Neurocritical care
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Although intracranial pressure (ICP) is essential to guide management of patients suffering from acute brain diseases, this signal is often neglected outside the neurocritical care environment. This is mainly attributed to the intrinsic risks of the available invasive techniques, which have prevented ICP monitoring in many conditions affecting the intracranial homeostasis, from mild traumatic brain injury to liver encephalopathy. In such scenario, methods for non-invasive monitoring of ICP (nICP) could improve clinical management of these conditions. ⋯ This discrepancy could result from inconsistent assessment measures and application in different conditions, from traumatic brain injury to hydrocephalus and stroke. Most of the reports stress a potential advantage of TCD as it provides the possibility to monitor changes of ICP in time. Overall accuracy for TCD-based methods ranges around ±12 mmHg, with a great potential of tracing dynamical changes of ICP in time, particularly those of vasogenic nature.
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External ventricular drains (EVD) are widely used to manage intracranial pressure (ICP) and hydrocephalus for aneurysmal subarachnoid hemorrhage (aSAH) patients. After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe ventricular size and clinical status. This practice may lead to prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation. This study aims to apply a validated morphological clustering analysis of ICP pulse (MOCAIP) algorithm to detect signatures from the pulse waveform to differentiate an intact CSF circulatory system from an abnormal one during EVD weaning. ⋯ Patients with an impaired CSF system showed a larger mean and variability of inter-pulse distances, indicating frequent changes on the morphology of pulses. This technique may provide a method to rapidly determine if patients will need placement of a shunt or can simply have the EVD removed.
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Existing studies of quantitative electroencephalography (qEEG) as a prognostic tool after cardiac arrest (CA) use methods that ignore the longitudinal pattern of qEEG data, resulting in significant information loss and precluding analysis of clinically important temporal trends. We tested the utility of group-based trajectory modeling (GBTM) for qEEG classification, focusing on the specific example of suppression ratio (SR). ⋯ Longitudinal analysis of continuous qEEG data using GBTM provides more predictive information than analysis of qEEG at single time-points after CA.
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Observational Study
Safety and Efficacy of Warfarin Reversal with Four-Factor Prothrombin Complex Concentrate for Subtherapeutic INR in Intracerebral Hemorrhage.
The use of vitamin K antagonists is an independent risk factor for the development of intracerebral hemorrhage (ICH). Four-factor prothrombin complex concentrate (4F-PCC) is recommended for urgent reversal of anticoagulation in this setting. The safety and efficacy of 4F-PCC in ICH with subtherapeutic levels of anticoagulation is yet to be determined. ⋯ The use of 4F-PCC in patients with INR between 1.4 and 1.9 results in an effective reduction in INR with similar thrombotic risks compared to patients presenting with an INR of 2-3.9.
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Observational Study
Intracranial Pressure Changes During Intrahospital Transports of Neurocritically Ill Patients.
Intrahospital transport is associated with a high rate of complications. Investigations of this problem using neuromonitoring remain scarce. ⋯ There is a considerable rate of complications during intrahospital transport of critically ill patients with severe brain diseases, with a significant increase of ICP during transport and CT scan. In one-fifth of all patients, additional therapy was necessary. From our point of view, transport of critically ill patients should only be performed by trained staff and under monitoring of ICP and CPP.