Neurocritical care
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Multicenter Study
Aggressive red blood cell transfusion: no association with improved outcomes for victims of isolated traumatic brain injury.
Clinical studies have caused blood transfusion practices in critically ill patients to become more conservative in the last decade. However, few studies have focused on trauma patients, particularly those with severe isolated traumatic brain injury. ⋯ Our results suggest that a restrictive transfusion practice is safe for severely head-injured patients.
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Dedicated stroke units are associated with improved patient outcomes after acute ischemic stroke in general. However, it is unknown whether the population of critically ill ischemic stroke patients admitted to the neurocritical care unit (NCCU) benefit from primary management by a specialized neurocritical care team (NCT). This study is intended to investigate such benefit. ⋯ In critically ill acute ischemic stroke patients, institution of a dedicated NCT was associated with a reduction in resource utilization and improved patient outcomes at hospital discharge. Several factors including improved patient care protocols may explain this association.
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Controlled Clinical Trial
Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus.
Catheter-associated infection of cerebrospinal fluid (CSF) is a potentially life-threatening complication of external ventricular drainage (EVD). The purpose of this pilot study was to address the efficacy of silver-impregnated EVD catheters in neurological and neurosurgical patients requiring external CSF drainage due to acute occlusive hydrocephalus. ⋯ This pilot study indicates that EVD catheters impregnated with silver nanoparticles might be a new option for preventing CAV in neurocritical care patients, and therefore evaluation in a large prospective randomized study is warranted.
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The objective of this study is to show the effectiveness of Factor IX complex concentrate (FIXCC) for rapid reversal of an elevated International Normalized Ratio (INR) in patients with anticoagulation-associated intracerebral hemorrhage (AAICH). ⋯ Our data suggests that FIXCC in combination with FFP and Vit.K may result in decreased time required when compared to FFP and Vit.K alone for correction of warfarin associated coagulopathy in neurosurgical emergencies.
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Hypothermic brain protection has been linked to how rapidly cooling is initiated and how quickly and uniformly the therapeutic hypothermic zone (THZ) is reached. The nasopharyngeal (NP) approach is uniquely suited for preferential brain cooling due to anatomic proximity to the cerebral circulation, cavernous sinus, and carotid arteries. This study explores a novel NP cooling approach employing evaporative characteristics of aerosolized perfluorochemical (PFC). ⋯ The NP-PFC procedure more rapidly induced preferential brain cooling as compared to WBC without adverse effects.