Neurocritical care
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Electroencephalography in the setting of hypothermia and anoxia has been studied in humans since the 1950s. Specific patterns after cardiac arrest have been associated with prognosis since the 1960s, with several prognostic rating scales developed in the second half of the twentieth century. In 2002, two pivotal clinical trials were published, demonstrating improved neurologic outcomes in patients treated with therapeutic hypothermia (TH) after cardiac arrest of shockable rhythms. ⋯ During the same time period, the use of continuous EEG monitoring in critically ill patients increased, which led to the recognition of subclinical seizures occurring in patients after cardiac arrest. As a result of these changes, greater amounts of EEG data are being collected, and the significance of specific patterns is being re-explored. We review the current role of EEG for the identification of seizures and the estimation of prognosis after cardiac resuscitation.
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This study was designed to identify factors related to delays in pre-hospital management of status epilepticus (SE). ⋯ We found remarkable inadequacy in recognition of SE both among laity and medical professionals. There is an obvious need for increasing awareness of imminent SE and optimizing the pre-hospital management of established SE. SE should be considered as a medical emergency comparable with stroke and cardiac infarction and be allocated with similar resources in the pre-hospital management.
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Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality. Clinicians and family members are often faced with a paucity of high quality clinical data as they attempt to determine the most appropriate course of treatment for patients with LHI, and current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients. ⋯ The panel devised a series of clinical questions related to LHI, and assessed the quality of data related to these questions using the Grading of Recommendation Assessment, Development and Evaluation guideline system. They then developed recommendations (denoted as strong or weak) based on the quality of the evidence, as well as the balance of benefits and harms of the studied interventions, the values and preferences of patients, and resource considerations.
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Reintubation among neurosurgical patients is poorly characterized. The aim of this study was to delineate the rate of reintubation among neurosurgical patients. In addition, we seek to characterize the patient demographic features, comorbidities, and surgical characteristics that may be associated with reintubation among neurosurgical patients. ⋯ Reintubation after neurosurgery is associated with older patients with a greater number of comorbidities. In particular, renal, pulmonary, and severe neurologic comorbidities; longer operative duration; and cranial, rather than spinal, pathology were associated with increased risk for reintubation. These findings may be helpful in triage decisions regarding postoperative intensity of care and monitoring.
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The presence of coagulopathy is common after severe trauma. The aim of this study was to identify whether isolated severe traumatic brain injury (TBI) is an independent risk factor for coagulopathy. ⋯ Isolated severe TBI is not an independent risk factor for the development of coagulopathy. However, severe TBI patients who develop coagulopathy have extremely high mortality rates.