Neurocritical Care最新文献

{"title":"Palliative General Anesthesia at Terminal Extubation: \"Go Gentle into that Good Night\".","authors":"Christos Lazaridis","doi":"10.1007/s12028-025-02228-x","DOIUrl":"10.1007/s12028-025-02228-x","url":null,"abstract":"<p><p>Withdrawal of life-sustaining treatments in the intensive care unit most often culminates into the discontinuation of mechanical ventilation and removal of the endotracheal tube or \"terminal extubation.\" Standards of practice call for the appropriate use of analgesia and sedation before, during and after extubation with an explicit goal to relieve suffering but not to hasten death. Patients subjected to this procedure are exposed to variable pharmacologic agents, modes, and doses, without any knowledge or monitoring of what these patients are experiencing. This practice seems to rest on contestable assumptions regarding the reliability of bedside examination, the experiential states of unresponsive patients, and the scope of the doctrine of double effect; instead, I argue for palliative general anesthesia in order to safeguard against potential suffering at the end of life. I employ philosophical notions of harm to justify the normative status of palliative anesthesia, in conjunction with contemporary evidence as it relates to the phenomena of covert consciousness and cognitive-motor dissociation. If this analysis is correct, then it may serve as a valid challenge toward current practice without having engaged into controversial debates over the soundness of the doctrine of double effect, or euthanasia. Primun non nocere offers the strongest justification for general anesthesia when terminal extubation is planned.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"385-391"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542632","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":"Metabolomics Analysis Reveals Potential Biomarkers for Diffuse Axonal Injury Article Category: Original Work.","authors":"Weiliang Chen, Shengwen Li, Jiayi Wu, Chunyu Yao, Wen Su, Lisheng Xu, Guanjun Wang","doi":"10.1007/s12028-025-02257-6","DOIUrl":"10.1007/s12028-025-02257-6","url":null,"abstract":"<p><strong>Background: </strong>Metabolism is essential for life maintenance, neurological function, and injury repair, yet its role in diffuse axonal injury (DAI) is not fully understood.</p><p><strong>Methods: </strong>Thirty patients with DAI and 34 patients without DAI were recruited based on the classification criteria using magnetic resonance imaging within 30 days of admission in this exploratory research. Serum samples and clinical parameters were collected on admission, with the Glasgow Outcome Scale Extended at 6 months after injury used as the neurological functional outcome. We did an untargeted metabolomic analysis using liquid chromatography-mass spectrometry.</p><p><strong>Results: </strong>The DAI group and non-DAI group showed significant differences in the expression levels of 27 metabolites in serum, as well as in pupillary light reflex, Glasgow Coma Scale score, and Marshall computed tomography score. Random forest analysis indicated that lysophosphatidylcholine 22:3 sn-2 and carnitine C8:1 greatly contributed to distinguishing patients with DAI from patients without DAI (MeanDecreaseGini: 3.81, 5.16). The combined prediction of DAI using these two metabolites yielded an area under the curve of 0.944, which was higher than the combination of clinical parameters.</p><p><strong>Conclusions: </strong>The serum metabolomics revealed potential biomarkers for DAI and has significant value for exploring pathogenesis, determining early diagnosis, and improving long-term neurological function.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"572-580"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803901","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":"Necessary Intensity of Monitoring After Elective Craniotomies: A Prediction Score for Postoperative Complications to Stratify Postoperative Monitoring.","authors":"Elena Kurz, Darius Kalasauskas, Dominik Wesp, Harald Krenzlin, Alicia Schulze, Melek Bulut, Thomas Kerz, Florian Ringel, Naureen Keric","doi":"10.1007/s12028-025-02242-z","DOIUrl":"10.1007/s12028-025-02242-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications requiring monitoring following elective craniotomies occur in ~ 2% of cases. Therefore, in most neurosurgical departments, an elective craniotomy is routinely followed by postoperative monitoring in an intensive or intermediate care unit. However, there is no systematic allocation to this procedure. Consequently, patients at risk are not monitored as a priority. The aim of this study was to develop a prediction score for the occurrence of postoperative complications after elective craniotomies and to redefine the monitoring algorithm.</p><p><strong>Methods: </strong>In this retrospective single-center analysis, all patients with elective craniotomy between 2018 and 2021 were included. Demographic data, diagnosis, location of the pathology (infratentorial/supratentorial), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), duration of surgery, blood loss, postoperative complications, and type and duration of monitoring were analyzed. The score was developed and validated internally to ensure its predictive reliability.</p><p><strong>Results: </strong>A total of 860 consecutive patients (376 male patients and 484 female patients) with a mean age of 60.6 years (range 19-93 years) were included. Forty-three patients experienced a postoperative adverse event that required monitoring. Independent predictors for postoperative complications were age (odds ratio [OR] 0.001, 95% confidence interval [CI] 1.0-1.04), CCI (OR 1.19, 95% CI 1.04-1.36), operative duration (OR 45.90, 95% CI 10.01-229.30), vestibular schwannoma as the treated pathology (OR 1.58, 95% CI 0.09-0.77), blood loss (OR 1.001, 95% CI 1.00-1.001), and ASA score (OR 1.1, 95% CI 1.01-1.2). The score was based on the most reliable characteristics and the calculated predictor error. The formula for score calculation is as follows: 1.3 age + 10 CCI + 65 1_{{vascular pathology = yes}} + 0.5 duration of surgery + 20.5 ASA score - 100. The discriminatory value for clinical outcomes achieved an area under the curve of 0.78 in validation data.</p><p><strong>Conclusions: </strong>This score provides a practical approach for individual risk assessment of patients undergoing elective craniotomy. Postoperative monitoring capacity can be optimally distributed, and fast-track pathways can be developed for low-risk patients to use this valuable resource effectively.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"484-492"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128351","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":"Postoperative Intracranial Hypotension.","authors":"Yu Chang, Po-Chia Cheng, Jung-Shun Lee, Ming-Tsung Chuang","doi":"10.1007/s12028-025-02298-x","DOIUrl":"10.1007/s12028-025-02298-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"699-701"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","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":"Multisite Open Pilot Trial of a Resilience Intervention for Caregivers of Patients with Severe Acute Brain Injury: The Coma Family Program.","authors":"Alexander M Presciutti, Elizabeth Rochon, Nicolás Alvarez-Frank, Jessica Daily, Emma Silverman, Melissa Motta, Ana-Maria Vranceanu, David Y Hwang","doi":"10.1007/s12028-025-02387-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02387-x","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of patients with severe acute brain injury (SABI) often experience chronic emotional distress and lack evidence-based psychosocial treatments. To address this problem, we followed the National Institutes of Health (NIH) Stage Model to develop and pilot the Coma Family Program (COMA-F), a resilience intervention for caregivers of patients with SABI.</p><p><strong>Methods: </strong>We conducted a single-arm open pilot clinical trial of COMA-F between February 2024 and February 2025 at three geographically diverse hospitals to test preliminary feasibility and acceptability and to refine the intervention prior to a larger randomized controlled trial (RCT) (NIH stage 1a). Caregivers endorsed elevated distress on the Hospital Anxiety and Depression Scale (HADS), and patients suffered coma for ≥ 24 hours and were committed to tracheostomy and/or gastrostomy. COMA-F involved six sessions focused on building mindfulness and coping skills for managing distress. Primary outcomes were: feasibility of recruitment, feasibility of assessments, adherence, therapist fidelity, satisfaction, credibility, and expectancy. Caregivers completed pretest and posttest measures of distress (HADS) and treatment mechanisms (dispositional mindfulness [Cognitive and Affective Mindfulness Scale-Revised], applied mindfulness [Applied Mindfulness Process Scale], coping [Measure of Current Status A]) and exit interviews to provide feedback. We calculated frequencies and proportions of feasibility and acceptability metrics, examined pretest and posttest changes on quantitative measures, and performed explanatory-sequential mixed methods to integrate the quantitative and qualitative data.</p><p><strong>Results: </strong>We screened 36 caregivers and enrolled 20. COMA-F exceeded feasibility and acceptability benchmarks (≥ 70% on all) and showed improvements in emotional distress, dispositional mindfulness, and coping, with large effect sizes (Cohen's d = 0.8-1.95, p < 0.01). Mixed methods confirmed feasibility, acceptability, and utility of program skills in improving distress.</p><p><strong>Conclusions: </strong>Results support preliminary feasibility and acceptability of COMA-F and further testing in a larger RCT (NIH stage 2).</p><p><strong>Trial registration information: </strong>ClinicalTrials.gov #NCT05761925; first submitted February 27, 2023; first caregiver enrolled April 16, 2024.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150151","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 Association between Hourly Systolic Blood Pressure Variability and Outcomes in Patients with Intracerebral Hemorrhage is Time-Dependent: Post-hoc Analysis of the ATACH-2 Trial.","authors":"Adnan I Qureshi, William Baskett, Joao A Gomes, Pashmeen Lakhani, Alejandro A Rabinstein, David Z Rose, Jose I Suarez, Thorsten Steiner, Chi-Ren Shyu","doi":"10.1007/s12028-025-02376-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02376-0","url":null,"abstract":"<p><strong>Background: </strong>Systolic blood pressure (SBP) variability has been associated with an increase in rates of death or disability in patients with intracerebral hemorrhage (ICH). We analyzed data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 trial to determine whether the association between SBP variability and death or disability at 90 days is dependent on the time from randomization.</p><p><strong>Methods: </strong>The difference between maximum and minimum SBP (hourly SBP range) for the first 24 h after enrollment was used to calculate the hourly SBP variability. The effect of hourly SBP variability was evaluated in logistic regression models on: (1) death or disability (modified Rankin scale score of 4-6 at 90 days), (2) hematoma expansion (increase of > 33% in volume on the computed tomography scan obtained at 24 h) within 24 h, (3) neurological deterioration within 24 h, and (4) acute kidney injury within 72 h after enrollment. We adjusted for age, baseline Glasgow Coma Scale score, intraventricular hemorrhage, hematoma volume, and maximum SBP values for each time window.</p><p><strong>Results: </strong>A total of 961 patients (mean age ± standard deviation [SD], 62 ± 13 years; 61.9% were men) who were enrolled at a mean ± SD time of 184 ± 56 min from symptom onset were analyzed. The mean ± SD hourly SBP variability was 15.6 ± 16 mm Hg. The hourly SBP variability became significantly lower with increasing time intervals from randomization (ranging from 41.8 ± 23.3 at hour 1 to 12.4 ± 14.0 at hour 24, P < 0.0001). SBP variability at five hours (P = 0.014) and six hours (P = 0.014) after enrollment was significantly associated with death or disability at 90 days, with positive but not statistically significant associations observed at all other points up to eight hours after randomization. Risk of neurological deterioration within 24 h was highly associated with SBP variability, with the largest association observed between one (P < 0.001) and five (P < 0.001) hours following randomization, with significant associations observed up to 22 h following randomization. Risk of hematoma expansion was associated with SBP variability between three (P = 0.015) and eight (P = 0.002) hours after randomization. Statistically significant associations between SPB variability and risk of acute kidney injury were not observed.</p><p><strong>Conclusions: </strong>Reduced SBP variability within the first eight hours following randomization appears most impactful on both short-term and long-term outcomes in patients with ICH, and the first eight hours may represent a time window for future interventions directed at reducing SBP variability in patients with ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138288","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 to: 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 E L Deen, Hani A Albialy, Ahmed M Gouda, Ahmed Beniamen","doi":"10.1007/s12028-025-02373-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02373-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124249","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 Mechanical Insufflation/Exsufflation Cough Assistance for Preventing Postoperative Pneumonia in Neurosurgical Patients: A Combined Physiological and Cohort Study.","authors":"Ruihua Zhang, Meizhizi Zhang, Xiaoyu Zhang, Yang Liu, Jingyi Li, Hui Wang, Song Han, Xiufeng Huang, Zhonghua Shi","doi":"10.1007/s12028-025-02386-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02386-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pneumonia (POP) is a common complication after neurosurgery, leading to worse outcomes. Although mechanical insufflation/exsufflation cough assistance (M-I/E-ca) may improve airway clearance, its safety and efficacy in this patient group remain underexplored. This study aimed to evaluate M-I/E-ca's impact on intracranial pressure (ICP) and hemodynamics and its role in preventing POP.</p><p><strong>Methods: </strong>This study consisted of two substudies: a prospective physiological study to evaluate ICP and hemodynamic changes and a retrospective-prospective cohort study to assess the incidence of POP. The first substudy enrolled ten patients after neurosurgery, whereas the second included 200 patients, with 100 in the M-I/E-ca group (prospective) and 100 in the control group (retrospective).</p><p><strong>Results: </strong>M-I/E-ca did not significantly alter ICP or hemodynamic parameters compared with the baseline. Instead, M-I/E-ca caused less disruption in ICP than traditional endotracheal suction, with insufflation/exsufflation pressure set at 40 mm Hg. The incidence of POP was 39%, with lower but not significant incidence in the M-I/E-ca (35%) compared with control (42%) groups (P = 0.309). In addition, patients in the M-I/E-ca group had significantly shorter intensive care unit (P = 0.006) and hospital (P = 0.002) stays compared with those in the control group.</p><p><strong>Conclusions: </strong>M-I/E-ca is safe for patients after neurosurgery, with no significant impact on ICP or hemodynamics. Although it did not significantly reduce POP, it may contribute to shorter intensive care unit and hospital stays, suggesting potential benefits that warrant further investigation in larger studies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124196","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":"Echoes of Danger: Clot in Transit Causing Stroke and Pulmonary Embolism.","authors":"Kevin R Olsen, Ekkehard M Kasper","doi":"10.1007/s12028-025-02353-7","DOIUrl":"https://doi.org/10.1007/s12028-025-02353-7","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086618","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":"Restrictive vs. Liberal Transfusion Strategy in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-analysis.","authors":"Amanda Boutrik, Udenilson Nunes da Silva Junior, Matheus de Medeiros Fernandes, Luís Otávio Nogueira, Douglas Dias E Silva, Dayany Leonel Boone","doi":"10.1007/s12028-025-02364-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02364-4","url":null,"abstract":"<p><p>The indications of red blood cell transfusions in the absence of life-threatening bleeding in neurocritical individuals are controversial. Recently, three large randomized controlled trials assessed transfusion strategies in this population, allowing an update of a previous meta-analysis, including a sample seven times bigger than the one analyzed previously. We performed a systematic review and updated meta-analysis of liberal versus restrictive transfusion strategy in patients with acute brain injury, comprising traumatic brain injury (TBI), intracerebral hemorrhage, and subarachnoid hemorrhage. A review protocol was registered on PROSPERO (CRD42024616143). We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing liberal versus restrictive transfusion strategy in neurocritical patients. We used Review Manager 5.4 to apply a random-effects model to pool risk ratios (RRs) and 95% confidence intervals (CIs), as available in the individual studies. Quality assessment was performed through the Cochrane Risk of Bias assessment tool (RoB 2.0 tool). Six randomized clinical trials were included, comprising 2,497 patients, of whom 1,431 presented with TBI. The liberal transfusion strategy led to statistically significant lower rates of unfavorable neurological outcomes compared to the restrictive strategy (RR 0.89; 95% CI 0.83-0.96; p = 0.002; I² = 0%). Although a trend favoring the liberal strategy was observed in most mortality and length of stay outcomes, the pooled analysis did not identify statistically significant differences between the two groups. TBI subgroup analysis led to similar results when compared to the general pooled analysis. The main study limitations include the limited number of studies, the imbalance in study weights within the analyses, and the presence of significant heterogeneity. In conclusion, our results suggest that a liberal transfusion strategy may be beneficial to neurocritical patients in terms of neurological outcome when compared to the restrictive strategy, although our results should be interpreted with caution. Further investigation is needed to provide support for updating guidelines for neurocritical care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091565","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}