Neurocritical care
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Comparative Study
Gender influences cerebral oxygenation after red blood cell transfusion in patients with severe traumatic brain injury.
Important differences with respect to gender exist in the prognosis and mortality of traumatic brain injury (TBI) patients. The objective of this study was to assess the role of gender as an independent factor in cerebral oxygenation variations following red blood cell transfusion (RBCT). ⋯ Our results suggest that the effect of RBCT on cerebral oxygenation, as measured by PbrO(2), is greater in women than in men.
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Clinical Trial
Lower head of the bed position does not change blood flow velocity in subarachnoid hemorrhage.
Transcranial Doppler (TCD) is commonly used to monitor for vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Changes in head of the bed (HOB) positions alter blood flow velocities measured by TCD in patients with ischemic stroke. However, the effects of HOB position on the velocities of the cerebral blood flow have not been studied in aSAH patients. ⋯ HOB position did not significantly affect MFV in our patients with aSAH.
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Traumatic brain injury (TBI) generates regional alterations in cerebral metabolism, leading to the potential evolution of persistent metabolic dysfunction. In the case of penetrating, firearm-related TBI, the pathophysiological mechanisms underlying these acute-phase metabolic derangements are not entirely understood-hindering the potential effectiveness of therapeutic intervention. The use of cerebral microdialysis to monitor biochemical alterations that occur, post-TBI, provides critical insight into the events that perpetuate neurological deterioration. ⋯ Microdialysis studies may significantly improve the understanding of the metabolic alterations that occur in patients who sustain a variety of forms of neurotrauma. Ultimately, monitoring these variations in brain tissue chemistry will improve the insight into the neuropathological mechanisms underlying penetrating traumatic brain injury, and enhance the therapeutic approach of these patients.
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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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Review Case Reports
H1N1 encephalitis with malignant edema and review of neurologic complications from influenza.
Influenza virus infection of the respiratory tract is associated with a range of neurologic complications. The emergence of 2009 pandemic influenza A (H1N1) virus has been linked to neurological complications, including encephalopathy and encephalitis. ⋯ 2009 H1N1-associated acute encephalitis and encephalopathy appear to be variable in severity, including a subset of patients with a malignant clinical course complicated by high morbidity and mortality. Since the H1N1 influenza virus has not been detected in the CSF or brain tissue in patients with this diagnosis, the emerging view is that the host immune response plays a key role in pathogenesis.