Neurocritical Care最新文献

{"title":"The Predictive Validity of the Full Outline of UnResponsiveness Score Compared to the Glasgow Coma Scale in the Intensive Care Unit: A Systematic Review.","authors":"Jaime E Schey, Monica Schoch, Debra Kerr","doi":"10.1007/s12028-024-02150-8","DOIUrl":"10.1007/s12028-024-02150-8","url":null,"abstract":"<p><p>The Full Outline of UnResponsiveness (FOUR) score was developed to overcome the limitations of the Glasgow Coma Scale (GCS) when assessing individuals with impaired consciousness. We sought to review the evidence regarding the predictive validity of the GCS and FOUR score in intensive care unit (ICU) settings. This review was prospectively registered in PROSPERO (CRD42023420528). Systematic searches of CINAHL, MEDLINE, and Embase were undertaken. Prospective observational studies were included if both GCS and FOUR score were assessed in adults during ICU admission and if mortality and/or validated functional outcome measure scores were collected. Studies were excluded if they exclusively investigated patients with traumatic brain injury. Screening, data extraction, and quality assessment using the Quality in Prognosis Studies tool were conducted by two reviewers. Twenty studies of poor to moderate quality were included. Many studies only included patients with neurological illness and excluded sedated patients, despite high proportions of intubated patients. The FOUR score achieved higher area under the receiver operating characteristic curve values for mortality prediction compared with the GCS, and the FOUR score achieved significantly higher area under the receiver operating characteristic curve values for predictions of ICU mortality. Both coma scales showed similar accuracy in predicting \"unfavorable\" functional outcome. The FOUR score appeared to be more responsive than the GCS in the ICU, as most patients with a GCS score of 3 obtained FOUR scores between 1 and 8 due to preserved brainstem function. The FOUR score may be superior to the GCS for predicting mortality in ICU settings. Further adequately powered studies with clear, reliable methods for assessment of index and outcome scores are required to clarify the predictive performance of both coma scales in ICUs. Inclusion of sedated patients may improve generalizability of findings in general ICU populations.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"645-658"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576553","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":"A Novel, Interpretable Machine Learning Model to Predict Neurological Outcomes Following Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Benjamin L Shou, Albert Leng, Preetham Bachina, Andrew Kalra, Alice L Zhou, Glenn Whitman, Sung-Min Cho","doi":"10.1007/s12028-025-02233-0","DOIUrl":"10.1007/s12028-025-02233-0","url":null,"abstract":"<p><strong>Background: </strong>We used machine learning models incorporating rich electronic medical record (EMR) data to predict neurological outcomes after venoarterial extracorporeal membrane oxygenation (VA-ECMO).</p><p><strong>Methods: </strong>This was a retrospective review of adult (≥ 18 years) patients undergoing VA-ECMO between 6/2016 and 4/2022 at a single center. The primary outcome was good neurological outcome, defined as a modified Rankin Scale score of 0 to 3, evaluated at hospital discharge. We extracted every measurement of 74 vital and laboratory values, as well as circuit and ventilator settings, from 24 h before cannulation through the entire duration of ECMO. An XGBoost model with Shapley Additive Explanations was developed and evaluated with leave-one-out cross-validation.</p><p><strong>Results: </strong>Overall, 194 patients undergoing VA-ECMO (median age 58 years, 63% male) were included. We extracted more than 14 million individual data points from the EMR. Of 194 patients, 39 patients (20%) had good neurological outcomes. Three models were generated: model A, which contained only pre-ECMO data; model B, which added data from the first 48 h of ECMO; and model C, which included data from the entire ECMO run. The leave-one-out cross-validation area under the receiver operator characteristics curves for models A, B, and C were 0.72, 0.81, and 0.90, respectively. The inclusion of on-ECMO physiologic, laboratory, and circuit data greatly improved model performance. Both modifiable and nonmodifiable variables, such as lower body mass index, lower age, higher mean arterial pressure, and higher hemoglobin, were associated with good neurological outcome.</p><p><strong>Conclusions: </strong>An interpretable machine learning model from EMR-extracted data was able to predict neurological outcomes for patients undergoing VA-ECMO with excellent accuracy.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"403-413"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730661","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":"Aneurysmal Subarachnoid Hemorrhage Risk Assessment Model Identifies Patients for Safe Early Discharge at Day 15-The SAFE-SaH Score.","authors":"Eric E Kennison, Nick M Murray, Dave S Collingridge, Daniel Knox, Gabriel V Fontaine","doi":"10.1007/s12028-025-02236-x","DOIUrl":"10.1007/s12028-025-02236-x","url":null,"abstract":"<p><strong>Background: </strong>Patients with aneurysmal subarachnoid hemorrhage (aSAH) are often hospitalized for 21 days after aneurysm rupture due to the risk of complications. However, some never experience complications and are unlikely to benefit from a prolonged hospitalization. The aim of this study is to derive a risk assessment model (RAM) using data from the first 14 days of hospitalization to identify low-risk patients for early discharge, at day 15 or after.</p><p><strong>Methods: </strong>Patients ≥ 18 years old with an acute aSAH at a Comprehensive Stroke Center from 2017 to 2024 were included. Baseline demographics, aSAH grading scales, and in-hospital complications requiring intervention were characterized. Complications included: vasospasm, delayed cerebral ischemia (DCI), cerebral salt wasting (CSW), cerebral edema, seizures, arrhythmias, respiratory failure, and hydrocephalus. Binary logistic regression with leave-one-out cross validation (LOOCV) was used to identify an optimal RAM.</p><p><strong>Results: </strong>Of 165 patients, the mean Hunt Hess Score (HHS) was 2.5 (standard deviation, SD 1.2), modified Fisher Score (mFS) was 3.1 (SD 1), endovascular therapy was used for aneurysm securement in 73% of patients, and 54.5% of patients experienced complications during days 15-21. In bivariate analyses, days 0-14 variables associated with days 15 + complications were the following: HHS, mFS, middle cerebral artery (MCA) aneurysm, clinical or radiologic vasospasm, endovascular therapies, intraventricular hemorrhage, hydrocephalus, presence of external ventricular drain (EVD), mechanical ventilation, vasopressors, hypertonic solutions, antiseizure medications, milrinone, and fludrocortisone (all p < 0.05). LOOCV regression for a best fit RAM included six variables: Sum of Vasopressors, Artery (MCA aneurysm), Fludrocortisone, EVD, Scale (mFS and HHS), \"SAFE-SaH\" and had an area under the receiver operator characteristics curve of 0.90 (95% confidence interval 0.85-0.95), sensitivity of 0.94, specificity of 0.69, positive predictive value of 79%, and negative predictive value of 91% for predicting complications on day 15 + .</p><p><strong>Conclusions: </strong>This is the first ever RAM to incorporate clinical data from the first 14 days of hospitalization to identify patients with an aSAH at low risk for complications after day 14. With 94% sensitivity, the RAM classifies patients who will not have complications and may assist in earlier disposition on day 15 or after.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"414-423"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743317","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":"Longitudinal Improvement in Respiratory Function Following Plasma Exchange in Patients with Severe Myasthenia Gravis.","authors":"Panayiotis N Varelas, Ileana Lopez-Plaza, Ashar Ata, Mohammed F Rehman, Chandan Mehta, Riad Ramadan, Vaso Zisimopoulou","doi":"10.1007/s12028-025-02238-9","DOIUrl":"10.1007/s12028-025-02238-9","url":null,"abstract":"<p><strong>Background: </strong>There are no data on the effect size and timing of plasma exchange (PLEX) in patients with myasthenic crisis (MC).</p><p><strong>Methods: </strong>We retrospectively analyzed measurements of forced vital capacity (FVC) and negative inspiratory force (NIF) in the days before and after PLEX (administered every other day) in patients with MC admitted to a tertiary hospital over 4 years. For multiple measurements in one day, the average value was used. The day immediately before the first treatment with PLEX was considered baseline. Using time as a continuous or categorical variable in mixed-effects multiple linear regressions, we estimated predicted values for these tests.</p><p><strong>Results: </strong>Twenty-two patients (mean age 67.3 years, 51.9% male patients) with 27 MC episodes and 508 measurements (234 FVC and 274 NIF; from 5 days before to 20 days after PLEX) were included. Presence of antibodies was detected in 70.4%. Intubation and mechanical ventilation occurred in 36.6% of patients. The mean number of PLEX was 5.1 (range 3-11). NIF values decreased before the first PLEX but increased after by on average 1 cm H₂O/day (95% confidence interval [CI] 0.68-1.32, p < 0.001). FVC fluctuated before the first PLEX but then increased by on average 51.2 mL/day (95% CI 35.8-66.1, p < 0.001). The maximum increase in NIF occurred during the day of the first PLEX (9.2 cm H₂O, 95% CI 3.3-15.1, p = 0.002) and rather slowed after day 10. FVC increase compared to baseline became significant the second day after the first PLEX (287 mL, 95% CI 7.5-567.6, p = 0.04) and continued overall to increase (with fluctuations) up to day 17.</p><p><strong>Conclusions: </strong>Significant increases in bedside respiratory measurements are observed as soon as the first PLEX day but with more variability on FVC than NIF, which may either reflect more FVC technique inconsistencies or more consistent effect of the treatment on NIF.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"458-466"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780636","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":"Electroencephalographic Findings Add Prognostic Value to Clinical Features Associated with Mortality on Venoarterial Extracorporeal Support.","authors":"Alyson Baker, Ekta Shah, Amy Ouyang, Maya Silver, Stuart R Tomko, Kristin Guilliams, Ahmed S Said, Réjean M Guerriero","doi":"10.1007/s12028-025-02248-7","DOIUrl":"10.1007/s12028-025-02248-7","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to identify clinical and continuous electroencephalogram (cEEG) variables associated with outcomes of pediatric venoarterial (V-A) extracorporeal membrane oxygenation support (ECMO).</p><p><strong>Methods: </strong>We conducted a retrospective single-center study of pediatric patients on V-A ECMO between January 1, 2015, and September 30, 2020. Serial clinical and cEEG variables were collected to assess the relationship of pre- and on-ECMO variables with hospital mortality in patients who underwent cEEG monitoring.</p><p><strong>Results: </strong>Ninety-four patients undergoing V-A ECMO had cEEG monitoring, with a hospital mortality of 43%. Nonsurvivors had significantly lower pH and higher lactate levels prior to ECMO initiation. Nineteen (20%) had seizures, with 7 (7%) developing status epilepticus. In the first 24 h patients were on ECMO, unfavorable background score and lack of cEEG variability or reactivity were associated with mortality. A multivariable model investigating in-hospital mortality that included pH and lactate level 2 h prior to ECMO initiation, presence of electrographic seizures, and asymmetry on cEEG as variables, had an area under the receiver operating characteristic curve (AUROC) of 0.8 (95% confidence interval [CI] 0.74-0.86, p < 0.02). The model for on-ECMO mortality (ECMO nonsurvivors) that included pH 2 h prior to ECMO initiation, presence of electrographic seizures, and lack of variability/reactivity at any point on cEEG as variables had an AUROC of 0.85 (95% CI 0.8-0.9, p < 0.001).</p><p><strong>Conclusions: </strong>These data demonstrate an association of evolving pre-ECMO impaired tissue oxygenation and on-ECMO neurophysiologic impairment, measured by cEEG, with mortality. They provide preliminary evidence that the timing of ECMO initiation, in relation to worsening tissue oxygenation, should be investigated further, and cEEG may be used to evaluate the potential impact on both neurologic injury and mortality.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"530-540"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972486","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 Influence of Different Arterial Carbon Dioxide Levels on the Cerebrovascular Autoregulation Curve in a Porcine Cranial Window Model.","authors":"Sofie Dietvorst, Bavo Kempen, Veerle De Sloovere, Nikky Corthout, Geert Meyfroidt, Bart Depreitere","doi":"10.1007/s12028-025-02250-z","DOIUrl":"10.1007/s12028-025-02250-z","url":null,"abstract":"<p><strong>Background: </strong>Cerebrovascular autoregulation (CA) is the ability to maintain adequate cerebral blood flow (CBF) over a wide range of arterial blood pressures (ABPs). Carbon dioxide (CO₂) is a potent vasodilator, but its precise influence on CA remains incompletely understood.</p><p><strong>Methods: </strong>A porcine cranial window model, in which CBF can be measured directly in the pial arterioles while ABP is mechanically manipulated, is used to investigate the effect of partial pressure of CO₂ in arterial blood (PaCO₂) on CA capacity. Hypercapnia and hypocapnia were induced in 12 male piglets each by adjusting the respiratory rate. Once stable PaCO₂ levels of 60 and 25 mm Hg, respectively, were achieved, ABP was gradually increased in half of the animals or decreased in the other half beyond limits of CA by inflating a balloon in the aorta or inferior vena cava.</p><p><strong>Results: </strong>Before ABP manipulation, hypercapnia already induced significant vasodilation (+ 33.9%) and an increase in CBF (+ 20.5%), whereas hypocapnia did not alter diameter or CBF. Both hypercapnia and hypocapnia significantly reduced the ability to adjust arteriolar diameters in response to changes in ABP.</p><p><strong>Conclusions: </strong>During hypocapnia as well as hypercapnia, narrowing of the CA range with a shorter plateau between the upper and lower limit of autoregulation was observed, compared to normocapnia.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"541-550"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012207","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":"Navigating IVF Shortages in the Neurocritical Care Unit.","authors":"Scott R DeBoer, Salia Farrokh, Melissa Dang, Romergryko G Geocadin","doi":"10.1007/s12028-025-02261-w","DOIUrl":"10.1007/s12028-025-02261-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"363-367"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021008","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 a Second Transcranial Doppler Study Needed to Confirm Neurocirculatory Arrest?","authors":"Tiffany Eatz, Yosdely Cabrera, Frank Cabrera, Mohan Kottapally, Amedeo Merenda, Ayham Alkhachroum, Jose G Romano, Sebastian Koch","doi":"10.1007/s12028-025-02241-0","DOIUrl":"10.1007/s12028-025-02241-0","url":null,"abstract":"<p><strong>Background: </strong>In determining brain death, transcranial Doppler (TCD) is one of the recommended ancillary tests when clinical examinations and apnea tests are contraindicated. The American Academy of Neurology 2023 guideline updates and 2020 World Brain Death Project advise conducting two TCDs 30 min apart to diagnose neurocirculatory arrest. Our study aimed to evaluate whether a second TCD is necessary when the first TCD shows neurocirculatory arrest (no flow, oscillating flow, or systolic spikes).</p><p><strong>Methods: </strong>We conducted a single-center retrospective analysis of patients admitted to intensive care units from January 1, 2021, to February 1, 2025, at a community-based academic hospital. We included patients whose first study showed neurocirculatory arrest and who subsequently underwent a confirmatory TCD at least 30 min apart. A total of 48 patients were included in our final analysis. We compared the findings of the first TCD study with those of the second study and noted any differences.</p><p><strong>Results: </strong>In all 48 patients (100%), the second TCD confirmed the findings of the first TCD. Of these 48 patients, 44 patients (91.7%) had the same flow pattern on repeat TCD examination and 4 patients' (8.30%) TCDs showed different flow patterns, although still consistent with neurocirculatory arrest. Of the 44 patients with the same flow patterns found on first and repeat TCD examinations, 18 patients (40.9%) had both TCDs demonstrate brief systolic spikes; three patients (6.80%) had both TCDs demonstrate brief systolic spikes and oscillating flow; eight patients (18.2%) had both TCDs demonstrate no flow; seven patients (15.9%) had both TCDs demonstrate no flow and brief systolic spikes; one patient (2.30%) had both TCDs demonstrate no flow, brief systolic spikes, and oscillating flow; and, lastly, seven patients (15.9%) had both TCDs demonstrate oscillating flow.</p><p><strong>Conclusions: </strong>We found that requiring two sequential TCD examinations to confirm neurocirculatory arrest may be unnecessary when the first TCD shows neurocirculatory arrest. Further investigation and studies such as ours in larger populations are warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"467-471"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710798","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":"Optic Nerve Sheath Diameter Sonography for the Diagnosis of Increased Intracranial Pressure in Nontraumatic Neurocritically Ill Patients: a Diagnostic Accuracy Systematic Review and Meta-Analysis.","authors":"Rafael Hortêncio Melo, Luciana Gioli-Pereira, Fábio Santana Machado, Chiara Robba","doi":"10.1007/s12028-025-02249-6","DOIUrl":"10.1007/s12028-025-02249-6","url":null,"abstract":"<p><strong>Background: </strong>Optic nerve sheath diameter (ONSD) assessed by ultrasound is a feasible bedside method for increased intracranial pressure (IICP) diagnosis. However, most of the evidence relies on the population of patients with traumatic brain injury, with few data available on other populations. Consequently, its efficacy in nontraumatic critically ill patients remains underexplored. Our purpose was to examine the accuracy of ONSD ultrasonography for diagnosing IICP in nontraumatic neurocritically ill patients.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, and the Cochrane Library databases for comparative studies of adult nontraumatic critically ill patients that evaluated the accuracy of sonographic ONSD for IICP diagnosis compared with invasive or noninvasive reference standards. Two reviewers independently completed the search, data abstraction, and quality assessment with Quality Assessment of Diagnostic Accuracy Studies-2 tool. Heterogeneity was examined with I² statistics. We used a bivariate model of random effects to summarize pooled diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic.</p><p><strong>Results: </strong>We included 18 observational studies, comprising 1,484 patients. Etiology of IICP was mixed, being composed of central nervous system infection, intracranial hemorrhage, acute ischemic stroke, aneurysmal subarachnoid hemorrhage, idiopathic intracranial hypertension, and hypoxic-ischemic brain injury. The pooled diagnostic odds ratio was 44.7 (95% confidence interval [CI] 22.5-80.1). Pooled sensitivity and specificity were 0.92 (95% CI 0.85-0.95) and 0.90 (95% CI 0.84-0.94), respectively, with a positive likelihood ratio of 6.19 (95% CI 4.4-8.5), and a negative likelihood ratio of 0.148 (95% CI 0.09-0.22). Summary receiver operating characteristic showed a calculated area under the curve of 0.925 (95% CI 0.84-0.927). Subgroup analysis of invasive and noninvasive reference standards showed similar accuracy of ultrasound ONSD for IICP diagnosis.</p><p><strong>Conclusions: </strong>Ultrasound ONSD may be a potentially useful noninvansive tool for IICP diagnosis in patients with nontraumatic brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"659-670"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764504","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":"Safety and Efficacy of a Novel Automated Intelligent Suction Device (VapCare) Among Mechanically Ventilated Neurocritical Care Patients: A Prospective Randomized Trial.","authors":"M S Varnitha, P Murlidhara, Archana Sharma, V Sudhir, Shwetha S Naik, Dhritiman Chakrabarti","doi":"10.1007/s12028-025-02253-w","DOIUrl":"10.1007/s12028-025-02253-w","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a significant concern in intensive care units (ICUs), affecting 7-32% of mechanically ventilated patients, which mounts to higher morbidity and mortality and extended hospital stays. Preventing VAP involves meticulous secretion management and oral hygiene, but in low-resource settings, VAP remains common owing to the absence of standardized oral care protocols. This randomized study assessed the efficacy and safety of the VapCare automated secretion management device in reducing microaspirations and improving clinical outcomes in ventilated patients.</p><p><strong>Methods: </strong>A single-center, open-label randomized trial was conducted involving adult neurocritical care patients requiring mechanical ventilation for 48 h or more, excluding tracheostomized patients and patients with bleeding disorders, difficult airways, or preexisting pneumonia. Participants were randomly assigned to a control group, receiving standard ICU care with manual oropharyngeal suctioning, or a study group, receiving VapCare management. We compared lung ultrasound scores (LUS), clinical pulmonary infection scores (CPIS), secretion volumes, tracheal cultures, and chest X-ray results from day 1 to day 5.</p><p><strong>Results: </strong>The VapCare group demonstrated a slower rise in LUS and CPIS compared to the control group. The median CPIS rose from 1 (interquartile range [IQR] 1-2) on the first day to 5 (IQR 2.75-6) on the fifth day in the control group versus 1 (IQR 0-2) on the first day to 3 (IQR 2-3) on the fifth day in the VapCare group (p < 0.001). The median LUS increased from 0 (IQR 0-2) on the first day to 6 (IQR 2-10) on the fifth in the control group, whereas the change was more muted in the VapCare group (0 [IQR 1-2] on the first day to 4 [IQR 2-6] on the fifth day [p < 0.001]). Additionally, chest X-ray scores were lower in the VapCare group (p = 0.028). Tracheal culture microbial growth and mortality were similar in both groups, but the length of ICU stay was significantly shorter in the VapCare group (p = 0.004). One patient in the VapCare group sustained mucosal erosions on the lip due to the VapCare mouthpiece.</p><p><strong>Conclusions: </strong>The VapCare device effectively reduces microaspiration and mitigates lung changes, demonstrating its potential to reduce the burden of microaspiration and suctioning in ventilated patients.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"551-562"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004188","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}