Neurocritical care
-
Osmotherapy has been the cornerstone in the management of patients with elevated intracranial pressure (ICP) following traumatic brain injury (TBI). Several studies have demonstrated that hypertonic saline (HTS) is a safe and effective osmotherapy agent. This study evaluated the effectiveness of HTS in reducing intracranial hypertension in the presence of a wide range of serum and cerebrospinal fluid (CSF) osmolalities. ⋯ This study demonstrates that 23.4% HTS bolus is effective for the reduction of elevated ICP in patients with severe TBI even in the presence of high serum and CSF osmolalities.
-
Intracerebral hemorrhage (ICH) expansion is common during the first 24 h after onset, but the pattern and pace of hyperacute hemorrhage growth have not been described because serial imaging is typically performed over the course of hours and days, not minutes. The purpose of this study is to elucidate the spatial and temporal characteristics of hyperacute hemorrhage expansion within minutes of ICH onset. ⋯ We provide evidence for asymmetric, non-uniform expansion of a hyperacute hemorrhage. These serial imaging observations suggest that hemorrhage expansion may be caused by local cascades of secondary vessel rupture as opposed to ongoing bleeding from a single ruptured vessel.
-
We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage. ⋯ Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.
-
The objective is to determine whether maximal inspiratory pressure (P(imax)) measurement is more sensitive than vital capacity (VC) measurement to detect acute respiratory muscle failure considering a theoretical curvilinear relationship between volume and pressure. ⋯ Because the regression between VC and P(imax) was linear rather than curvilinear, P(imax) was not more sensitive than VC for early detection of respiratory muscle failure in patients hospitalized in ICU for GBS and MG exacerbation. Therefore, VC remains well suited to assess acute respiratory muscle failure and P(imax) gives poor additional information.
-
The presence of an intracranial aneurysm is listed as an exclusion criterion for the administration of recombinant tissue-plasminogen activator (rt-PA). This study was designed to test the hypothesis that the administration of rt-PA is safe in patients who have an unruptured intracranial aneurysm. ⋯ Incidental intracranial aneurysms are common in patients who were present with acute ischemic stroke and not associated with sICH in our population. The concern that these patients are at increased risk of hemorrhage after thrombolysis may not be warranted.