive intracerebral hemorrhage.</p><p><strong>Methods: </strong>This prospective observational cohort study enrolled 100 neurocritical intensive care unit (ICU) patients with acute nontraumatic brain injury [ischemic stroke or hypertensive intracerebral hemorrhage; Glasgow Coma Scale (GCS) < 9] who underwent admission computed tomography (CT) and bedside ONSD ultrasonography. Sixty age- and sex-matched healthy volunteers were enrolled exclusively to provide descriptive reference values for physiological ONSD and were not included in the primary diagnostic or prognostic analyses. CT-based radiologic ICP surrogates were the reference standard. Exploratory analyses evaluated inter-eye variability, adjusted models, and in-hospital survival.</p><p><strong>Results: </strong>ONSD increased stepwise across healthy controls, patients with negative CT, and patients with positive CT (4.62 ± 0.33, 5.52 ± 0.51, and 6.50 ± 0.51 mm, respectively). Among neurocritical patients, a cohort-derived cutoff of ≥ 6.00 mm yielded 86.7% sensitivity, 85.0% specificity, 89.7% positive predictive value, 81.0% negative predictive value, 86.0% accuracy, and 0.901 area under the curve (AUC). Above-threshold ONSD remained independently associated with CT-positive elevated ICP after adjustment for age, body mass index (BMI), GCS, and systolic blood pressure (SBP) in exploratory multivariable analysis. Exploratory survival analysis showed significantly higher in-hospital mortality in patients with ONSD above the cohort-derived threshold (log-rank p = 4.77 × 10^-13).</p><p><strong>Conclusions: </strong>Bedside ultrasonographic ONSD measurement appears clinically useful for early triage and longitudinal bedside surveillance in neurocritical patients with ischemic stroke or hypertensive intracerebral hemorrhage, particularly when invasive monitoring is unavailable or delayed.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195720","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":"Artificial Intelligence for Early Prediction of Intracranial Hypertension: From Single-Centre Development to Multicentre Validation.","authors":"Peter Galos, Ludvig Hult, Giuseppe Citerio, Anders Lewén, Anders Hånell, Thomas B Schön, Per Enblad","doi":"10.1007/s12028-026-02633-w","DOIUrl":"https://doi.org/10.1007/s12028-026-02633-w","url":null,"abstract":"<p><strong>Background: </strong>Raised intracranial pressure is one of the most severe secondary insults after traumatic brain injury. Recognising physiological patterns before they progress to dangerous intracranial pressure elevations could enable preventive rather than reactive interventions. In our previous Uppsala single-centre study, an XGBoost machine learning model showed high discriminative performance for prediction of imminent intracranial pressure insults. The model identifies short-term physiological trajectories associated with imminent threshold crossing rather than predicting independent future clinical events. Whether these results are generalisable across centres is unknown. The aim was therefore to evaluate whether the XGBoost model trained on an Uppsala dataset maintains similar performance when applied to a multicentre TBI cohort - The CENTER-TBI High-Resolution ICU cohort.</p><p><strong>Methods: </strong>The XGBoost model trained on the Uppsala high frequency traumatic brain injury cohort was externally validated using data from the multicentre CENTER-TBI cohort. Minute-level averages of intracranial pressure and invasive arterial blood pressure were used to predict the onset of an intracranial pressure insult within 30 min on the basis of a 4h historical window. A bidirectional validation design was applied and performance was assessed using multiple metrics.</p><p><strong>Results: </strong>The cohorts comprised 602 patients from Uppsala and 255 patients from the CENTER-TBI database. When trained on the Uppsala cohort and tested on CENTER-TBI, the model achieved an area under the receiver operating characteristic curve (AUROC) of 97.4%, sensitivity of 93.8%, and specificity of 98.6%. Training on CENTER-TBI and testing on the Uppsala dataset yielded an AUROC of 96.1%, sensitivity of 81.2%, and specificity of 98.7%. Balanced accuracy exceeded 88% in both validation directions.</p><p><strong>Conclusions: </strong>The XGBoost model retained high performance under external multicentre validation, indicating that pre-insult physiological patterns preceding increased intracranial pressure are shared across cohorts. Differences in sensitivity between validation directions were observed and may reflect cohort characteristics or dataset size. These findings support the need for local evaluation before clinical implementation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183605","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":"Optimal Transfusion Thresholds in Patients with Acute Brain Injury: A Bayesian Network Meta-analysis of Randomized Controlled Trials.","authors":"Xing Wang, Wei Fu, Wuqian Chen, Lu Ma, Chao You","doi":"10.1007/s12028-026-02674-1","DOIUrl":"https://doi.org/10.1007/s12028-026-02674-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal transfusion threshold for acute brain injury (ABI) remains uncertain. Previous studies comparing liberal and restrictive transfusion strategies have yielded inconsistent findings. Therefore, we performed a Bayesian network meta-analysis to compare the effectiveness and safety of different transfusion thresholds in patients with ABI.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Library was performed to identify randomized controlled trials (RCTs) comparing red blood cell transfusion thresholds in patients with ABI. The primary outcomes were mortality and unfavorable functional outcome. Risk ratios (RRs) with 95% credible intervals (CrIs) were estimated from the Bayesian network meta-analysis, and treatment rankings were assessed using the surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>Six RCTs involving 2599 patients were included. Four transfusion thresholds were evaluated (hemoglobin levels of 7, 8, 9, and 10 g/dL). Compared with a transfusion threshold of 7 g/dL, a threshold of 9 g/dL was associated with a lower risk of unfavorable functional outcome (RR 0.86, 95% CrI 0.78-0.94; direct evidence from two trials). Compared with 8 g/dL, the estimated effect favored a 9 g/dL threshold, but the evidence was indirect and did not reach statistical significance (RR 0.79, 95% CrI 0.63-1.00). No clear differences in adverse events were observed across the evaluated thresholds. The 9 g/dL threshold ranked highest according to SUCRA values for both mortality and neurological outcomes. Meta-regression analysis suggested that baseline hemoglobin level may represent a potential source of heterogeneity in the effect of liberal transfusion strategies on functional outcomes.</p><p><strong>Conclusions: </strong>Among the evaluated transfusion thresholds, a threshold of 9 g/dL ranked most favorably for functional outcome and was associated with a lower risk of unfavorable functional outcome than 7 g/dL, without clear differences in mortality, infectious complications, or thromboembolic events.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165772","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":"Use of Desmopressin in Spontaneous Nontraumatic Intracerebral Hemorrhage Among Patients Taking Antiplatelet Therapy: Systematic Review and Bayesian Meta-analysis.","authors":"Paweł Łajczak, Rafael Reis de Oliveira, Anna Łajczak, Wellingson Silva Paiva, Raphael Bertani","doi":"10.1007/s12028-026-02672-3","DOIUrl":"https://doi.org/10.1007/s12028-026-02672-3","url":null,"abstract":"<p><p>Antiplatelet therapy-associated intracerebral hemorrhage (APT-ICH) remains a significant neurological concern due to high morbidity and mortality among these patients. Early trials of desmopressin (DDAVP) suggested clinical benefit; however, the number of studies available at the time was limited. This systematic review and Bayesian meta-analysis aim to answer whether administration of DDAVP among patients with APT-ICH improves clinical course. Five databases were searched for studies comparing DDAVP and placebo/control/usual care in patients with APT-ICH. Bayesian meta-analysis was performed using a random-effects model with three different priors. A total of seven studies were included. There was no difference in overall mortality [odds ratio (OR) 1.23; 95% credible interval (CrI) 0.79-1.91], in-hospital mortality (OR 1.41; 95% CrI 0.88-2.26), or good functional outcome (OR 0.66; 95% CrI 0.34-1.31). Posterior distribution analysis suggested a possible increase in thromboembolic complications and the proportion of patients with poor neurological outcomes among patients on DDAVP. There is currently a lack of convincing evidence of benefit regarding the administration of DDAVP for patients with APT-ICH. Furthermore, there are several signals that raise concerns for harm.This review indicates that there is no clear, well-supported recommendation to administer DDAVP to patients with APT-ICH.The results of Bayesian meta-analysis reveal a concerning signal for harm with DDAVP administration.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168396","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":"Neurocritical Care Society Abstracts from the 24th Annual Meeting 2026.","authors":"","doi":"10.1007/s12028-026-02638-5","DOIUrl":"10.1007/s12028-026-02638-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137188","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":"Prone Positioning in Neurocritical Care Patients with Invasive Intracranial Pressure Monitoring: A Systematic Review and Meta-analysis.","authors":"Annika Meyer, Remco Overbeek, Laura Mühlhausen, Jan Küchler, Claudia Ditz, André Foit, Marion Hof, Roland Goldbrunner, Andrea U Steinbicker","doi":"10.1007/s12028-026-02667-0","DOIUrl":"https://doi.org/10.1007/s12028-026-02667-0","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications are common after acute brain injury and may worsen neurologic outcomes. Although prone positioning (PP) is an established treatment strategy for acute respiratory distress syndrome (ARDS) with severe hypoxemia in general intensive care unit populations, it is often avoided in neurocritical care due to concerns that PP may increase intracranial pressure (ICP). However, evidence supporting these concerns remains limited.</p><p><strong>Methods: </strong>A systematic search of multiple databases and supplementary sources using keywords related to ICP and PP yielded 778 records. Ten studies with 177 patients met the inclusion criteria for the systematic review and eight (n = 120 patients) provided extractable data for meta-analysis of the primary outcome [change in ICP from baseline (supine) to PP]. Pooled means and mean differences were calculated using random-effects models.</p><p><strong>Results: </strong>The pooled within-subject mean change in ICP from baseline to PP was + 5.06 mm Hg (95% CI 2.05-8.06; I² = 76.7%). Accordingly, pooled mean ICP increased from 11.10 mm Hg (95% CI 8.43-13.76) at baseline to 16.13 mm Hg (95% CI 13.83-18.43) during PP, remaining below commonly used treatment thresholds for intracranial hypertension although clinically relevant ICP elevations occurred in a small subset of patients. By contrast, the pooled change in ICP between baseline and after returning to the supine position in five studies (n = 45) was - 0.41 mm Hg (95% CI - 2.34 to 1.51), indicating that the increase in ICP during PP was transient and reversible. Systemic oxygenation and brain tissue oxygenation improved in PP.</p><p><strong>Conclusions: </strong>In patients with acute brain injury, PP improves systemic and brain tissue oxygenation while causing a modest, transient increase in ICP that resolves after resupination. These findings support cautious use of PP in selected neurocritical care patients with respiratory failure when invasive ICP monitoring is available. Given the limited evidence base, larger prospective studies are needed.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128102","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 the Letter to the Editor Entitled \"Cerebrospinal Fluid Hemopexin as a Sepsis-Specific Signal After Intracerebral Hemorrhage\" Regarding the Study \"Cerebrospinal Fluid Hemopexin as a Candidate Biomarker for Secondary Sepsis and In-hospital Outcome After Spontaneous Intracerebral Hemorrhage: An Exploratory Translational Proteomics Study\".","authors":"Tuxiu Xie, Weixiao Feng, Yu He, Yuhang Cao, Shuixiang Deng","doi":"10.1007/s12028-026-02663-4","DOIUrl":"https://doi.org/10.1007/s12028-026-02663-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112572","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":"Rethinking Platelet Dysfunction in Traumatic Brain Injury: From Platelet Count to Hemostatic Phenotype.","authors":"Manuel Quintana Diaz, Daniel Agustin Godoy","doi":"10.1007/s12028-026-02670-5","DOIUrl":"https://doi.org/10.1007/s12028-026-02670-5","url":null,"abstract":"<p><p>Coagulopathy after traumatic brain injury (TBI) is multifactorial and dynamic, with major implications for hemorrhagic progression and outcome. Platelet dysfunction is an underrecognized component that may occur despite preserved platelet count. For the purpose of this point of view, platelet dysfunction refers to any measurable impairment in agonist-induced aggregation, receptor-pathway responsiveness [adenosine diphosphate (ADP)/P2Y12 and arachidonic acid (AA)/ cyclooxygenase-1 (COX-1) axes], or platelet contribution to whole-blood-clot strength, occurring disproportionate to or in the absence of thrombocytopenia. Functional impairment can appear early and has been associated with TBI severity, intracranial hemorrhage progression, transfusion requirements, and mortality. Conventional coagulation tests and platelet count are insufficient to identify this phenotype. Platelet function assays, including thromboelastography (TEG) with platelet mapping, may help characterize selected high-risk patients. However, the evidence remains largely observational, thresholds are heterogeneous, interassay concordance is poor, and platelet transfusion or desmopressin should not be regarded as routine interventions. This point of view reframes platelet dysfunction after TBI as a dynamic hemostatic phenotype and argues for prospective phenotype-guided trials.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112703","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":"Cerebrospinal Fluid Hemopexin as a Sepsis-Specific Signal After Intracerebral Hemorrhage.","authors":"Humaiz Ahmed, Mahroo Niazi","doi":"10.1007/s12028-026-02664-3","DOIUrl":"https://doi.org/10.1007/s12028-026-02664-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112477","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":"Physiological Effects of High-Flow Tracheal Oxygen vs. Pressure Support Ventilation in Neurosurgical Patients with Brain Tumors Facing Delayed Extubation: A Pilot Study.","authors":"Yi-Min Zhou, Yan-Juan Ma, Ye Tian, Jian-Fan Zhou, Guang-Zhi Shi, Jian-Xin Zhou, Guang-Qiang Chen","doi":"10.1007/s12028-026-02656-3","DOIUrl":"https://doi.org/10.1007/s12028-026-02656-3","url":null,"abstract":"<p><strong>Background: </strong>Postoperative neurosurgical patients who successfully pass a spontaneous breathing trial (SBT) may still require delayed extubation due to impaired airway protection. Continued mechanical ventilation may contribute to diaphragm underuse. High-flow tracheal oxygen (HFTO) offers an alternative-discontinuing positive pressure while maintaining airway access-but its physiological effects in intubated neurosurgical patients remain poorly characterized.</p><p><strong>Methods: </strong>In this prospective, randomized physiological pilot study, postoperative neurosurgical patients who required delayed extubation were assigned (1:1) to HFTO or low-level pressure support ventilation (PSV). Esophageal pressure monitoring and diaphragmatic ultrasound were performed at baseline and at 2, 12, 24, and 48 h. The primary endpoint was inspiratory effort assessed by esophageal pressure-time product (PTPes) per min. Secondary outcomes included diaphragmatic function, respiratory parameters, safety, and clinical outcomes.</p><p><strong>Results: </strong>A total of 24 patients were randomized; 1 patient was withdrawn due to intracranial rebleeding, leaving 23 patients for analysis (HFTO, n = 12; PSV, n = 11). HFTO exhibited a significantly different temporal trajectory in inspiratory effort (group-by-time interaction P = 0.019), characterized by an acute physiological step-up immediately after withdrawing positive pressure support, followed by a stable plateau from 2 to 48 h. Diaphragmatic indices remained unchanged in both groups over 48 h. Airway pressures were significantly lower in the HFTO group (all P < 0.001), accompanied by modest declines in partial pressure of arterial oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) and slight partial pressure of arterial carbon dioxide (PaCO₂) increases. Respiratory deterioration rate was similar between groups (25.0% vs. 18.2%, P = 1.000). Ventilator-free days at day 28 were univariately higher with HFTO (27.0 [23.0-27.0] vs. 21.0 [17.0-24.0] days, P = 0.022); artificial airway-free days and ICU length of stay were comparable between groups.</p><p><strong>Conclusions: </strong>HFTO was univariately associated with increased inspiratory effort compared with low-level PSV, without short-term diaphragmatic harm or increased clinical instability in postoperative neurosurgical patients requiring delayed extubation. These findings suggest HFTO as a feasible strategy for liberation from mechanical ventilation while maintaining airway safety. Larger multicenter studies are warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112583","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}