Neurocritical care
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Hemodynamic augmentation by increasing cardiac output with dobutamine (DOB) is believed to be a useful method of elevating decreased cerebral blood flow in the territory affected by vasospasm following aneurysmal subarachnoid hemorrhage (SAH). We described the clinical utility of uncalibrated radial artery-based pulse contour cardiac output (APCO) and near-infrared spectroscopy regional cerebral oxygen saturation (rSO(2)) monitoring for reversing vasospasm symptoms with DOB-induced hyperdynamic therapy. ⋯ Our clinical experience indicates that integrative monitoring with APCO and rSO(2) may provide continuous, real-time, and clinically relevant information on the effectiveness of medical treatment of distal vessel vasospasm.
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Myocardial injury after aneurysmal subarachnoid hemorrhage (aSAH) is associated with poor outcomes. Delayed cerebral ischemia (DCI) is also a complication of aSAH. We sought to determine whether (1) DCI could be predicted by demographics, aSAH severity/aneurysm location, or aSAH-associated myocardial injury (SAHMI), and (2) DCI is associated with increased mortality after aSAH. ⋯ Elevated CO and Fisher grade are predictors of DCI after aSAH. However, prevention of DCI may not decrease mortality.
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Decompressive surgery for malignant middle cerebral artery infarction increases the number of surviving patients; this, however, leaves some patients severely disabled. This study analyzed the patients' retrospective consent to hemicraniectomy in light of the experienced functional outcome 12 months after hospital stay. ⋯ Retrospective consent to hemicraniectomy for treatment of malignant MCA infarction depends on functional long-term outcome. We need to identify those patients who would survive the malignant MCA infarction due to decompressive surgery but only reach a severely reduced functional status.
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Studies devoted to intensive glucose control suggested that the intensive insulin therapy (IIT) approach could effectively reduce complications associated with critical illness. A program of IIT with the goal of achieving a blood glucose of 80-120 mg/dL was, therefore, adopted in this study. To explore the impact of this approach in patients admitted to a neurocritical care unit, we compared the short-term outcomes of patients treated before and after our policy change. ⋯ IIT was not only able to reduce overall mean glucose levels, but also resulted in significantly more episodes of hypoglycemia, increased mortality, and increased length of stay. The relationship between hypoglycemia and mortality indicates that efforts to control glucose levels should also aggressively avoid induction of hypoglycemia.
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Prolonged heart rate-corrected QT (QTc) interval is frequently observed in subarachnoid hemorrhage (SAH). This study was conducted to determine the relationship between QTc interval and neurological outcome during the acute posthemorrhagic period after aneurysmal SAH. ⋯ This study confirms that QTc interval prolongation continues in the SAH patients with an unfavorable outcome but that QTc interval prolongation improves in patients with a good outcome, suggesting that a QTc interval of more than 448 ms at 7 days after operation is a predictor of neurological outcome after SAH.