Neurocritical care
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Critical closing pressure (CCP) denotes a threshold of arterial blood pressure (ABP) below which brain vessels collapse and cerebral blood flow ceases. Theoretically, CCP is the sum of intracranial pressure (ICP) and arterial wall tension (WT). The aim of this study is to describe the behavior of CCP and WT during spontaneous increases of ICP, termed plateau waves, in order to quantify ischemic risk. ⋯ Rising CCP during plateau waves increases the probability of cerebral vascular collapse and zero flow when the difference: ABP-CCP (the "collapsing margin") becomes zero or negative.
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Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes are poorly understood. ⋯ ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high risk patients. Survival associations of time-dependent complications warrant cautious interpretation.
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Cardiac dysfunction is a well-known complication of subarachnoid hemorrhage (SAH). Our objective was to determine the frequency of troponin abnormalities in SAH and determine its impact on in-hospital mortality. ⋯ Troponin I elevation after SAH is not an independent predictor of in-hospital mortality.
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Observational Study
Intra-hospital transport of brain-injured patients: a prospective, observational study.
Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients. ⋯ Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO2 (ET(CO(2)))] during transport is recommended.
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Observational Study
The effect of a neurocritical care service without a dedicated neuro-ICU on quality of care in intracerebral hemorrhage.
Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. ⋯ Introduction of a neurocritical service without a neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH.