Neurocritical Care最新文献

{"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}

{"title":"Delirium in Children Hospitalized with Acute COVID-19 or MIS-C: Secondary Analysis of the 2020-2021 Global Consortium Study of Neurologic Dysfunction in COVID-19.","authors":"Neelima K Marupudi, Diana Paola Escobar-Serna, Leslie Dervan, Anna Janas, Andrew S Geneslaw, Ericka L Fink, Juan David Roa Giraldo","doi":"10.1007/s12028-026-02503-5","DOIUrl":"10.1007/s12028-026-02503-5","url":null,"abstract":"<p><strong>Background/objective: </strong>The aims of this study were to describe pediatric delirium and its association with inflammatory, neurodiagnostic, and clinical severity profiles in children hospitalized with acute coronavirus disease 2019 (COVID-19) infection or multisystem inflammatory syndrome in children (MIS-C).</p><p><strong>Methods: </strong>We performed a secondary analysis of a multicenter, prospective observational cohort study including hospitalized children (< 18 years) with confirmed acute COVID-19 infection or MIS-C enrolled between 1 January 2020 and 31 July 2021 at 46 hospitals across ten countries participating in the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID).</p><p><strong>Results: </strong>Among 3211 patients, 57 (1.8%) had documented delirium. Delirium was more common in MIS-C than in acute COVID-19 (3.6% vs. 1.5%, p = 0.004). Children with delirium had higher inflammatory markers (e.g., C-reactive protein, ferritin, D-dimer, procalcitonin) and more frequently presented with severe neurologic manifestations (all p < 0.001). Patients with delirium underwent more neurodiagnostic testing (p < 0.001). Among children with delirium who received electroencephalogram (EEG) testing, abnormalities were universal (n = 23). Delirium was associated with longer hospital stays (median 17 vs. 4 days; p < 0.001), higher mortality (7.5% vs. 1.1%; p = 0.01), and worse functional outcomes, including higher rates of new disability at discharge as assessed by Pediatric Cerebral Performance Category (PCPC; 22.5% vs. 1.7%, p < 0.001) and functional status scale (FSS; 22.7% vs. 2.1%, p = 0.001).</p><p><strong>Conclusions: </strong>Delirium in a select group of patients with pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related illness was associated with systemic inflammation, severe neurologic injury, and worse clinical outcomes in a multicenter cohort. These findings underscore the importance of routine delirium screening and intervention in children hospitalized with SARS-CoV-2-related illnesses and other inflammatory conditions.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"593-601"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628111","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":"Efficacy of Dexmedetomidine in Preventing Postoperative Delirium in Patients Undergoing Brain Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Maria Angélica Otero de Melo Dos Reis, Eloísa Bittencurt Thomaz de Assis, Harshada Kalaiarasan Swamy, Baltazar César Miranda Matos, Marcio Yuri Ferreira, Netanel Ben-Shalom, Juliana Estima Rissi Polverini, Allan Dias Polverini","doi":"10.1007/s12028-026-02533-z","DOIUrl":"10.1007/s12028-026-02533-z","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine (DEX), a selective alpha-2 adrenergic receptor agonist, is widely used in various surgical settings, including cardiac and general surgeries, for its sedative, analgesic, and neuroprotective properties. Patients undergoing brain surgery are particularly susceptible to postoperative delirium (POD). Given the established benefits of dexmedetomidine in other surgical fields, its potential to mitigate delirium in neurosurgery warrants investigation.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Scopus, and Cochrane databases was conducted from inception to January 2025 and updated in April 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed, and a meta-analysis was performed using Review Manager 5.4.1. Five randomized controlled trials were included, evaluating the efficacy of DEX in preventing POD in adult patients undergoing brain surgery.</p><p><strong>Results: </strong>A total of 646 patients were enrolled, with DEX administered with a loading dose ranging from 0.5 to 1 μg/kg over 10 min, followed by a maintenance infusion rate of 0.1 to 0.5 μg/kg/h during the surgical procedure. The pooled risk ratio (RR) for POD with DEX was 0.47 (95% confidence interval (CI): 0.35-0.63; p < 0.00001); reflecting a 53% reduction in the risk of postoperative delirium, with no statistical heterogeneity detected (χ² = 2.09, degrees of freedom (df) = 4, p = 0.72; I² = 0%). Subgroup analyses showed similar effect estimates across brain tumor and other cranial procedures. Adverse events were comparable between groups and generally mild.</p><p><strong>Conclusions: </strong>This meta-analysis found that perioperative dexmedetomidine was associated with a significant reduction in postoperative delirium risk in neurosurgical patients. Further multicenter trials are needed to confirm these findings and to refine optimal administration strategies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"737-749"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974436","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":"Guidelines for Seizure Prophylaxis in Patients with Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society.","authors":"A Shaun Rowe, Sahar F Zafar, Eljim Tesoro, Emily J Gilmore, Emily L Johnson, DaiWai Olson, Appaji Rayi, Jamie Ullman, Yuhong Yuan, Jennifer A Frontera","doi":"10.1007/s12028-026-02614-z","DOIUrl":"10.1007/s12028-026-02614-z","url":null,"abstract":"<p><strong>Background: </strong>There are limited data to guide antiseizure medication (ASM) prophylaxis in patients with aneurysmal subarachnoid hemorrhage (SAH). This results in practice variation in the use and duration of ASM prophylaxis.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of articles assessing ASM prophylaxis in adults with aneurysmal SAH. The population, intervention, comparator, and outcome (PICO) questions were as follows: (1) Should ASM or no ASM be used in patients hospitalized for aneurysmal subarachnoid hemorrhage who have no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam or phenytoin/fosphenytoin be preferentially used? (3) If an ASM is used, should a long (> 3 days) or short (≤ 3 days) duration of prophylaxis be used? The main outcomes were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional outcomes. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to generate recommendations.</p><p><strong>Results: </strong>The initial literature search yielded 1988 articles, of which 10 formed the basis of the recommendations: Regarding PICO 1, we did not find a significant difference in outcomes of early seizure, adverse events, mortality, or functional outcomes when comparing ASM to no ASM. In regard to PICO 2, we found fewer early seizures with phenytoin/fosphenytoin and lower risk for neurologic decline with levetiracetam; however, there was low certainty of evidence. There was no significant difference in mortality between the different treatment types. Regarding PICO 3, we found extended use of ASM may be associated with lower seizure risk, but at the same time be associated with higher risk for adverse effects.</p><p><strong>Conclusions: </strong>Overall, the quality of evidence is low, precluding strong recommendations. We suggest that ASM or no ASM may be used in patients hospitalized with aneurysmal subarachnoid hemorrhage (conditional recommendation, low quality of evidence). If used, we suggest either levetiracetam or phenytoin/fosphenytoin (conditional recommendation, very low quality of evidence) for a short or long duration (conditional recommendation, moderate quality of evidence).</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"445-463"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673782","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":"Response to the Letter to the Editor entitled \"Hematocrit-to-Hemoglobin Ratio in Aneurysmal Subarachnoid Hemorrhage: A Prognostic Signal, but Not Yet a Surrogate for Blood Viscosity\" Regarding the Study \"Hematocrit-to-Hemoglobin Ratio as a Novel Independent Predictor for In-Hospital Mortality and Delayed Cerebral Ischemia in Critically Ill Patients with Aneurysmal Subarachnoid Hemorrhage Requiring Neurosurgical or Endovascular Treatment: A Retrospective Analysis\".","authors":"Emanuel Moisa, Georgeana Tuculeanu, Claudia Mihail, Liviu Ioan Serban, Silvius Ioan Negoita","doi":"10.1007/s12028-026-02612-1","DOIUrl":"10.1007/s12028-026-02612-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"882-884"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562539","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":"Harnessing Scalp Gamma Oscillations to Predict Clinical Outcomes in Patients with Periodic Discharges.","authors":"Kongpop Sutantikorn, Totsapol Surawattanawong, Chusak Limotai","doi":"10.1007/s12028-026-02483-6","DOIUrl":"10.1007/s12028-026-02483-6","url":null,"abstract":"<p><strong>Background: </strong>Periodic discharges (PDs) are frequently observed in critically ill patients and are associated with diverse etiologies and variable prognoses. While high-frequency oscillations have been extensively studied in epilepsy, the clinical significance of scalp gamma oscillations (SGOs)-defined as activity > 30 Hz-remains poorly understood in neurocritical care settings.</p><p><strong>Objective: </strong>To evaluate the prognostic value of SGOs in predicting short-term functional outcomes among critically ill patients with PDs.</p><p><strong>Methods: </strong>This retrospective cohort study included patients aged > 15 years admitted to our center (2014-2022) who underwent continuous electroencephalograph (EEG) monitoring and had electrographic PDs. EEG data were analyzed using standardized protocols. SGOs were defined as discrete oscillations > 30 Hz superimposed on spike/sharp waveforms. Two parameters were extracted: mean frequency and SGO count (per 60 s). Functional outcome was assessed using the modified Rankin Scale (mRS) at discharge and 90 days postdischarge, with outcomes dichotomized as favorable (mRS 0-3) or poor (mRS 4-6). Multivariable logistic regression was used to identify predictors of outcome.</p><p><strong>Results: </strong>A total of 72 patients were included (mean age 66.5 ± 17.1 years; 50% male). Poor outcomes were observed in 77.8% at discharge and 76.4% at 90 days. Both higher mean SGO frequency and increased SGO count were significantly associated with poor functional outcomes. A median SGO frequency > 51.5 Hz (adjusted OR 5.08, 95% CI 1.21-21.34; p = 0.027) and a median SGO count > 14 per 60 s (adjusted OR 5.82, 95% CI 1.11-30.47; p = 0.037) were both independent predictors of poor outcomes after controlling for relevant clinical variables.</p><p><strong>Conclusions: </strong>SGOs may serve as a novel and practical biomarker for predicting short-term functional outcomes in critically ill patients with PDs. Their detection using standard EEG protocols supports the feasibility of integrating SGO analysis into routine ICU care. Further prospective studies are warranted to validate these findings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"543-552"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486496","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 of Impaired Hematoma Clearance After Aneurysmal Subarachnoid Hemorrhage with Delayed Cerebral Ischemia, Hydrocephalus, and Long-Term Outcomes.","authors":"Kokyo Sakurada, Takuma Maeda, Yushiro Take, Natsuki Shozuhara, Jun Yanagida, Kuya Azekami, Hiroki Kobayashi, Akio Teranishi, Tomomichi Kayahara, Hiroki Kurita","doi":"10.1007/s12028-026-02525-z","DOIUrl":"10.1007/s12028-026-02525-z","url":null,"abstract":"<p><strong>Objective: </strong>Although delayed cerebral ischemia (DCI) and hydrocephalus contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH), it remains unclear whether improved subarachnoid hematoma clearance translates into better long-term outcomes and through which mechanisms. We investigated the association between hematoma clearance and long-term outcomes and quantified the mediating effects of DCI and shunt-dependent hydrocephalus.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with aSAH who underwent aneurysmal clipping between April 2012 and March 2024 at a single center. Hematoma burden was assessed using the Hijdra sum score (HSS). Hematoma clearance was defined as the percentage reduction in HSS between admission and days 7‒10 and dichotomized using the median (91.5%). Poor outcome was defined as a modified Rankin Scale (mRS) score ≥ 3 at 6 months. Multivariate logistic regression analyses and causal mediation analyses were performed to assess direct and indirect effects of hematoma clearance on long-term outcomes mediated by DCI and shunt-dependent hydrocephalus.</p><p><strong>Results: </strong>A total of 442 patients were included. Poor hematoma clearance was independently associated with poor 6-month outcomes [odds ratio (OR) 2.32, p = 0.003], DCI (OR 1.83, p = 0.025), and shunt-dependent hydrocephalus (OR 2.55, p < 0.001). Mediation analysis showed that shunt-dependent hydrocephalus mediated approximately 22% of the total effect of poor clearance on poor outcome [average causal mediation effect (ACME) 0.035, p < 0.001], whereas mediation via DCI was smaller and did not reach statistical significance (ACME 0.020 p = 0.078). A substantial direct effect independent of these mediators was observed.</p><p><strong>Conclusions: </strong>Poor hematoma clearance after aSAH is associated with worse long-term outcomes, partly mediated by shunt-dependent hydrocephalus and to a lesser extent by DCI. However, a large proportion of the effect appears to be independent of these pathways, suggesting the involvement of additional mechanisms beyond DCI and hydrocephalus.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"663-672"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777259","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":"Response to: \"INTERACT3 in Intensive Blood Pressure Meta‑Analysis: A Methodological Reappraisal\".","authors":"Pedro Henrique Reginato, Henrique Alexsander Ferreira Neves, Leonardo Zumerkorn Pipek","doi":"10.1007/s12028-026-02557-5","DOIUrl":"10.1007/s12028-026-02557-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"875-877"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265381","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":"Intracranial Pressure and Brain Tissue Oxygen Trajectories after Cardiac Arrest.","authors":"Laura Faiver, Patrick J Coppler, Cecelia R Ratay, Jonathan Tam, Lori A Shutter, Nicholas Case, Jonathan Elmer","doi":"10.1007/s12028-026-02541-z","DOIUrl":"10.1007/s12028-026-02541-z","url":null,"abstract":"<p><strong>Background: </strong>Brain tissue hypoxia [brain tissue oxygen tension (PbtO₂) < 20 mm Hg] and elevated intracranial pressure (ICP) ≥ 22 mm Hg exacerbate hypoxic-ischemic brain injury (HIBI) after cardiac arrest. Multiple pathophysiologic derangements can cause brain tissue hypoxia and/or elevated ICP with impaired intracranial compliance. The mechanisms and severity of these pathophysiologic changes vary both between patients and within patients over time. Clinically distinct phenotypes of HIBI may have different trajectories of PbtO₂ and ICP.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study of patients who survived until hospitalization after cardiac arrest and underwent invasive neuromonitoring. We used group-based trajectory modeling to identify distinct trajectories of PbtO₂ and ICP separately over the first 72 h post-arrest and described the clinical characteristics of each trajectory group.</p><p><strong>Results: </strong>We included 43 patients who underwent invasive neuromonitoring. We identified three ICP trajectory groups. Group 1 was characterized by normal ICP throughout monitoring, while group 2 demonstrated High-normal ICP during the study period. Group 3 had initially normal ICP, which rapidly increased and remained pathologically elevated thereafter. All ICP trajectory groups had episodically abnormal ICP, PbtO₂, and cerebral perfusion pressure (CPP) during monitoring. We identified three PbtO₂ trajectory groups. Group 1 had persistent brain tissue hypoxia with more pathological elevations in ICP and inadequate CPP than the other PbtO₂ trajectory groups. Group 2 had mostly normal PbtO₂, while PbtO2 in group 3 increased linearly over 72 h, though there was a comparable incidence of brain tissue hypoxia, elevated ICP, and low CPP. However, PbtO₂ group 3 had lower survival and more frequently exhibited evidence of severe HIBI.</p><p><strong>Conclusions: </strong>We identified distinct PbtO₂ and ICP trajectories after cardiac arrest. Our findings suggest that the physiology of hypoxic-ischemic brain injury is variable, and trajectory groups may represent distinct phenotypes. This work provides a foundation for future studies aimed at disentangling the heterogeneity of hypoxic-ischemic brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"813-822"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043210","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}