Current opinion in critical care
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Curr Opin Crit Care · Apr 2020
ReviewMolecular biomarkers in the neurological ICU: is there a role?
The aim of the article is to summarize recent advances in the field of molecular biomarkers in neurocritical care. ⋯ Although not yet ready for adoption into routine clinical practice, several molecular biomarkers are on the cusp of clinical validation. The availability of such tests likely will revolutionize the practice of neurocritical care.
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Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH. ⋯ MIS is an appealing treatment modality for supratentorial ICH and with careful patient selection and technologic advances has the potential to improve neurologic outcomes and reduce mortality. Early and extensive hematoma evacuation are important therapeutic targets and current studies are underway that have the potential to change the management for ICH patients.
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Curr Opin Crit Care · Apr 2020
ReviewAnticoagulation reversal for intracranial hemorrhage in the era of the direct oral anticoagulants.
This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility. ⋯ Numerous options for reversal of DOAC-associated ICH are currently available. Recent clinical trials have demonstrated drug-specific reversal agents are effective in this setting, but additional research is needed to determine whether these agents should be routinely preferred over nonspecific reversal agents.
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Curr Opin Crit Care · Apr 2020
ReviewBrain death: optimizing support of the traumatic brain injury patient awaiting organ procurement.
Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply-demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs. ⋯ New studies have questioned previous considerations of donor eligibility, demonstrating the ability to use donated organs from a wider pool of possible donors, with less exclusion for associated injury or comorbid conditions. There are identifiable benefits from improved donor resuscitation and bundled treatment approaches, provoking systematic assessments of effect and new clinical trials in previously overlooked areas of clinical intervention.
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Curr Opin Crit Care · Apr 2020
ReviewQuality improvement in neurocritical care: current state and looking to the future.
Neurocritical care has matured as a field and there is now a growing body of literature on the subject of quality improvement in neurocritically ill patients. This review will highlight major recent contributions in this field and discuss future directions. ⋯ The quality improvement movement is gaining momentum in neurocritical care with evaluation of general medical and surgical critical care quality improvement approaches in this specific patient population. Future work should focus on improving systems of neurocritical care delivery through iterative evaluation of structure, staffing, minimizing unnecessary variation, and evaluation of neurocritical care-specific metrics.