Neurocritical care
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Controlled Clinical Trial
Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults.
To study the correlation between a dynamic index of cerebral autoregulation assessed with blood flow velocity (FV) using transcranial Doppler, and a tissue oxygenation index (TOI) recorded with near-infrared spectroscopy (NIRS). ⋯ NIRS shows promise for the continuous assessment of cerebral autoregulation in adults.
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Ancillary testing is frequently required in the determination of death by brain criteria, particularly in cases in which the clinical examination is drawn into question. Newer tests, such as computed tomographic angiography (CTA), have garnered enthusiasm for their ease of performance, but have not been validated as acceptable tests compared with a gold standard. ⋯ CTA should be studied further in comparison to validated tests, such as conventional angiography or single photon emission computed tomography (SPECT), before being accepted as a standard ancillary test in determining death by brain criteria.
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Comparative Study Clinical Trial
Alpha-stat versus pH-stat guided ventilation in patients with large ischemic stroke treated by hypothermia.
Moderate hypothermia (MH) is a therapeutic approach for ischemic stroke as well as cardiac arrest. Two different technical strategies of ventilation during MH called alpha- and pH-stat dramatically influence cerebral blood flow (CBF). In turn this might influence neuronal damage and intracranial pressure (ICP). Therefore, effects of ventilation on CBF and ICP were measured in patients undergoing MH because of large ischemic stroke to address optimal ventilation management. ⋯ pH-stat implies a better CBF to the injured brain, while it might be dangerous by elevating ICP in more subacute stages.
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There are few predictors of acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) after subarachnoid hemorrhage (SAH). We hypothesized that cardiac troponin I, which is associated with cardiovascular morbidity, would also predict ALI. ⋯ Troponin I is associated with the development of ALI after SAH.
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Refractory status epilepticus (RSE) treatment is usually performed with coma induction using an appropriate general anesthetic. Most frequent complications are represented by hypotension and infection. Other side-effects may however be encountered. ⋯ In these two patients, mechanical vascular ischemia may have resulted from drug-induced paralytic ileus. To our knowledge, this is the first report describing this potential fatal side effect in adults with RSE.