Neurocritical care
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Symptomatic cerebral vasospasm (SCV) is a morbid sequela of subarachnoid hemorrhage (SAH). Its etiology is multifactorial and predicting onset can be challenging. Diabetes mellitus (DM) is known to affect vasoactive properties of vessels, but it has not been definitively correlated with SCV. We report that pre-existing DM is independently and strongly correlated with SCV, despite intensive glycemic control. ⋯ In this group of patients with SAH, diabetes mellitus is identified as a risk factor for development of SCV. Blood glucose management during hospitalization was similar in diabetics and non-diabetics, suggesting that the longstanding effects of microvascular disease may be more relevant in the development of SCV then acute glycemic control in these patients.
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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.
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While tight glucose control has been widely adopted in the critical care setting, the optimal target glucose level following acute traumatic brain injury (TBI) remains debatable. This observational study was conducted to delineate the relationship between glucose levels and clinical outcomes during acute phase (first 5 days) of TBI. ⋯ Findings from our study suggest a glucose level > or =160 mg/dl within the first 24 h of admission following TBI is associated with poor outcomes irrespective of severity of injury, and this presents a timeframe for which active therapeutic interventions may improve clinical outcomes. Prospective efficacy trials are needed to corroborate these findings.
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Multicenter Study Comparative Study
A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage.
No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission. ⋯ Use of nicardipine compared with nitroprusside infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.