Neurocritical care
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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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We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage. ⋯ Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.
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Cerebral autoregulation assessed using transcranial Doppler (TCD) mean flow velocity (FV) in response to various physiological challenges is predictive of outcome after traumatic brain injury (TBI). Systolic and diastolic FV have been explored in other diseases. This study aims to evaluate the systolic, mean and diastolic FV for monitoring autoregulation and predicting outcome after TBI. ⋯ Systolic flow indices (Sx and Sxa) demonstrated a stronger association with outcome than the mean flow indices (Mx and Mxa), irrespective of whether CPP or ABP was used for calculation.
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We investigated in a porcine model of anhepatic acute liver failure (ALF), the value of two parameters describing cerebrovascular autoregulatory capacity, pressure reactivity index (PRx) and brain tissue oxygen pressure reactivity (ORx), regarding their power to predict the development of intracranial hypertension. ⋯ The loss of cerebrovascular autoregulatory capacity, indicated by a rise of PRx and ORx precedes the final crisis of uncontrollable intracranial hypertension in this animal model by hours. During this phase cerebral blood flow, as reflected in tissue oxygenation, deteriorates despite unchanged CPP. Monitoring of AR during ALF therefore seems to carry the power to identify a risk for development of critical CBF and intracranial hypertension.
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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.