Neurocritical care
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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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Clinical Trial
Feasibility of a continuous computerized monitoring of cerebral autoregulation in neurointensive care.
In order to monitor cerebral autoregulation status, a software package was developed to calculate a cerebral autoregulation index (pressure reactivity index, PRx). The aim of this study is to evaluate whether the application of this methodology is feasible and useful in the clinical setting. ⋯ Our study demonstrates that a daily bedside measure of cerebral autoregulation is feasible. PRx values can support clinicians in the identification of a targeted CPP in patients suffering from different intracranial pathologies and requiring an intensive monitoring.
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The placement of cerebrospinal fluid (CSF) diversion devices requires an appropriate technical expertise associated with proper surgical training in order to minimize undue complications. This study sought to review a single institution's experience with placement of external ventricular drains (EVD) and ventriculoperitoneal (VP) shunts as performed by neurosurgeons with procedure-specific training. ⋯ The placement of intraventricular catheters by neurosurgeons remains a relatively safe and effective procedure that is associated with infrequent rates of symptomatic hemorrhage and infection.