Neurocritical care
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Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage.
Anemia is frequently encountered in critically ill patients and adversely affects cerebral oxygen delivery and brain tissue oxygen (PbtO2). The objective of this study is to assess whether there is an association between anemia and metabolic distress or brain tissue hypoxia in patients with subarachnoid hemorrhage. ⋯ Anemia is associated with a progressively increased risk of cerebral metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage.
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Post-opioid toxic encephalopathy is described associated with the synthetic opioid, methadone, and after heroin intoxication, (inhaled, injected or ingested). ⋯ To our knowledge, this is the first report of this condition associated with oxycodone and oxycontin ingestion. The occurrence of this rare toxic encephalopathy may be related to distribution patterns of opioid receptor subtypes, genetic susceptibility, sensitization, and other specific comorbidities.
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Hypertonic saline is routinely used to treat rises in intracranial pressure (ICP) post-traumatic head injury. Repeated doses often cause a hyperchloremic metabolic acidosis. We investigated the efficacy of 8.4% sodium bicarbonate as an alternative method of lowering ICP without generating a metabolic acidosis. ⋯ A single dose of 8.4% sodium bicarbonate is effective at treating rises in ICP for at least 6 h. Serum sodium was raised but without generation of a hyperchloremic metabolic acidosis.
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Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU. ⋯ Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.
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The objective of our study is to assess the reliability of the distensibility of the inferior vena cava (dIVC), as measured by ultrasound, as an indicator of fluid responsiveness in patients with subarachnoid hemorrhage. ⋯ dIVC proved to be a reliable predictor of fluid responsiveness in ICU patients with subarachnoid hemorrhage.