Neurocritical care
-
The objectives of this study are to determine the incidence of symptomatic venous thromboembolism (VTE) in neurosurgery intensive care unit (NSICU) patients with spontaneous or traumatic intracranial hemorrhage and to identify the common VTE risk factors by injury type. ⋯ This is the first study to determine symptomatic VTE incidence and to identify common risk factors by injury type in nontumor patients who are not routinely screened with venous duplex ultrasonography but receiving early IPC and LDUH. Further studies are needed to determine the overall incident of symptomatic and nonsymptomatic VTE and independent risk factors for VTE events in NSICU patients.
-
To determine the safety and tolerability of super-selective intra-arterial magnesium sulfate in combination with intra-arterial nicardipine in patients with cerebral vasospasm after subarachnoid hemorrhage. ⋯ Administration of intra-arterial magnesium sulfate in combination with nicardipine was well tolerated in patients with subarachnoid hemorrhage and cerebral vasospasm without a significant change in MAP and ICP. The efficacy of this combination therapy should be evaluated in a larger, controlled setting.
-
Predicting extubation failure (EF) is one of the most challenging aspects of critical care medicine. The literature on EF in neurocritical care patients is very scarce. We sought to determine the ability of traditional weaning parameters to predict EF in neurocritical patients. ⋯ In this sample of neurocritical care patients undergoing extubation trial, traditional weaning parameters do not predict extubation failure.
-
The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time interval during which this study needs to be completed. ⋯ We propose that only CT scans obtained within 24 h of a subarachnoid bleeding event should be used to estimate the risk of vasospasm.
-
Propofol infusion syndrome (PRIS) is a rare, but lethal complication of high-dose propofol infusions. We undertook this study to evaluate the incidence of PRIS in a cohort of patients with severe head trauma and its relation to the use of vasopressors. ⋯ Awareness and early recognition of PRIS in critically ill neurosurgical patients on vasopressors and daily screening for creatine kinase elevation, unexplained acidosis, or electrocardiographic changes may reduce the incidence and case-fatality.