Neurocritical care
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Randomized Controlled Trial
A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients.
To assess whether monitoring sedation status using bispectral index (BIS) as an adjunct to clinical evaluation was associated with a reduction in the total amount of sedative drug used in a 12 h period. ⋯ BIS-augmented sedation monitoring resulted in a marked reduction in the total dose of sedative used to achieve the same level of clinical sedation resulting in shortened time to wake up without any measurable adverse effects. Physiologic sedation assessment tools may provide a useful means of improving the care of sedated critically ill patients.
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Controlled Clinical Trial
Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults.
To study the correlation between a dynamic index of cerebral autoregulation assessed with blood flow velocity (FV) using transcranial Doppler, and a tissue oxygenation index (TOI) recorded with near-infrared spectroscopy (NIRS). ⋯ NIRS shows promise for the continuous assessment of cerebral autoregulation in adults.
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Ancillary testing is frequently required in the determination of death by brain criteria, particularly in cases in which the clinical examination is drawn into question. Newer tests, such as computed tomographic angiography (CTA), have garnered enthusiasm for their ease of performance, but have not been validated as acceptable tests compared with a gold standard. ⋯ CTA should be studied further in comparison to validated tests, such as conventional angiography or single photon emission computed tomography (SPECT), before being accepted as a standard ancillary test in determining death by brain criteria.
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Comparative Study Clinical Trial
Alpha-stat versus pH-stat guided ventilation in patients with large ischemic stroke treated by hypothermia.
Moderate hypothermia (MH) is a therapeutic approach for ischemic stroke as well as cardiac arrest. Two different technical strategies of ventilation during MH called alpha- and pH-stat dramatically influence cerebral blood flow (CBF). In turn this might influence neuronal damage and intracranial pressure (ICP). Therefore, effects of ventilation on CBF and ICP were measured in patients undergoing MH because of large ischemic stroke to address optimal ventilation management. ⋯ pH-stat implies a better CBF to the injured brain, while it might be dangerous by elevating ICP in more subacute stages.
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Clinical Trial
Inpatient hyperglycemia following aneurysmal subarachnoid hemorrhage: relation to cerebral metabolism and outcome.
Despite its clear association with impaired prognosis, it remains controversial whether hyperglycemia after aneurysmal subarachnoid hemorrhage (SAH) actively contributes to neuronal damage. This study aimed to identify a threshold for blood glucose predicting unfavorable outcome, and to evaluate differences in cerebral metabolism in normo and hyperglycemic SAH patients. ⋯ Blood glucose levels >7.8 mmol/l (140 mg/dl), but not levels >6.1 mmol/l (110 mg/dl), independently predicted unfavorable outcome. While blood glucose levels >6.1 mmol/l (110 mg/dl) were already associated with slight metabolic derangements, cerebral glucose increased only at blood levels >7.8 mmol/l (140 mg/dl). Considering the risks associated with tight glycemic control, a moderate regimen accepting blood glucose levels up to 7.8 mmol/l (140 mg/dl) might be more reasonable after SAH.