Neurocritical care
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Our objective was to characterize the impact of common initial sedation practices on invasive mechanical ventilation (IMV) duration and in-hospital outcomes in patients with acute brain injury (ABI) and to elucidate variations in practices between high-income and middle-income countries. ⋯ In an international registry of patients with ABI requiring IMV, IMV duration did not differ significantly relative to initial sedation strategy. However, patients started on midazolam had longer ICU stay.
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Neuroleptic malignant syndrome (NMS) is a psychiatric-neurologic emergency that may require intensive care management. There is a paucity of information about NMS as a critical illness. We reviewed the Mayo Clinic experience. ⋯ Neuroleptic malignant syndrome can become a critical illness, but there is often rapid recovery. Mortality proximate to NMS was uncommon, but late mortality remained substantial. The overwhelming majority of cases coded as NMS did not meet DSM-5 diagnostic criteria. Stricter criteria should be applied when diagnosing NMS in critical care and emergency medicine settings.
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Traumatic brain injury (TBI) is a major cause of health loss and disabilities globally, burdening health care systems. Mild TBI is a common cause of emergency department visits. Computed tomography (CT) scans are the mainstay for acute TBI imaging. ⋯ These findings indicate that S100B analysis could minimize the need for unnecessary CT scans in individuals with mild TBI. The test's diagnostic accuracy improves when the S100B analysis is done within 3 h of the injury. However, further research is warranted to validate its superiority to other biomarkers before considering it the standard routine for managing mild TBI.
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Neurovascular coupling (NVC) refers to the process of aligning cerebral blood flow with neuronal metabolic demand. This study explores the potential of contralateral NVC-linking neural electrical activity on the stroke side with cerebral blood flow velocity (CBFV) on the contralesional side-as a marker of physiological function of the brain. Our aim was to examine the association between contralateral NVC and neurological outcomes in patients with ischemic stroke following endovascular thrombectomy. ⋯ A better contralateral coupling between stroke-side EEG and contralesional CBFV is associated with favorable neurological outcomes, suggesting that contralateral NVC analysis may aid in assessing brain function after recanalization. Replication with a deeper understanding of the mechanisms is needed before clinical translation.
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Paroxysmal sympathetic hyperactivity (PSH) occurs with high prevalence among critically ill patients with traumatic brain injury (TBI) and is associated with worse outcomes. The PSH-Assessment Measure (PSH-AM) consists of a Clinical Features Scale and a diagnosis likelihood tool (DLT) intended to quantify the severity of sympathetically mediated symptoms and the likelihood that they are due to PSH, respectively, on a daily basis. Here, we aim to identify and explore the value of dynamic trends in the evolution of sympathetic hyperactivity following acute TBI using elements of the PSH-AM. ⋯ This study adds to the sparse research characterizing the heterogeneous temporal trends of sympathetic nervous system activation during the acute phase following TBI. This may open avenues for early identification of at-risk patients to receive tailored interventions to limit secondary brain injury associated with autonomic dysfunction and thereby improve outcomes in patients with TBI.