Neurocritical care
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Osmotherapy has been the cornerstone in the management of patients with elevated intracranial pressure (ICP) following traumatic brain injury (TBI). Several studies have demonstrated that hypertonic saline (HTS) is a safe and effective osmotherapy agent. This study evaluated the effectiveness of HTS in reducing intracranial hypertension in the presence of a wide range of serum and cerebrospinal fluid (CSF) osmolalities. ⋯ This study demonstrates that 23.4% HTS bolus is effective for the reduction of elevated ICP in patients with severe TBI even in the presence of high serum and CSF osmolalities.
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Neurologic emergencies are common, frequently devastating, and benefit from timely diagnosis and treatment. Point of care (POC) technologies have the potential to assist clinicians caring for these patients. In order to prioritize development of new POC testing, a thorough assessment of clinical needs is required. We describe the methods of the clinical needs assessment (CNA) process and provide the initial findings of a CNA for POC technologies in neurologic emergencies performed to support a National Institute of Biomedical Imaging and Bioengineering (NIBIB) initiative. ⋯ Assessing clinical needs is a necessary first step in developing new technologies. A multi-faceted approach assures that the views of interested stakeholders are represented and can influence success.
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Randomized Controlled Trial Comparative Study
Dobutamine-induced high cardiac index did not prevent vasospasm in subarachnoid hemorrhage patients: a randomized controlled pilot study.
Prevention of vasospasm is a challenging issue in subarachnoid hemorrhage (SAH) patients and the objective is to compare high dobutamine-induced cardiac index (CI) and high norepinephrine-induced hypertension for the prevention of vasospasm in SAH patients. ⋯ As compared to norepinephrine-induced hypertension, dobutamine-induced high CI did not reduce the rate of vasospasm in SAH patients. Dobutamine may reduce durations of mechanical ventilation and ICU LOS.
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Airway pressure release ventilation (APRV) is an alternative approach to the low-tidal volume "open-lung" ventilation strategy. APRV is associated with a higher mean airway pressure than conventional ventilation and has therefore not been evaluated in patients with acute neurological injuries. ⋯ APRV may safely be applied to neurocritically ill patients, and that this mode of ventilation may increase cerebral blood flow without increasing intracranial pressure.
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Plantar flexion with plantar stimulation has been well described in brain death, and is compatible with brain death. However, plantar flexion with stimulation to the dorsal surface of the foot has not been reported previously in brain dead patients. ⋯ Noxious stimulation to the dorsal surface of the foot may trigger spinally mediated plantar flexion in patients with brain death.