Neurocritical care
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To describe the concept, implementation, patient characteristics, and preliminary outcomes of a Neonatal Neurocritical Care Service (NNCS) recently established at the University of California, San Francisco. ⋯ While specialized neurocritical care has improved outcomes in adult populations, longitudinal studies are needed to determine whether specialized neurocritical care services will also result in improved neurodevelopmental outcomes for newborns.
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In a recent publication (Wijdicks et al. in Neurology 71(16):1240, 2008), apnea test safety during brain death determination was evaluated at a single tertiary care center. One major conclusion was that apnea testing was safe in hemodynamically compromised patients in most circumstances and rarely aborted. Determinants of apnea test completion failure are unknown. ⋯ Acute lung injury is common in patients undergoing brain death evaluation. Patients that failed completion of apnea testing tended to be younger, had significantly greater A-a gradients, and were more acidotic.
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To examine if the metabolic distress after traumatic brain injury (TBI) is associated with a unique proteome. ⋯ Metabolic distress after TBI is associated with a differential proteome that indicates cellular destruction during the acute phase of illness. This suggests that metabolic distress has immediate cellular consequences after TBI.
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Alcoholic hand rubs (AHRs) have been proven effective in preventing nosocomial infections, and healthcare authorities include AHRs use among quality-of-care criteria. Since the onset of the influenza A (H1N1) pandemic, AHRs have gained considerable popularity among the general public. ⋯ Whereas overdrinking in social settings (wine and liquor) leads to a gradual increase in blood alcohol levels, AHRs poisoning is usually characterized by a sudden massive alcohol load. The unusual nature of the alcohol source may lead to diagnostic wanderings. AHRs are currently available in bottles that facilitate the ingestion of large amounts. Unit-dose packaging or dispensing might decrease the risk of AHRs poisoning.
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Dexmedetomidine is a highly selective alpha(2)-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Dexmedetomidine has been used in critically ill medical, surgical, and pediatric patients, as an adjunct to sedation and/or for treating drug or alcohol withdrawal. Information regarding the dosing and utilization of dexmedetomidine has been derived primarily from studies in critically ill patients in the medical intensive care unit. There has been no study designed specifically to evaluate dexmedetomidine for these therapeutic uses in the neurocritical care population. The primary and secondary objectives were to evaluate the starting dose of dexmedetomidine for neurocritical care patients and to assess the effect on hemodynamic parameters, respectively. ⋯ Neurocritically ill patients may require high doses of dexmedetomidine to achieve desired levels of sedation. The high rates and long duration of dexmedetomidine infusion had a statistically, but not clinically, significant impact on hemodynamic parameters.