Neurocritical care
-
Hypertonic saline is routinely used to treat rises in intracranial pressure (ICP) post-traumatic head injury. Repeated doses often cause a hyperchloremic metabolic acidosis. We investigated the efficacy of 8.4% sodium bicarbonate as an alternative method of lowering ICP without generating a metabolic acidosis. ⋯ A single dose of 8.4% sodium bicarbonate is effective at treating rises in ICP for at least 6 h. Serum sodium was raised but without generation of a hyperchloremic metabolic acidosis.
-
Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU. ⋯ Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.
-
The objective of our study is to assess the reliability of the distensibility of the inferior vena cava (dIVC), as measured by ultrasound, as an indicator of fluid responsiveness in patients with subarachnoid hemorrhage. ⋯ dIVC proved to be a reliable predictor of fluid responsiveness in ICU patients with subarachnoid hemorrhage.
-
Guillain-Barre syndrome (GBS) is a well known entity that has many infectious agents reported as antecedent events. The spectrum of GBS includes acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), and some other variants like Miller-Fisher syndrome (MFS). ⋯ We report a case of AMAN variant of GBS associated with proven H1N1 influenza A infection. This virus has not been reported previously as the agent of antecedent infection that induced this disorder. Risk factors for other causes of ICU neuromuscular weakness are usually present in the ICU patients and should not be the reason for reluctance in active quest for GBS. Once the diagnosis of GBS is established or suspected the treatment with plasma exchange or intravenous immune globulin is indicated.
-
Refractory intracranial hypertension (RIH) frequently complicates severe traumatic brain injury (TBI) and is associated with worse outcomes. Aggressive fluid resuscitation contributes to the development of peripheral and pulmonary edema, but an effect on cerebral edema is not well established. Some clinicians, including advocates of the "Lund Concept", practice fluid restriction as a means of limiting cerebral edema and reducing intracranial pressure (ICP). ⋯ We found no association between cumulative fluid balance and the development of RIH. However, more judicious volume management has the potential to reduce the occurrence of pulmonary complications. Further research is needed to clarify optimal approaches to fluid management among patients with severe TBI and to guide the interpretation and integration of information derived from P(bt)O(2) monitors.