Neurocritical Care最新文献

{"title":"Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Are Old Data Enough to Justify Its Current Treatment Regimen?","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Daniel Agustín Godoy","doi":"10.1007/s12028-024-02182-0","DOIUrl":"https://doi.org/10.1007/s12028-024-02182-0","url":null,"abstract":"<p><p>Nimodipine, a dihydropyridine L-type calcium channel antagonist, constitutes one of the mainstays of care to prevent delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage (aSAH) because it has been associated with a reduction in infarction rates and improvement in functional outcomes despite not significantly preventing angiographic vasospasm. Although it is a widely accepted treatment, controversies surrounding the current regimen of nimodipine in patients with aSAH exist. Still, there is a wide space open for randomized controlled trials or alternative study designs comparing different routes of administration, dosing, and timing of nimodipine treatment regimen in patients with aSAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847016","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":"Point-of-Care Ultrasound and Critical Care Ultrasound use Among Providers in Neurocritical Units: A National Survey.","authors":"Melvin Parasram, Shamelia Y Loiseau, Thanujaa Subramaniam, Neha S Dangayach, Aarti Sarwal, Judy H Ch'ang","doi":"10.1007/s12028-024-02174-0","DOIUrl":"https://doi.org/10.1007/s12028-024-02174-0","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS)/critical care ultrasound (CCU) use in medical and surgical intensive care units has surged over the last few decades. It is unclear if this has similarly translated in neurocritical care (NCC) units. We designed a survey to describe the current state of POCUS/CCU use and training among NCC providers.</p><p><strong>Methods: </strong>An online 13-question survey was distributed nationally through newsletters and social media after endorsement by the Neurocritical Care Society. Participation was voluntary, and responses were anonymous. The survey queried respondent demographics, training, clinical use, confidence in POCUS/CCU, and barriers to POCUS/CCU use.</p><p><strong>Results: </strong>Overall, 119 NCC providers responded to the survey. Most respondents were attending neurointensivists (52.1%) and had completed neurology residency training (62.2%). Approximately 23% of respondents did not have training in POCUS/CCU, and 71% of respondents had not completed POCUS/CCU board-certified training. Fifty-five percent of respondents used POCUS/CCU in their practice frequently, and 37% used it rarely on a weekly basis. Thirty-six percent and 42% of respondents felt moderately skilled at acquiring and interpreting POCUS/CCU images, respectively. Ultrasound guidance for procedures was the most common technique used by respondents. Most respondents felt that using ultrasound for volume status, procedural guidance, and evaluation of shock influenced clinical decision-making. Lack of confidence in interpreting data/imaging and comfort in performing POCUS/CCU were the most common barriers to ultrasound use. Respondents agreed with incorporation of POCUS/CCU training in NCC fellowship milestones and creating resources for credentialing providers in POCUS/CCU to increase use of POCUS/CCU in NCC.</p><p><strong>Conclusions: </strong>This national survey indicated that POCUS/CCU is moderately used among NCC providers. However, more formalized and robust training in POCUS/CCU is needed for trainees and practitioners in NCC to enhance comfortability with using ultrasound for clinical assessments.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847018","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":"Intraspinal Pressure is Not Elevated After Traumatic Spinal Cord Injury in a Porcine Model Sham-Controlled Trial.","authors":"Mathias Møller Thygesen, Seyar Entezari, Nanna Houlind, Teresa Haugaard Nielsen, Nicholas Østergaard Olsen, Tim Damgaard Nielsen, Mathias Skov, Alp Tankisi, Mads Rasmussen, Halldór Bjarki Einarsson, Dariusz Orlowski, Stig Eric Dyrskog, Line Thorup, Michael Pedersen, Mikkel Mylius Rasmussen","doi":"10.1007/s12028-024-02181-1","DOIUrl":"https://doi.org/10.1007/s12028-024-02181-1","url":null,"abstract":"<p><strong>Background: </strong>It has been suggested that intraspinal pressure (ISP) below the dura is elevated following traumatic spinal cord injury (TSCI). The dura can maintain the pressure, and hence a subdural compartment syndrome has been hypothesized to develop regardless of bony decompression. This study aimed to evaluate whether a such intradural compartment syndrome develops during the first 72 h in a porcine TSCI model.</p><p><strong>Methods: </strong>First, in a randomized sham controlled-trial design, longitudinal ISP measurements were performed over a period of 72 h from onset of TSCI. TSCI was inflicted by a weight-drop contusion regime: 75-g rod, 75-mm free fall, and 5-min compression of the spinal cord. Second, in a sham-controlled dose-response design longitudinal ISP measurements were performed over a period of 16 h from the onset of TSCI, using two other contusion regimes: 75-g rod, 125-mm free fall, and 5-min compression; and 75-g rod, 75-mm free fall, and 240-min compression. Animals were kept sedated for the entire course of the study using propofol, fentanyl, and midazolam.</p><p><strong>Results: </strong>Intraspinal pressure increased in TSCI and sham animals alike, but we found no significant increases in ISP following TSCI compared with the sham group, and we found no relationship between the ISP increase and larger impacts or increased time of compression.</p><p><strong>Conclusion: </strong>These findings suggest that the subdural swelling of the spinal cord following thoracic TSCI is not responsible for the ISP increase measured in our TSCI model, but that the ISP increase was caused by the surgical procedure or the reconstitution of normal cerebrospinal fluid pressure.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813441","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":"Machine Learning Reveals Demographic Disparities in Palliative Care Timing Among Patients With Traumatic Brain Injury Receiving Neurosurgical Consultation.","authors":"Carlos A Aude, Vikas N Vattipally, Oishika Das, Kathleen R Ran, Ganiat A Giwa, Jordina Rincon-Torroella, Risheng Xu, James P Byrne, Susanne Muehlschlegel, Jose I Suarez, Debraj Mukherjee, Judy Huang, Tej D Azad, Chetan Bettegowda","doi":"10.1007/s12028-024-02172-2","DOIUrl":"10.1007/s12028-024-02172-2","url":null,"abstract":"<p><strong>Background: </strong>Timely palliative care (PC) consultations offer demonstrable benefits for patients with traumatic brain injury (TBI), yet their implementation remains inconsistent. This study employs machine learning methods to identify distinct patient phenotypes and elucidate the primary drivers of PC consultation timing variability in TBI management, aiming to uncover disparities and inform more equitable care strategies.</p><p><strong>Methods: </strong>Data on admission, hospital course, and outcomes were collected for a cohort of 232 patients with TBI who received both PC consultations and neurosurgical consultations during the same hospitalization. Patient phenotypes were uncovered using principal component analysis and K-means clustering; time-to-PC consultation for each phenotype was subsequently compared by Kaplan-Meier analysis. An extreme gradient boosting model with Shapley Additive Explanations identified key factors influencing PC consultation timing.</p><p><strong>Results: </strong>Three distinct patient clusters emerged: cluster A (n = 86), comprising older adult White women (median 87 years) with mild TBI, received the earliest PC consultations (median 2.5 days); cluster B (n = 108), older adult White men (median 81 years) with mild TBI, experienced delayed PC consultations (median 5.0 days); and cluster C (n = 38), middle-aged (median: 46.5 years), severely injured, non-White patients, had the latest PC consultations (median 9.0 days). The clusters did not differ by discharge disposition (p = 0.4) or inpatient mortality (p > 0.9); however, Kaplan-Meier analysis revealed a significant difference in time-to-PC consultation (p < 0.001), despite no differences in time-to-mortality (p = 0.18). Shapley Additive Explanations analysis of the extreme gradient boosting model identified age, sex, and race as the most influential drivers of PC consultation timing.</p><p><strong>Conclusions: </strong>This study unveils crucial disparities in PC consultation timing for patients with TBI, primarily driven by demographic factors rather than clinical presentation or injury characteristics. The identification of distinct patient phenotypes and quantification of factors influencing PC consultation timing provide a foundation for developing for standardized protocols and decision support tools to ensure timely and equitable palliative care access for patients with TBI.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801613","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":"Small Molecule Myeloperoxidase (MPO) Inhibition Prevents Delayed Cerebral Injury (DCI) After Subarachnoid Hemorrhage (SAH) in a Murine Model.","authors":"Safiye Limon, Aminata P Coulibaly, Jose Javier Provencio","doi":"10.1007/s12028-024-02169-x","DOIUrl":"https://doi.org/10.1007/s12028-024-02169-x","url":null,"abstract":"<p><strong>Background: </strong>Delayed cerebral injury (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is a preventable injury that would improve patient outcomes if an effective treatment can be developed. The most common long-term disability in patients with SAH is cognitive dysfunction. Contrary to the common theory that damage from DCI originates solely from ischemia caused by cerebral vasospasm, inflammation has been shown to be an important independent mediator of DCI.</p><p><strong>Methods: </strong>Neutrophil infiltration of the meninges is a critical step in developing late spatial memory deficits in a murine model of SAH and may serve as a surrogate marker for disease progression. Importantly, myeloperoxidase (MPO) null mice do not develop meningeal neutrophilia and are protected from spatial memory deficits.</p><p><strong>Results: </strong>In this study, wildtype mice administered a single dose of the MPO inhibitor (MPOi) AZD5904 at peak neutrophil entry day have a higher percentage of neutrophils that remain in the meningeal blood vessel 6 days after the hemorrhage suggesting neutrophil extravasation into the meninges is inhibited (79 ± 20 vs. 28 ± 24, p < 0.01). Interestingly, the intraperitoneal route of administration has a larger effect than the intrathecal route suggesting that MPO inhibition is best administered systemically not in the central nervous system. Second, mice administered AZD5904 intraperitoneal for 4 consecutive days starting 2 days after the hemorrhage do not develop delayed spatial memory dysfunction (two-way analysis of variance, p > 0.001 F [2, 22] = 10.11).</p><p><strong>Conclusions: </strong>Systemic MPOi prevents neutrophil entry into the meninges and prevents spatial memory dysfunction. MPOi is a promising strategy for translation to patients with aneurysmal SAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801800","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":"Modifying the Apnea Test to Minimize Complications.","authors":"Summit Dev Bloria","doi":"10.1007/s12028-024-02179-9","DOIUrl":"https://doi.org/10.1007/s12028-024-02179-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801614","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":"Challenges with Formulating Accurate Prognosis for Patients with Severe Acute Brain Injury.","authors":"Lourdes R Carhuapoma, David Y Hwang","doi":"10.1007/s12028-024-02170-4","DOIUrl":"https://doi.org/10.1007/s12028-024-02170-4","url":null,"abstract":"<p><p>Prognostication is fundamental to determining the intensity of care offered for many critically ill patients with severe acute brain injury (SABI). Inherent uncertainties linked to predicting outcomes for patients with SABI primarily arise from a lack of complete data regarding the natural disease/injury progression that follows various forms of SABI, stemming from early withdrawal of life-sustaining treatment. This potential bias has led to limitations in using outcome data associated with clinical grading scales and a risk of perpetuating high mortality following SABI, leading to self-fulfilling prophecies. The aims of this article are to (1) review contemporary prognostication practices among clinicians for patients with SABI, (2) discuss inherent challenges in prognosticating outcomes following SABI, (3) summarize statements and guidelines from professional societies regarding SABI prognostication, and (4) identify directions for future research in prognostication after SABI.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770703","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 History of Treating Cerebral Abscesses: Sir William Macewen's Optimism.","authors":"Eelco F M Wijdicks","doi":"10.1007/s12028-024-02162-4","DOIUrl":"https://doi.org/10.1007/s12028-024-02162-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770722","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 Case of Guillain-Barré Syndrome and Repurposing cEEG to Enable Communication in Total Locked-in Syndrome.","authors":"Thomas J Pisano, Joshua M Levine","doi":"10.1007/s12028-024-02171-3","DOIUrl":"https://doi.org/10.1007/s12028-024-02171-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770699","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":"Authors' Response: Robotic Assisted Transcranial Doppler Monitoring in Acute Neurovascular Care: A Feasibility and Safety Study.","authors":"Alvise Fattorello Salimbeni, Ludovica De Rosa, Claudio Baracchini","doi":"10.1007/s12028-024-02185-x","DOIUrl":"https://doi.org/10.1007/s12028-024-02185-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770701","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}