Neurocritical care
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Observational Study
Bivalirudin as a bridge for anticoagulation in high risk neurosurgical patients with active DVT or high risk of thrombosis.
Bivalirudin is an ultrashort acting direct thrombin inhibitor, which has been used in place of heparin in selected settings. We describe our preliminary experience with the use of bivalirudin in patients who required anticoagulation for a deep vein thrombosis, prosthetic heart valve, or hypercoagulable state but were felt to be at high risk for the use of heparin. ⋯ Based on these findings, bivalirudin may represent a reasonable alternative in patients for whom heparin anticoagulation is contraindicated. A larger multicenter trial of bivalirudin in this setting may be appropriate.
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Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the bedside relevant information on the state of aeration and ventilation of the lung. ⋯ Lung ultrasound at the bedside can provide accurate information on lung status in neurocritically ill patients with acute respiratory failure. The addition of transthoracic echocardiography to lung sonography provides an additive insight on the eventual pulmonary involvement. Lung ultrasound has the potential to become a reference tool for bedside dynamic respiratory monitoring in the Neuro ICU.
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Observational Study
First clinical experience with intranasal cooling for hyperthermia in brain-injured patients.
Hyperthermia is common in brain-injured patients and associated with a worse outcome. As brain rather than body temperature reduction, theoretically, is the most important in cerebral protection, there is logic in targeting cooling at the brain. Selective brain cooling can, in theory, be obtained by cooling the skull or by heat loss from the upper airways. In this preliminary safety and efficacy study, we report clinical data from brain-injured patients who because of hyperthermia were treated with intranasal cooling. ⋯ In brain-injured patients with hyperthermia, cooling with a prototype intranasal balloon system was clinically inadequate as the effect was delayed and not brain selective.
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As part of the development of the Neurocritical Care Society (NCS) Status Epilepticus (SE) Guidelines, the NCS SE Writing Committee conducted an international survey of SE experts. ⋯ There is close agreement between the recently published NCS guideline for SE and this survey of experts in the treatment of SE.