Neurocritical Care最新文献

{"title":"Contextualizing India's Medicolegal Controversies Related to Brain Death/Death by Neurologic Criteria: Regulation, Religion, and Resource Allocation.","authors":"Ariane Lewis, Kapil Zirpe","doi":"10.1007/s12028-025-02300-6","DOIUrl":"10.1007/s12028-025-02300-6","url":null,"abstract":"<p><p>Brain death/death by neurologic criteria (BD/DNC) is accepted as legal death throughout much of the world. The World Brain Death Project and a subsequent review of the literature through 2023 highlighted several medicolegal controversies related to BD/DNC in Canada, the United Kingdom, and the United States but did not discuss medicolegal controversies related to BD/DNC in low- and middle-income countries, such as India. Although the Transplantation of Human Organs Act of 1994 acknowledged BD/DNC as death in India, BD/DNC evaluations are not always completed when BD/DNC is suspected. This has been attributed to lack of awareness/acceptance by medical professionals, lack of public awareness/acceptance of BD/DNC, communication challenges, fear, time limitations, and the inclusion of BD/DNC in organ donation law (but not general law). There has been a gradual rise in the number of donations after BD/DNC (a correlate for the number of BD/DNC determinations) in southern and western states, but the number of donations after BD/DNC has decreased in the southwestern state of Kerala in the setting of recent medicolegal controversies. This article reviews the history of BD/DNC determination in India as a whole, then describes the recent medicolegal controversies related to BD/DNC in the state of Kerala. Finally, these controversies are contextualized relative to the aforementioned controversies in high-income countries. Three key international themes of medicolegal controversies related to BD/DNC are regulation, religion, and resource allocation. The global neurocritical care community must advocate for consistency and accuracy in BD/DNC determination and collaborate with legal and policy experts to develop means to mitigate these challenges through revisions to the law, standardization of practice and policies, education, and communication.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333610","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":"Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients.","authors":"Essamedin M Negm, Hossam Tharwat Ali, Hanaa A Nofal, Ahmed Mosallem, Ashraf Elsayed Ahmed, Ahmed Ali Morsy, Tamer S Elserafy, Marwan Elgohary, Khaled Mohamed Altaher, Sherif Sharaf El Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen","doi":"10.1007/s12028-025-02302-4","DOIUrl":"10.1007/s12028-025-02302-4","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a recognized cause of global mortality in intensive care units. Sedation and analgesia management are essential for patients with sepsis or hemodynamic instability. Although considered safe concerning hemodynamic changes, ketamine use might cause a substantial rise in intracranial pressure (ICP).</p><p><strong>Methods: </strong>An interventional study was conducted at the intensive care unit of Zagazig University Hospitals from December 2021 to March 2023 and covered 100 adult patients with septic shock requiring mechanical ventilation, sedation, and vasopressors. Patients with acute brain injury were excluded. Noninvasive ICP including ICP derived from pulsatility index, ICP derived from diastolic flow velocity (ICP_FVd), and ICP derived from optic nerve sheath diameter, and hemodynamic monitoring were measured before adjunct low-dosage (0.3 μg/kg/hr) continuous ketamine infusion (T0), after 12 h (T1), and after 24 h of infusion (T2).</p><p><strong>Results: </strong>Baseline ICP derived from optic nerve sheath diameter, ICP derived from pulsatility index, and ICP_FVd medians were 14.5 (interquartile range [IQR] 7), 16.8 (IQR 0.91), and 13.8 (IQR 9.38) mm Hg, respectively. Only ICP_FVd showed a significant slight increase from 13.75 (IQR 8.5) at T1 to 13.90 (IQR 8.5) at T2 (P value = 0.042). The baseline median noninvasive cerebral perfusion pressure was 74.56 (IQR 12.39) mm Hg without significant change at T1 or T2 (P value = 0.09). The respiratory rate, heart rate, and mean arterial blood pressure showed no significant changes across timepoints (P values = 0.95, 0.86, and 0.14, respectively). The median doses of midazolam, fentanyl, and norepinephrine significantly decreased across the study timepoints, especially at the first 12 h (P value < 0.001 for each).</p><p><strong>Conclusions: </strong>The present pilot study showed promising results of low-dose continuous ketamine infusion adjunctly on ICP and hemodynamics with a substantial reduction of sedatives and vasopressor dose. Further studies with large sample sizes and longer duration of administration and follow-up are needed to expand the current findings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326304","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":"Postoperative Intracranial Hypotension.","authors":"Yu Chang, Po-Chia Cheng, Jung-Shun Lee, Ming-Tsung Chuang","doi":"10.1007/s12028-025-02298-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02298-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258539","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":"A Machine Learning Model to Predict Treatment Effect Associated with Targeted Temperature Management After Cardiac Arrest.","authors":"Jocelyn Hsu, Han Kim, Kirby Gong, Carl Harris, Tej D Azad, Robert D Stevens","doi":"10.1007/s12028-025-02299-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02299-w","url":null,"abstract":"<p><strong>Background: </strong>Targeted temperature management (TTM) has been associated with neurological recovery among comatose survivors of cardiac arrest. The aim of this study is to determine whether models leveraging acute phase multimodal data after intensive care unit admission (hyperacute phase) can predict short-term outcome after TTM.</p><p><strong>Methods: </strong>Clinical, physiologic, and laboratory data in the hyperacute phase were analyzed from adult patients receiving TTM after cardiac arrest. Primary end points were survival and favorable neurological outcome. Three machine learning algorithms were trained: generalized linear models, random forest, and gradient boosting. Models with optimal features from forward selection were tenfold cross-validated and resampled 10 times.</p><p><strong>Results: </strong>The generalized linear model performed best, with an area under the receiver operating characteristic curve ± standard deviation of 0.86 ± 0.04 for the prediction of survival and 0.85 ± 0.03 for the prediction of favorable neurological outcome. Features most predictive of both end points included lower serum chloride concentration, higher serum pH, and greater neutrophil counts.</p><p><strong>Conclusions: </strong>We found that in patients receiving TTM after cardiac arrest, short-term outcomes can be accurately determined using machine learning applied to data routinely collected in the first 12 h after intensive care unit admission. With validation, hyperacute prediction could enable personalized decision-making in the postcardiac arrest setting.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258538","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":"Characterizing Stressors and Coping Strategies Among Caregivers of Patients with Severe Acute Brain Injury by Level of Distress.","authors":"Katherine J Meurer, Alexander M Presciutti, Sarah M Bannon, Rina Kubota, Nithyashri Baskaran, Jisoo Kim, Qiang Zhang, Mira Reichman, Nathan S Fishbein, Kaitlyn Lichstein, Melissa Motta, Susanne Muehlschlegel, Michael E Reznik, Matthew N Jaffa, Claire J Creutzfeldt, Corey R Fehnel, Amanda D Tomlinson, Craig A Williamson, Ana-Maria Vranceanu, David Y Hwang","doi":"10.1007/s12028-025-02294-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02294-1","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of patients with severe acute brain injury (SABI) who commit to tracheostomy and/or percutaneous endoscopic/surgical gastrostomy for the patient often develop chronic emotional distress. To inform future interventions to mitigate this distress, we characterized the stressors and coping strategies of caregivers of patients with SABI with varying levels of emotional distress during the acute and postacute stages of treatment.</p><p><strong>Methods: </strong>We conducted semistructured interviews with family caregivers of patients with SABI around the time of neurological intensive care unit discharge (T1) and at 2-month follow-up (T2). All caregivers included in this current study completed the Hospital Anxiety and Depression Scale at T1 and/or T2. We then stratified transcripts by caregiver distress level, characterizing caregivers who scored > 11 on at least one Hospital Anxiety and Depression Scale subscale as \"high distress\" and ≤ 11 as \"low distress.\" We conducted deductive, conceptual content analysis to compare perceived stressors and coping strategies employed at both time points.</p><p><strong>Results: </strong>Caregivers in both strata reported many similar stressors at each time point, including ongoing uncertainty. However, there were also differences in stressors by level of distress and time point of assessment. At T1, high-distress caregivers reported pronounced stress related to navigating the health care system and communicating with providers, staff, and the patient. At T2, high-distress caregivers noted heightened difficulty with transitioning to long-term caregiving, co-occurring complex emotions, and communication with family and friends. Conversely, low-distress caregivers focused on challenges with team-based medical decision making at T2. Clear differences in coping strategies also emerged, such that high-distress caregivers relied primarily on avoidance at both points, whereas low-distress caregivers incorporated more problem-solving and self-care strategies.</p><p><strong>Conclusions: </strong>Psychosocial interventions for caregivers of patients with SABI are needed to reduce emotional distress. Skills should be applied to relevant topics based on time since neurological intensive care unit discharge and distress level. Skills should focus on reducing avoidance, promoting active coping, and targeting the perceived stressors specific to high-distress versus low-distress caregivers revealed here.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248806","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":"Is There a Place for Cerebrospinal Fluid External Lumbar Drainage in Posttraumatic Intracranial Hypertension? Pros, Cons, and Uncertainties.","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Chiara Robba, Daniel Agustín Godoy","doi":"10.1007/s12028-025-02297-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02297-y","url":null,"abstract":"<p><p>Although different single-center series have shown the beneficial effects of cerebrospinal fluid external lumbar drainage in intracranial pressure control in patients with traumatic brain injury presenting with refractory intracranial hypertension, benefits must be balanced with potential life-threatening complications. In this article, we discuss the pros and cons and the uncertainties related to the use of cerebrospinal fluid external lumbar drainage in patients with traumatic brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226056","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":"KidsBrainIT: Visualization of the Impact of Cerebral Perfusion Pressure Insult Intensity and Duration on Childhood Brain Trauma Outcome.","authors":"Bavo Kempen, Bart Depreitere, Ian Piper, Maria Poca, Stefan Mircea Iencean, Mireia Garcia, James Weitz, Gayathri Subramanian, Roddy O'Kane, Julian Zipfel, Arta Barzdina, Stefano Pezzato, Patricia A Jones, Tsz-Yan Milly Lo","doi":"10.1007/s12028-025-02296-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02296-z","url":null,"abstract":"<p><strong>Background: </strong>Cerebral perfusion pressure (CPP) dose-response on post-traumatic brain injury (TBI) outcome in children remains unknown. This project aimed to produce the first pediatric post-TBI CPP dose-response visualization plot from the international multicenter KidsBrainIT data set.</p><p><strong>Methods: </strong>Fully anonymized prospectively collected routine minute-by-minute intracranial pressure (ICP), mean arterial blood pressure, and CPP time series data from 104 pediatric patients with TBI were categorized into CPP intensity duration episodes, albeit CPP above or below a range of thresholds. These episodes were then correlated with the 6-month modified Glasgow Outcome Score (GOS) and depicted in 3D color-coded CPP dose-response plots. Additionally, the effects of cerebrovascular reactivity patterns and ICP were examined.</p><p><strong>Results: </strong>Our pediatric CPP dose-response plots resembled the previously published adult CPP dose-response plots: on the CPP pressure time plots, an exponential \"black\" transition curve separated CPP episodes associated with poor (\"red,\" GOS < 4) and good (\"blue\") outcome. Lower and higher ends of CPP intensity were only tolerated for shorter durations. A \"safe\" CPP zone (56-89 mm Hg) was identified for childhood TBI with active cerebrovascular reactivity pattern and ICP < 20 mm Hg. Passive cerebrovascular reactivity pattern reduced the area of safe CPP doses. ICP levels > 20 mm Hg were associated with worse outcome, irrespective of CPP dose.</p><p><strong>Conclusions: </strong>The pediatric CPP dose-response on poor outcome was visualized successfully for the first time. Because the \"critical\" lower CPP limit exceeds the current recommended minimum CPP target for pediatric TBI treatments, there is an urgent need to validate childhood CPP dose-response to provide evidence-based CPP clinical targets in the future.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216337","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 Stroke Alert that Wasn't: Lessons Learned from Meningitis-Associated Vasospasm.","authors":"Julian L Moran, Erika J Sigman, Catherine S W Albin","doi":"10.1007/s12028-025-02291-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02291-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208953","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":"Hypothermia Alleviates TBI-Induced Tau Hyperphosphorylation Through RBM3-Dependent GSK-3β and AMPK Pathways.","authors":"Bingjin Liu, Qunfang Zhao, Qingqing Shi, Weiqi Xu, Fangxiao Shi, Ruhui Yang, Xinwen Zhou","doi":"10.1007/s12028-025-02293-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02293-2","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) often results in tau hyperphosphorylation, a key pathological feature of neurodegenerative diseases such as Alzheimer's disease. Hypothermia (HT) is a promising therapeutic intervention for TBI, but the underlying molecular mechanisms remain unclear. This study investigates the role of RNA-binding motif protein 3 (RBM3) in mediating the neuroprotective effects of HT on tau phosphorylation and its involvement in glycogen synthase kinase 3 beta (GSK-3β) and AMP-activated protein kinase (AMPK) signaling.</p><p><strong>Methods: </strong>We used a TBI mouse model to assess the effects of HT on tau phosphorylation using Western blotting and immunohistochemistry. The phosphorylation status of GSK-3β (Ser9) and AMPK (Thr172) was also analyzed to explore key signaling pathways. RBM3 expression was modulated using RBM3 short hairpin RNA (knockdown) and adenovirus-RBM3 plasmid (overexpression) to determine its role in HT-induced changes in tau phosphorylation.</p><p><strong>Results: </strong>Hypothermia treatment significantly reduced tau hyperphosphorylation in TBI mice compared with controls. Western blotting revealed a significant increase in GSK-3β Ser9 phosphorylation (p < 0.01) and AMPK Thr172 phosphorylation (p < 0.05) in the HT group. Manipulation of RBM3 expression showed that both RBM3 knockdown and overexpression affected the extent of tau dephosphorylation mediated by HT. Specifically, RBM3 overexpression enhanced the protective effects of HT, whereas knockdown diminished its efficacy.</p><p><strong>Conclusions: </strong>Our findings suggest that RBM3 is a crucial mediator of the neuroprotective effects of hypothermia in TBI, acting through modulation of GSK-3β and AMPK signaling pathways. These results provide new insights into the molecular mechanisms of TBI treatment and highlight RBM3 as a potential therapeutic target for neurodegenerative diseases associated with tauopathies. Limitations include the need for further validation in clinical models.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208952","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":"Unsupervised Clustering in Neurocritical Care: A Systematic Review.","authors":"Jeanette Tas, Verena Rass, Bogdan-Andrei Ianosi, Anna Heidbreder, Melanie Bergmann, Raimund Helbok","doi":"10.1007/s12028-024-02140-w","DOIUrl":"10.1007/s12028-024-02140-w","url":null,"abstract":"<p><p>Managing patients with acute brain injury in the neurocritical care (NCC) unit has become increasingly complex because of technological advances and increasing information derived from multiple data sources. Diverse data streams necessitate innovative approaches for clinicians to understand interactions between recorded variables. Unsupervised clustering integrates different data streams and could be supportive. Here, we provide a systematic review on the use of unsupervised clustering using NCC data. The primary objective was to provide an overview of clustering applications in NCC studies. As a secondary objective, we discuss considerations for future NCC studies. Databases (Medline, Scopus, Web of Science) were searched for unsupervised clustering in acute brain injury studies including traumatic brain injury (TBI), subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and hypoxic-ischemic brain injury published until  March 13th 2024. We performed the systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We identified 18 studies that used unsupervised clustering in NCC. Predominantly, studies focused on patients with TBI (12 of 18 studies). Multiple research questions used a variety of resource data, including demographics,  clinical- and monitoring data, of which intracranial pressure was most often included (8 of 18 studies). Studies also covered various clustering methods, both traditional methods (e.g., k-means) and advanced methods, which are able to retain the temporal aspect. Finally, unsupervised clustering identified novel phenotypes for clinical outcomes in 9 of 12 studies. Unsupervised clustering can be used to phenotype NCC patients, especially patients with TBI, in diverse disease stages and identify clusters that may be used for prognostication. Despite the need for validation studies, this methodology could help to improve outcome prediction models, diagnostics, and understanding of pathophysiology.Registration number: PROSPERO: CRD4202347097676.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1074-1086"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676246","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}