Neurocritical care
-
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. ⋯ We review the pre-hospital management of a patient with an acute SCI, including triage, immobilization, and transportation. Upon arrival to the definitive treatment facility, we review initial evaluation and management steps, including initial neurological assessment, radiographic assessment, cervical collar clearance protocols, and closed reduction of cervical fracture/dislocation injuries. Finally, we review ICU issues including airway, hemodynamic, and pharmacological management, as well as future directions of care.
-
Studies suggested that the neutrophil-to-lymphocyte ratio (NLR) was associated with unfavorable outcomes in different diseases such as intracerebral hemorrhage, cardiovascular problem, cancer, and severe traumatic brain injury (sTBI). We aimed to evaluate the relationship between peak NLR and 1-year outcomes in patients with sTBI. ⋯ Peak NLR was associated with the clinical prognosis after sTBI and was a promising predictor for 1-year outcomes.
-
Intracranial pressure (ICP) monitoring is fundamental for neurocritical care patient management. For many years, ventricular and parenchymal devices have been available for this aim. The purpose of this paper is to review the published literature comparing ICP recordings via an intraventricular catheter or an intraparenchymal (brain tissue) catheter. ⋯ We propose two new terms that more accurately identify the anatomical site of recording for the referenced ICP: intracranial pressure ventricular (ICP-v) and intracranial pressure brain tissue (ICP-bt). Further delineation of the conventional term "ICP" into these two new terms will clarify the difference between ICP-v and ICP-bt and their respective measurement locations.
-
Observational Study
Re-evaluating the Weekend Effect on SAH: A Nationwide Analysis of the Association Between Mortality and Weekend Admission.
Multiple studies have shown worse outcomes in patients admitted for medical and surgical conditions on the weekend. However, past literature analyzing this "weekend effect" on subarachnoid hemorrhage (SAH) found no significant increase in mortality. This study utilizes more recent data to re-evaluate the association between weekend admission and mortality of patients hospitalized for SAH. ⋯ Based on our findings, the likelihood of the in-hospital mortality was higher for patients admitted over the weekend. However, the characteristics of the study, primarily observational, prevent us arriving at an accurate conclusion about why this occurs; hence, we believe it is an important starting point to consider for future research.
-
Observational Study
Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage.
Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. ⋯ HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.