Neurocritical care
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Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheric infarction undergoing decompressive hemicraniectomy. ⋯ The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group.
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In patients with traumatic brain injury (TBI), multicenter randomized controlled trials have assessed decompressive craniectomy (DC) exclusively as treatment for refractory elevation of intracranial pressure (ICP). DC reliably lowers ICP but does not necessarily improve outcomes. However, some patients undergo DC as treatment for impending or established transtentorial herniation, irrespective of ICP. ⋯ DC is most often performed for clinical and radiographic evidence of herniation, rather than for refractory ICP elevation. Results of previously completed randomized trials do not directly apply to a large proportion of patients undergoing DC in practice.
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The incidence of cerebral infarction and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH) is reduced by oral nimodipine but acute effects of the drug may include a significant decrease in mean arterial blood pressure (MAP). A dose reduction or discontinuation of the drug is recommended if recurrent MAP drops occur. The aim of our study was to evaluate the frequency and clinical significance of nimodipine dose modifications in patients suffering from aSAH. ⋯ Our results show that dose reduction or discontinuation of nimodipine due to changes in MAP occur frequently in clinical routine and may be associated with unfavorable clinical outcome.
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Heart Rate Variability Predicts Neurogenic Pulmonary Edema in Patients with Subarachnoid Hemorrhage.
An alternation of sympathetic and vagal nervous activity has been suggested to be one possible mechanism of neurogenic pulmonary edema (NPE) in patients with subarachnoid hemorrhage (SAH). The study aimed to explore if sympathovagal modulation assessed by frequency domains of heart rate variability (HRV) is associated with impending NPE in patients with SAH. ⋯ Loss of cardiac variability and depressed sympathovagal modulation, represented by TP and LF %, may predict the development of NPE in the early stage in patients with SAH.
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Patients with severe stroke who require mechanical ventilation and neurointensive care unit (NICU) management often require a tracheostomy (TT). The optimal time point for TT remains unclear and a controversy in everyday NICU life. Here, we prospectively evaluated a score for prediction of TT need in NICU patients with cerebrovascular disease. ⋯ Based on this monocentric study, the SETscore seems to be a valid tool to indicate prolonged NICU-LOS and VT, as well as TT need in cerebrovascular NICU patients. Confirmation of these results in larger cohorts with various settings may help to develop the SETscore as a decisive tool on primary TT early in time to avoid extubation failure.