Neurocritical Care最新文献

{"title":"Rethinking Cefepime Neurotoxicity: An Integrated PK-Neuromonitoring Approach for Neurocritical Care.","authors":"Helena Barrasa, Thiago H G Silva, Ana Alarcia-Lacalle, Ana Tejero, Amaia Quintano","doi":"10.1007/s12028-026-02544-w","DOIUrl":"10.1007/s12028-026-02544-w","url":null,"abstract":"<p><p>Cefepime-induced neurotoxicity (CIN) remains under-recognized despite being a largely exposure-driven and multifactorial complication in neurocritical care. Early identification is often hindered by limited clinical evaluability, delayed electroencephalography (EEG) access, and rapidly evolving renal function that compromises dosing accuracy. Although higher cefepime exposure is consistently associated with increased neurotoxicity risk, no universally accepted therapeutic range clearly separates efficacy from toxicity across critically ill populations. This Viewpoint proposes an anticipatory approach integrating pharmacokinetic principles, therapeutic drug monitoring (TDM), and simplified neuromonitoring to facilitate earlier detection and prevent progression to severe encephalopathy or nonconvulsive seizures. We outline a pragmatic framework to enhance neurological safety while preserving antimicrobial efficacy.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"492-497"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006105","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":"Limited Accuracy of Prognostic Models for Predicting in-Hospital Mortality Among Patients with Refractory Status Epilepticus Admitted to Resource-Limited Intensive Care Units Compared with Those Treated Outside the Intensive Care Unit.","authors":"Dannys Rivero Rodríguez, Yanelis Pernas Sanchez, Daniela DiCapua Sacoto, Claudio Enrique Scherle Matamoros, María Isabel Morales-Casado, Graham Pluck","doi":"10.1007/s12028-026-02523-1","DOIUrl":"10.1007/s12028-026-02523-1","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of scoring systems for status epilepticus (SE), including the Status Epilepticus Severity Score (STESS), modified STESS (mSTESS), and Epidemiology-Based Mortality Score in SE (EMSE), has been demonstrated primarily in studies from high-income countries (HICs). However, data on their performance in subgroups such as older adults, patients with refractory SE (RSE) in intensive care unit (ICU), and populations from low- and middle-income countries (LMICs) remain limited.</p><p><strong>Methods: </strong>Retrospectively analysis was performed on data from the Eugenio Espejo Hospital SE database (November 2015-January 2020). Among 112 evaluated patients, 109 SE episodes in 107 individuals were included. Receiver operating characteristic (ROC) curves for STESS, mSTESS, and EMSE variants were generated to assess predictive accuracy for in-hospital mortality in patients treated outside the ICU and those treated in the ICU. The DeLong test was used to compare areas under the ROC curve (AUROC).</p><p><strong>Results: </strong>A total of 50 of 109 SE episodes required ICU admission, and 42 were treated with anesthetic drugs, with induction of a therapeutic coma. Acute etiologies were more frequent among refractory episodes (40.7% vs. 78.0%, p = 0.03). Unfavorable outcomes at discharge were significantly higher among patients treated in the ICU (p = 0.04). Across the entire cohort, AUROC values for in-hospital mortality were 0.74 (95% CI 0.65-0.84) for STESS, 0.77 (95% CI 0.68-0.86) for mSTESS, 0.80 (95% CI 0.72-0.89) for EMSE-Etiology, Age, and Comorbidity (EAC), 0.82 (95% CI 0.74-0.90) for EMSE-ECLE, and 0.83 (95% CI 0.74-0.91) for EMSE-Etiology, Age, Comorbidity, and Electroencephalography Pattern (EACE). Among patients treated in the ICU, predictive performance decreased for STESS (0.77 vs. 0.71, p = 0.58), mSTESS (0.79 vs. 0.75, p = 0.65), EMSE-EAC (0.89 vs. 0.70, p = 0.03), EMSE-Etiology, Comorbidity, Level of Consciousness, and Electroencephalography Pattern (ECLE; 0.90 vs. 0.71, p = 0.02), and EMSE-EACE (0.92 vs. 0.71, p = 0.01).</p><p><strong>Conclusions: </strong>The prognostic performance of STESS, mSTESS, and EMSE scores for predicting in-hospital mortality declined among patients with RSE treated in the ICU. This reduction, particularly evident for EMSE, underscores the influence of disease severity and resource limitations in LMIC settings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"726-736"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840844","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":"Neurocritical Care Society Abstracts from the 24th Annual Meeting 2026.","authors":"","doi":"10.1007/s12028-026-02638-5","DOIUrl":"10.1007/s12028-026-02638-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1-352"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137188","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":"Letter to the Editor: \"INTERACT3 in Intensive Blood Pressure Meta-analysis: A Methodological Reappraisal\".","authors":"Pan Ma, Gang Tian","doi":"10.1007/s12028-026-02556-6","DOIUrl":"10.1007/s12028-026-02556-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"880-881"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265367","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":"Communicating with Families after Severe Acute Brain Injury.","authors":"Adeline L Goss, Claire J Creutzfeldt","doi":"10.1007/s12028-026-02530-2","DOIUrl":"10.1007/s12028-026-02530-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"885-886"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840811","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":"Rehabilitation in the Intensive Care Unit for Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis.","authors":"Fiona Howroyd, David McWilliams, Jonathan Weblin, Hon Sing Geoffrey Wu, Grace Turner, Fang Gao Smith, Tonny Veenith, Niharika A Duggal, Zubair Ahmed","doi":"10.1007/s12028-026-02551-x","DOIUrl":"10.1007/s12028-026-02551-x","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a leading cause of disability worldwide. Rehabilitation in the intensive care unit (ICU) is a recommended intervention for the critically ill. However, the safety and effectiveness of physical rehabilitation in adults admitted to the ICU with TBI is currently unknown.</p><p><strong>Objectives: </strong>The primary objective was to evaluate the safety of physical ICU rehabilitation in adults with TBI, and secondary outcomes aimed to evaluate its effect upon physical outcomes and length of admission.</p><p><strong>Methods: </strong>Five electronic databases were searched up to 1 September, 2025, including studies investigating physical ICU rehabilitation interventions in adults with acute TBI. A narrative synthesis of safety outcomes was conducted owing to heterogeneity. Meta-analysis was performed for secondary outcomes using the random-effects model to compare pooled data for rehabilitation and no-rehabilitation groups. Risk of bias was assessed using the ROBINS-E tool for observational studies and the RoB2 tool for randomised studies.</p><p><strong>Results: </strong>Overall, 13 studies consisting of 3582 adults with TBI were included. Four studies reported safety outcomes, reporting no or low rates of adverse events. Meta-analysis identified an increase in the Perme ICU Mobility Scores at ICU discharge in those that received ICU rehabilitation [Mean Difference 3.25 (2.05-4.44), p < 0.00001]. Risk of bias assessment identified very high risk of bias in observational studies and some concerns of bias in randomised studies.</p><p><strong>Conclusions: </strong>Physical rehabilitation for adults with TBI in the ICU is potentially safe with suggested benefit upon mobility status at ICU discharge. Further high-quality studies of ICU rehabilitation for adults with TBI are required.</p><p><strong>Trial registration: </strong>PROSPERO CRD420251131380.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"771-786"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006188","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":"Prognostic Value of Natriuretic Peptides for Delayed Cerebral Ischemia and Outcomes After Aneurysmal Subarachnoid Hemorrhage: An Updated-Systematic Review and Meta-Analysis.","authors":"Gustavo Adolfo Villegas-Gomez, Oscar Iván Molina, Alejandra Ramírez-Romero, Juan Diego Sandoval-Rojas, Alexandra Ramos-Márquez, Edgar G Ordóñez-Rubiano, Diego F Gomez-Amarillo, Juan F Ramón, Fernando Hakim, Jorge Carrizosa","doi":"10.1007/s12028-026-02524-0","DOIUrl":"10.1007/s12028-026-02524-0","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is a type of hemorrhagic stroke with high morbidity and mortality, with life-threatening secondary complications including delayed cerebral ischemia (DCI). Biomarkers capable of improving early risk of DCI remain understudied. DCI frequently triggers neurogenic cardiac injury, manifested through left ventricular dysfunction and wall strain. Natriuretic peptides (NP), including brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP), have been implicated in the cardiac stress responses after aSAH, but their prognostic utility for DCI remains uncertain.</p><p><strong>Objective: </strong>The objective was to systematically review and meta-analyze observational studies evaluating the association of NP with DCI, mortality, and functional outcome in patients with aSAH.</p><p><strong>Methods: </strong>Following PRISMA guidelines, five databases were searched up to September 2025. Eligible studies included adult patients with confirmed aSAH and measured NP levels within 7 days, reporting outcomes of interest. Data were synthesized using random-effects models, with effect sizes expressed as odds ratios (ORs) or standardized mean differences (SMDs). Risk of bias was assessed with the ROBINS-I tool.</p><p><strong>Results: </strong>In total, 17 studies (n = 3172 patients) were included, with 12 proving data for quantitative synthesis. Elevated NP levels were significantly associated with DCI in dichotomous (OR 2.66, 95% CI 1.16-6.10) adjusted models (adjusted OR (aOR) 1.84, 95% CI 1.01-3.35), and continuous analyses (SMD 0.94, 95% CI 0.20-1.68). Admission NP demonstrated moderate diagnostic accuracy for DCI prediction (pooled area under the curve, AUC, 0.76). In contrast, no statistically significant associations were observed for mortality (OR 2.37, 95% CI 0.66-8.50) or unfavorable functional outcomes (OR 1.90, 95% CI 0.65-5.52). Heterogeneity across studies was substantial.</p><p><strong>Conclusions: </strong>Elevated NP levels are significantly associated with DCI in patients with aSAH. These findings support the use of NP as useful prognostic biomarkers. However, their utility in predicting mortality and functional outcomes remains inconclusive. Large prospective studies with standardized methodologies are required to validate their clinical applicability.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"703-725"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840752","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":"Common Consent Elements for Research Involving Persons with Disorders of Consciousness (CCE-DOC).","authors":"Michael J Young, Saptharishi Lalgudi Ganesan, Ralf J Jox, Anna Teresa Mazzeo, Michael A Rubin, Jennifer K Walter, Ariane Lewis","doi":"10.1007/s12028-026-02498-z","DOIUrl":"10.1007/s12028-026-02498-z","url":null,"abstract":"<p><p>Persons with disorders of consciousness (DoC) occupy an ethically charged space in modern medicine and biomedical research. Their decisional capacity is characteristically absent or limited or unpredictably fluctuates, requiring clinicians and investigators to rely on surrogates. Although there is general guidance for informed consent (IC) for research studies, there is no specific guidance for research involving persons with DoC. There are inconsistencies in IC forms for these studies related to explanation of a DoC, evaluation of capacity, description of risks/benefits, and sharing investigational results. This is problematic for persons with DoC, their surrogates, researchers, and institutional review boards (IRBs)/research ethics boards (REBs). To address these issues, the Curing Coma Campaign (CCC) Ethics Workgroup developed the Common Consent Elements for Research Involving Persons with Disorders of Consciousness (CCE-DoC). This practical framework aims to clarify and standardize consent processes in this complex and ethically sensitive research area. Through this structured, adaptable approach, CCE-DoC may have the potential to enhance participant protections, strengthen trust, help families and decision-makers understand studies, reduce duplicative efforts across research groups, and guide investigators and IRBs/REBs in navigating the complex ethical terrain of consent in DoC research. In so doing, CCE-DoC seeks to extend respect for autonomy and trust and promote responsible research urgently needed to advance paradigms of diagnosis, prognosis, and treatment for individuals with disorders of consciousness. The framework offers example language to encourage standardization, while allowing teams flexibility to customize to local needs.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"505-516"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974493","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":"Intravenous Milrinone after Aneurysmal Subarachnoid Hemorrhage: Is It Time to Be More Aggressive with Treatment Protocols?","authors":"Yasser B Abulhasan, Jeanne Teitelbaum, Mark R Angle","doi":"10.1007/s12028-026-02508-0","DOIUrl":"10.1007/s12028-026-02508-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"878-879"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654505","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 Novel Anti-Inflammatory Small Molecule MW189 Reduces Microglial Activation and Improves Functional Outcomes in a Murine Model of Subarachnoid Hemorrhage.","authors":"Haichen Wang, Timothy D Faw, Viviana Cantillana, Matthew S Neehouse, Nina Zhang, Brianna R Cellini, Victor Shifrin, David J Braun, Linda J Van Eldik, Daniel T Laskowitz","doi":"10.1007/s12028-026-02492-5","DOIUrl":"10.1007/s12028-026-02492-5","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with significant neurological morbidity. In current practice, there are limited pharmacological interventions to reduce the neurologic and functional deficits after SAH. The current study tests a novel therapy designed to reduce neuroinflammatory responses and improve functional outcomes in a clinically relevant murine model of SAH.</p><p><strong>Methods: </strong>The effect of MW189, an anti-inflammatory small molecule investigational drug, was tested in a murine model of SAH induced by endovascular filament perforation. Male C57BL/6 J mice (10-12 weeks old) were treated with MW189 at a dose of 5 mg/kg in 100 µl 0.9% NaCl or vehicle delivered by intraperitoneal injection at 30 min post-SAH and every 12 h (q12h) for 7 days. Functional outcomes, including Rotarod latency, neuroseverity score, and gait performance were assessed, as well as the effect of treatment on histological evidence of microgliosis, using unbiased stereological measurements with TMEM119 immunohistochemistry. To assess sex effects, functional outcomes were determined in a separate cohort of female mice using the same SAH induction/treatment paradigm.</p><p><strong>Results: </strong>In male mice, treatment with MW189 was associated with durable functional improvements during the 35-day testing period, including improvements in Rotarod latency, neuroseverity score, CatWalk gait speed, and shortened run duration. MW189 treatment reduced microglial activation as assessed by TMEM119 staining. In female animals, there was overall increased mortality following SAH induction, but MW189 treatment was associated with increased survival compared with vehicle treatment, significant improvements in Rotarod latency and CatWalk run duration, and trends toward improvement in CatWalk speed and neuroseverity score.</p><p><strong>Conclusions: </strong>Treatment with MW189 was associated with durable functional improvement in a murine model of SAH. MW189-treated mice also showed a reduction in microgliosis and several proinflammatory proteins consistent with an anti-inflammatory mechanism of action.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"553-563"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513524","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}