Neurocritical care
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Review Comparative Study
High-frequency oscillation as a rescue strategy for brain-injured adult patients with acute lung injury and acute respiratory distress syndrome.
Acute lung injury and acute respiratory distress syndrome (ARDS) occur frequently in brain-injured patients. Single organ dysfunction ventilator strategies result in a conflict between lung protective ventilation and the prevention of secondary neurological insult(s). The objectives of this study were to determine if clinical and physiological benefits of high-frequency oscillatory ventilation (HFOV) exist compared to conventional ventilation and to determine what data there are on the effects of HFOV on cerebral perfusion pressure and intracranial pressure. ⋯ In the small, low quality, studies that have been reported there have not been uncontrollable changes in intracranial pressure. HFOV has not been shown to have any mortality benefit in adults with ARDS. There are insufficient data to clarify the role, or safety, of HFOV in adults with TBI and concurrent ARDS.
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Terson's syndrome is intraocular hemorrhage (IOH) subsequent to subarachnoid hemorrhage (SAH). Its presence is associated with higher mortality in SAH. We report a case of Terson's syndrome and review the literature. ⋯ Terson's syndrome occurs frequently following SAH, although it is under-reported. Suspected visual loss following SAH should prompt a search for Terson's syndrome by funduscopy, as its presence is an adverse prognostic factor.
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Multicenter Study
Poor correlation between perihematomal MRI hyperintensity and brain swelling after intracerebral hemorrhage.
The perihematomal hyperintensity (PHH) is commonly interpreted to represent cerebral edema following intracerebral hemorrhage (ICH), but the accuracy of this interpretation is unknown. We therefore investigated the relationship between the changes in PHH and the changes in hemispheric brain volume as a measure of edema during the first week after ICH. ⋯ In patients with small-to-moderate-sized hematomas, change in PHH was a poor measure of brain edema in the first week following ICH. A small degree of bihemispheric brain swelling occurred, but was of little clinical significance.
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Cerebral vasospasm is one of the most serious complications after subarachnoid hemorrhage (SAH). The cerebral artery diameter is regulated by complex physiological mechanisms. Among them the regulation of intracellular calcium homeostasis seems to play a crucial role. Recent data suggest that ryanodine receptors (RYRs) are involved in regulating the luminal calcium concentration in vascular smooth muscle cells. In this gene association investigation, we studied the question as to whether variants in the gene for the ryanodine receptors subtype 1 (RYR1) are associated with symptomatic cerebral vasospasm following SAH. ⋯ Our pilot study suggests that RYRs are involved in the complex pathophysiology of vasospasm development following SAH. The potential role of RYR1 as a biomarker for prediction of cerebral vasospasm after SAH has to be confirmed in a larger clinical trial.
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Randomized Controlled Trial Comparative Study
A prospective randomized study to evaluate the antipyretic effect of the combination of acetaminophen and ibuprofen in neurological ICU patients.
To compare the antipyretic effect of simultaneously administered acetaminophen (APAP) plus ibuprofen (IBU) to either APAP or IBU alone in critically ill febrile neurological and neurosurgical patients. ⋯ The combination of IBU and APAP produces significantly greater fever control than APAP alone, with trends favoring the combination over IBU alone and IBU over APAP alone.