Neurocritical care
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Adequate caloric intake is associated with improved outcome in neurocritical illness, but factors influencing the provision of enteral nutrition (EN) have not been systematically evaluated. The primary goal of the study was to determine the EN intake of neurosurgical intensive care unit (ICU) patients within the first week of illness and investigate the factors contributing to achieving caloric goals. ⋯ System-based clinical care factors appear to have great impact on the successful provision of EN in the first week of neurocritical illness.
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To describe the reasons for and methods of resolution of ethics consultations conducted in neurological and neurointensive care units affiliated with a single health care facility. ⋯ Although there may be a role for ethics consultations in neurological practice, future studies are needed to better clarify how to optimize their use.
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To investigate the impact of statins on perihematomal edema following spontaneous supratentorial intracerebral hemorrhage (ICH). ⋯ We report the association between statin use prior to ICH and decreased absolute and relative perihematomal edema. A prospective study analyzing the role of statins in perihematomal edema reduction and the resultant effect on mortality and functional outcomes following ICH is warranted.
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Release of cardiac biomarkers is reported in patients with subarachnoid hemorrhage (SAH). Data addressing the impact of cardiac injury on outcome in these patients is sparse. This study was conducted to ascertain the association of elevation of serum cardiac Troponin-I (cTnI) with mortality and neurological outcome in patients with SAH. ⋯ Patients with subarachnoid hemorrhage and elevated cTnI are found to have worse neurological status at admission. These patients have a worse neurological outcome and in-hospital mortality.
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Comparative Study
One-minute dynamic cerebral autoregulation in severe head injury patients and its comparison with static autoregulation. A transcranial Doppler study.
To compare dynamic and static responses of cerebral blood flow to sudden or slow changes in arterial pressure in severe traumatic brain injury (TBI) patients. ⋯ A sharp dynamic vasodilator response could not be sustained, and a slow or absent reaction to a sudden hypotensive challenge could show an acceptable cerebral autoregulation in the steady state. We found that patients with impaired static cerebral autoregulation had a poor outcome, whereas those with preserved static cerebral autoregulation experience favorable outcomes.