Neurocritical care
-
Randomized Controlled Trial Multicenter Study
Association between disability measures and short-term health care costs following intracerebral hemorrhage.
Small improvements in clinical outcomes after intracerebral hemorrhage (ICH) can have a substantial impact on overall health care costs, yet little data exists on the costs associated with the most commonly studied clinical outcomes in this type of stroke. ⋯ Health care costs vary significantly by levels of disability as measured by the mRS, but costs do not vary across the full range of mRS outcomes. The mRS is more informative than the Barthel index and NIHSS for discriminating the resource use and costs associated with different levels of disability after ICH.
-
The management of Dysautonomia following severe traumatic brain injury (TBI) remains problematic, primarily due to an inadequate understanding of the pathophysiology of the condition. While the original theories inferred an epileptogenic source, there is greater support for disconnection theories in the literature. Disconnection theories suggest that Dysautonomia follows the release of one or more excitatory centres from higher centre control. ⋯ This article presents a critical review of the competing theories against the available observational, clinical and neurotransmitter evidence. Following this process, it is suggested that the EIR Model more readily explains pathophysiological and treatment data compared to conventional disconnection models. In particular, the EIR Model provides an explanatory model that encompasses other acute autonomic emergency syndromes, accommodates 'triggering' of paroxysms and provides a rationale for all known medication effects.
-
Randomized Controlled Trial
Intensive insulin therapy after severe traumatic brain injury: a randomized clinical trial.
To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic events defined as a glucose concentration less than 80 mg/dl (<4.44 mmol/l) in patients admitted to the intensive care unit (ICU) after severe traumatic brain injury (TBI). ⋯ Intensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must be taken to avoid hypoglycemia.
-
Clinical Trial
The prediction of extubation success of postoperative neurosurgical patients using frequency-tidal volume ratios.
The process of discontinuing neurological patients from mechanical ventilation is still controversial. The aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V (t) ratio. ⋯ The f/V (t) ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.
-
Randomized Controlled Trial
Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety.
The optimal blood pressure (BP) for treating acute intracerebral hemorrhage remains (ICH) uncertain. High BP may contribute to hematoma growth while excessive BP reduction might precipitate peri-hemorrhage ischemia. We examine here the feasibility and safety of reducing BP to lower than presently recommended levels in patients with acute ICH. ⋯ A more aggressive reduction of acute hypertension after ICH does not increase the rate of neurological deterioration even when treatment is initiated within hours of symptom onset. Lowering BP aggressively did not affect hematoma and edema expansion but this possibility deserves further study.