Neurocritical Care最新文献

{"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A total of 24 patients were randomized; 1 patient was withdrawn due to intracranial rebleeding, leaving 23 patients for analysis (HFTO, n = 12; PSV, n = 11).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}

{"title":"Association Between GLP-1 RECEPTOR Agonist use and Survival in Surgically Treated Patients with Traumatic Brain Injury.","authors":"Wei-Thing Khor, Kuan-Yu Chi, Yu Chang, Pang-Shuo Perng, Hong-Min Lin, Yen-Ta Huang, Chih-Yuan Huang","doi":"10.1007/s12028-026-02676-z","DOIUrl":"https://doi.org/10.1007/s12028-026-02676-z","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112496","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":"Prognostic Significance of Early Fever in Convulsive Status Epilepticus: Insights from the ICTAL Registry.","authors":"Alexis Carriere, Jonathan Chelly, Jean-Pierre Quenot, Jean-Baptiste Lascarrou, Charles Bernard, Olivier Lesieur, Mehran Monchi, Pascal Beuret, Florian Sigaud, Ghada Sboui, Pierre Bailly, Raphaël Chambon, Candice Fontaine, Nicolas Mongardon, Charles Cerf, Cédric Bruel, Nicolas Pichon, Laurent Argaud, Isabelle Desmeulles, Thibault Vieille, Mehdi Marzouk, Hugues Ravaux, David Schnell, Hela Kallel, Gwenaëlle Jacq, Stephane Legriel","doi":"10.1007/s12028-026-02673-2","DOIUrl":"https://doi.org/10.1007/s12028-026-02673-2","url":null,"abstract":"<p><strong>Background: </strong>Fever is one of the secondary brain insults that may alter outcome after acute brain injury. However, its deleterious role in convulsive status epilepticus (CSE) remains insufficiently established in humans. We aimed to determine whether early fever is associated with functional neurological outcome in patients with CSE.</p><p><strong>Methods: </strong>We conducted a prospective multicenter study using data from the ICTAL Registry, including adult patients with CSE admitted to 23 French intensive care units (ICUs). Fever, defined as a core temperature ≥ 38 °C, was assessed during the first 24 h following CSE onset. Multivariable logistic regression analyses were used to evaluate the independent association between early fever and 90-day favorable neurological outcome, defined as a Glasgow Outcome Scale (GOS) score of 4-5.</p><p><strong>Results: </strong>Among 952 included patients, 382 (41.2%) developed fever within the first 24 h of ICU stay. The underlying causes of fever appeared to be multifactorial, including infectious etiologies related to CSE itself (either systemic or central nervous system infections), early aspiration pneumonia, and the intensity of convulsive activity. After matching, only the intensity of convulsive activity remained associated with the occurrence of fever. In multivariable analyses, independent predictors of favorable outcome were age < 60 years and a Charlson Comorbidity Index < 3, whereas cerebral insult as CSE etiology and refractory CSE were associated with unfavorable outcome. Early fever was not independently associated with 90-day functional outcome.</p><p><strong>Conclusions: </strong>Early fever is highly prevalent in convulsive status epilepticus and appears to reflect seizure intensity rather than overall disease severity. It was not independently associated with 90-day neurological outcome, suggesting no major prognostic impact, although a modest association cannot be excluded. These findings should therefore be interpreted with caution and do not allow conclusions regarding the impact of temperature-control strategies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112569","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":"Correction: Glycemic Control in Severe Acute Brain Injury: Systematic Review and Meta-analysis with Trial Sequential Analysis.","authors":"Anne-Sophie Worm Fenger, Markus Harboe Olsen, Helene Ravnholt Jensen, Signe Janum Eskildsen, Lea Rue Honoré, Maria Louise Fabritius, Daniel Kondziella, Signe Tellerup Nielsen, Rikke Krogh-Madsen, Christian Gunge Riberholt, Kirsten Møller","doi":"10.1007/s12028-026-02647-4","DOIUrl":"https://doi.org/10.1007/s12028-026-02647-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112610","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":"Risk Factors and Outcomes Associated with Atrial Fibrillation Detected after Intracerebral Hemorrhage.","authors":"Farid Khasiyev, Karin Oh, Angela Velazquez, Sandy Song, Jerina Carmona, Daysha Fliginger, Shivani Ghoshal, Sachin Agarwal, Soojin Park, Jan Claassen, E Sander Connolly, David J Roh","doi":"10.1007/s12028-026-02479-2","DOIUrl":"10.1007/s12028-026-02479-2","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation detected after stroke (AFDAS) refers to newly identified atrial fibrillation occurring after an index cerebrovascular event, most commonly ischemic stroke, but little is known about its occurrence and clinical implications in patients with spontaneous intracerebral hemorrhage (ICH). We aimed to characterize AFDAS risk factors in ICH and AFDAS' relationship with long-term ICH outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutively admitted and enrolled patients with spontaneous ICH to a single tertiary comprehensive stroke center between 2009 and 2018 who underwent continuous cardiac monitoring. Patients were categorized as having sinus rhythm [SR (reference)], atrial fibrillation detected after stroke (AFDAS, defined here as atrial fibrillation (AF) detected during the index ICH hospitalization), and known AF. Demographic, clinical, imaging, and hospitalization complication data were compared across rhythm groups. Poor modified Rankin scale (mRS 4-6) at 3-month follow-up was assessed as the primary clinical outcome. Multivariable logistic regression assessed independent relationships of AFDAS with poor outcomes adjusting for demographics, ICH severity, and AFDAS risk factors.</p><p><strong>Results: </strong>Amongst 532 patients with ICH, AFDAS occurred in 5% on median ICH hospital day 3. Outside of increased hypertension prevalence, patients with AFDAS had fewer baseline cardiovascular comorbidities compared with patients with known AF yet had similar cardiac risk profiles and structural/function measurements on echocardiogram compared with patients with SR. Baseline ICH characteristics and severity were similar between groups, but patients with AFDAS were more likely to have hospitalization infection complications (67% vs. 32% in known AF, 42% in SR, p = 0.01). Poor 3-month outcome was more common in patients with AFDAS (94%) compared with those with known AF (78%) and sinus rhythm (65%) (p = 0.01), and AFDAS was independently associated with poor outcomes [adjusted odds ratio (OR) 11.07, 95% confidence interval (CI) 1.30-94.27].</p><p><strong>Conclusions: </strong>We identified that patients with ICH and AFDAS have less severe cardiovascular comorbidities yet are more likely to have worse long-term outcomes. Further prospective studies are required to confirm these results and characterize drivers for AFDAS development and links between AFDAS and poor ICH outcomes to assess whether AFDAS detection and prevention can improve ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"535-542"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474749","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":"Should Aggressive Blood Pressure Management of Spontaneous Intracerebral Hemorrhage Be Guided with Invasive Blood Pressure Monitoring?","authors":"Mohamed Reda Bensaidane, Jonathan P Coles","doi":"10.1007/s12028-026-02526-y","DOIUrl":"10.1007/s12028-026-02526-y","url":null,"abstract":"<p><p>Early, intensive systolic blood pressure (SBP) lowering is recommended in acute spontaneous intracerebral hemorrhage (sICH), with growing emphasis on rapid target attainment and minimal blood pressure variability. However, outcome trials and guidelines have not addressed whether titration should be guided by invasive arterial blood pressure (IABP) or by intermittent noninvasive monitoring using a cuff. Evidence from emergency and intensive care unit (ICU) cohorts shows clinically meaningful disagreement between cuff and invasive measurements that widens at higher SBP and during motion-prone phases such as transport and agitation, precisely when active titration is needed. Variability in blood pressure measurements based on the technique will lead to differences in patient management that might impact outcome. In addition, data are scarce on how IABP monitoring should be operationalized to treat SBP more effectively, in a smooth and sustained fashion. This commentary delineates the key knowledge gaps and further research needed to define the role of invasive blood pressure monitoring in sICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"498-504"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875182","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":"Full Medical Support versus Limited Medical Care in Malignant Middle Cerebral Artery Infarction after Successful Recanalization for Large-Vessel Occlusion Stroke.","authors":"Guo Yiting, Hu Chenzi, Yukai Liu, Zhou Junshan, Gao Jie, Huang Zhihui, Fu Yijia","doi":"10.1007/s12028-026-02519-x","DOIUrl":"10.1007/s12028-026-02519-x","url":null,"abstract":"<p><strong>Background: </strong>A subset of patients with anterior circulation large-vessel occlusion (LVO) stroke progressed to malignant middle cerebral artery infarction (mMCAi) despite successful recanalization following endovascular treatment. This study investigated whether full medical support (FMS) could improve functional outcomes beyond reducing mortality in this population.</p><p><strong>Methods: </strong>In this retrospective cohort study, consecutive patients from hospital-based stroke registry (May 2015 to August 2021) with anterior LVO stroke who developed mMCAi despite successful recanalization were included. Patients were stratified into two groups on the basis of the intensity of postprocedural care: the FMS group (aggressive neurocritical care) and the non-FMS group (limited medical support or comfort care). The primary outcome was survival without severe disability, defined as a modified Rankin Scale (mRS) score of 0-4 at 90 days. Secondary outcomes included ordinal shift analysis of the mRS, rates of functional independence (mRS 0-2 and 0-3), and 90-day mortality.</p><p><strong>Results: </strong>Among 114 eligible patients, 65 were assigned to the FMS group and 49 to the non-FMS group. The FMS group demonstrated a significantly higher rate of the primary outcome (46.2% vs. 6.1%; P < 0.001) along with a markedly lower 90-day mortality (23.1% vs. 81.6%; P < 0.001) compared with the non-FMS group. After adjustment for age, gender, and confounders, FMS remained independently associated with increased odds of achieving mRS 0-4 [adjusted odds ratio (aOR), 5.88; 95% confidence interval (CI) 1.31-26.40; P = 0.021) and with reduced mortality (aOR, 0.14; 95% CI 0.05-0.42; P < 0.001), while no statistically significant difference was observed in the proportion of patients achieving an mRS of 0-2 or in those achieving an mRS of 0-3.</p><p><strong>Conclusions: </strong>In patients who developed mMCAi after successful recanalization, FMS is associated with a greater likelihood of survival without severe disability (mRS 0-4). These findings suggest that withdrawal of aggressive medical care in this population should be approached with caution.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"643-650"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691210","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":"What Do We Do When the ICP Goes Up?","authors":"Randall M Chesnut, Nancy Temkin, Jason Barber, Christine Park, Robert H Bonow","doi":"10.1007/s12028-026-02504-4","DOIUrl":"10.1007/s12028-026-02504-4","url":null,"abstract":"<p><strong>Background/objective: </strong>We sought to study which intracranial pressure (ICP)-lowering treatments are actually administered following the diagnosis of a clinical intracranial hypertension episode (CLICHÉ) during modern, routine care.</p><p><strong>Methods: </strong>We performed a secondary analysis of data from patients with ICP only (normal or blinded partial pressure of brain tissue oxygen [PbtO₂]) in the Brain Tissue Oxygen Monitoring and Management in Severe Traumatic Brain Injury (BOOST II) randomized trial. We identified \"minimalist\" (forme fruste) CLICHÉs (defined by 5 min of ICP > 20 lasting ≤ 60 min, requiring only Tier One treatments) and catalogued all interventions by frequency, grouping and distribution of administration. Tier One treatments were not rank-ordered.</p><p><strong>Results: </strong>Of the 119 randomized patients, 70 had 509 CLICHÉs that met forme fruste definition with complete datasets (71% of total CLICHÉs). Analgosedation adjustment and cerebrospinal fluid (CSF) drainage were the predominant treatments, used respectively in 72% and 33% of full CLICHÉs and within the first 15 min in 53% and 31%. In combination, they were the third most common intervention. Treatments often involved agent combinations (41% for full CLICHÉs; 46% within the first 15 min). Treatments that could be readily and discretionally administered by the bedside clinician represented 76% of treatments for full CLICHÉs and 69% for early interventions.</p><p><strong>Conclusions: </strong>Analgosedation adjustment predominates as the treatment of choice for forme fruste CLICHÉs despite scarce literature support regarding mechanism, efficacy or influence on outcome. Frequent use of agent combinations confounds use of treatments (e.g. therapeutic intensity level) as a descriptive variable. Although details regarding clinical reasoning underlying intervention choices are lacking, it appears that intervention choice may be influenced by expediency outside of effectiveness. These findings accent the importance of understanding how treatment protocols are actually implemented. Investigation of the proper role of analgosedation adjustment and treatment combinations in ICP control is needed. Current management practices require targeted, physiology-based treatment guidance.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"622-631"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633930","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":"Education and Ethical Guidance for Organ Donation at the End-of-Life: An Ethical Guidance Statement from the Neurocritical Care Society.","authors":"Alexandra S Reynolds, Matthew N Jaffa, Daryl McHugh, Marc A Babi, Stefanie Cappucci, Chad Condie, Julia Durrant, Richard Gandee, Krista Lim-Hing, Alyssa Runco, Ariane Lewis","doi":"10.1007/s12028-026-02619-8","DOIUrl":"10.1007/s12028-026-02619-8","url":null,"abstract":"<p><p>The neurocritical care treatment team frequently interacts with patient surrogates and Organ Procurement Organizations (OPOs) at the end-of-life. A 2025 survey of Neurocritical Care Society (NCS) members assessing experiences and attitudes related to organ donation identified the need to enhance education for the treatment team about organ donation and opportunities for improvement in palliative interventions after withdrawal of life-sustaining therapies for potential donation after cardiac death/death by circulatory-respiratory criteria. Additionally, members noted concerns regarding blurred boundaries between patient care and care directed towards organ donation; a potential lack of transparency, empathy and cultural sensitivity in communication between OPOs and patient surrogates; and the ethics of first-person authorization for organ donation. In response to these concerns, the NCS Ethics Committee developed this statement to provide education and ethical guidance for organ donation at the end-of-life. Members had an opportunity to share feedback on the statement from April 6-19, 2026. This statement provides an informal narrative review of the literature related to organ donation that is pertinent to the care of potential organ donors at the end-of-life and includes practical guidance related to the legal definitions of death and first-person authorization, collaborative communication, and management of potential conflicts.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"464-485"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881145","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}