Neurocritical care
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Despite intensive research, neurological morbidity from delayed cerebral ischemia remains common after aneurysmal subarachnoid hemorrhage (SAH). In the current study, we evaluate the neuroprotective effects of a pH-dependent GluN2B subunit-selective NMDA receptor antagonist in a murine model of SAH. ⋯ These data demonstrate that use of a pH-dependent NMDA antagonist has the potential to work selectively in areas of ischemia known to undergo acidic pH shifts, and thus may be associated with selective regional efficacy and fewer behavioral side effects than non-selective NMDA antagonists.
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Comparative Study
Intermittent Versus Continuous Cerebrospinal Fluid Drainage Management in Adult Severe Traumatic Brain Injury: Assessment of Intracranial Pressure Burden.
There is clinical equipoise regarding whether neurointensive care unit management of external ventricular drains (EVD) in severe traumatic brain injury (TBI) should involve an open EVD, with continuous drainage of cerebrospinal fluid (CSF), versus a closed EVD, with intermittent opening as necessary to drain CSF. In a matched cohort design, we assessed the relative impact of continuous versus intermittent CSF drainage on intracranial pressure in the management of adult severe TBI. ⋯ Continuous CSF drainage via an open EVD seemed to be associated with more effective ICP control in the management of adult severe TBI.
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The use of intracranial pressure (ICP) monitors is nearly synonymous with Neurocritical Care. Recent studies in nursing literature have report high levels of practice variance associated with ICP monitoring and treatment. There are no recent practice surveys to describe how critical care physicians and nurses who are familiar with ICP management provide care to their patients. ⋯ The results highlight the need to develop standardized approaches to measuring, monitoring, recording, and treating ICP.
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Neurocritical care relies on the continuous, real-time measurement of numerous physiologic parameters. While our capability to obtain such measurements from patients has grown markedly with multimodal monitoring in many neurologic or neurosurgical intensive care units (ICUs), our ability to transform the raw data into actionable information is limited. One reason is that the proprietary nature of medical devices and software often prevents neuro-ICUs from capturing and centrally storing high-density data. ⋯ Although many different approaches to informatics are discussed and considered, here we focus on the Bayesian probabilistic paradigm. It quantifies the uncertainty inherent in neurocritical care instead of ignoring it, and formalizes the natural clinical thought process of updating prior beliefs using incoming patient data. We review this and other opportunities, as well as challenges, for the development and refinement of informatics tools in neurocritical care.
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Continuous EEG recordings (cEEGs) are increasingly used in evaluation of acutely ill adults. Pre-screening using compressed data formats, such as compressed spectral array (CSA), may accelerate EEG review. We tested whether screening with CSA can enable detection of seizures and other relevant patterns. ⋯ CSA-guided review can support sensitive screening of critical pathological information in cEEG recordings. However, some patients with seizures may not be identified.