Neurocritical care
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Multicenter Study
Early Hyperoxia in Patients with Traumatic Brain Injury Admitted to Intensive Care in Australia and New Zealand: A Retrospective Multicenter Cohort Study.
Early hyperoxia may be an independent risk factor for mortality in critically ill traumatic brain injury (TBI) patients, although current data are inconclusive. Accordingly, we conducted a retrospective cohort study to determine the association between systemic oxygenation and in-hospital mortality, in critically ill mechanically ventilated TBI patients. ⋯ In this large multicenter cohort of TBI patients, hyperoxia in the first 24 h after ICU admission was not independently associated with greater in-hospital mortality. Hypoxia remains associated with greater in-hospital mortality risk and should be avoided where possible.
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Review Case Reports
Cerebral Fat Embolism: Recognition, Complications, and Prognosis.
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. ⋯ Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
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The goal of this study was to investigate the association of tracheostomy timing with outcomes after aneurysmal subarachnoid hemorrhage (SAH) in a national population. ⋯ In this analysis of a large, national data set, variation in hospital practices was the strongest predictor of tracheostomy timing for an individual. In patients with moderately poor grade, later tracheostomy was independently associated with pulmonary complications, venous thromboembolism, pneumonia, and a longer hospitalization, but not with mortality, neurological complications, or discharge disposition. However, tracheostomy timing was not significantly associated with outcomes in very poor-grade patients.
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Case Reports
A Callosal Catastrophe: Toxic Leukoencephalopathy Associated with Thermogenic Weight Loss Supplement Use.
The use of weight loss drugs and dietary supplements is common, but safety profiles for these drugs are largely unknown. Reports of toxicity have been published, and the use of these agents should be considered in clinical differential diagnoses. ⋯ The pathophysiology of this patient's hyponatremia and toxic leukoencephalopathy is unknown. However, physicians must be aware of the association between thermogenic dietary supplements and toxic leukoencephalopathy. Vigilance for life-threatening complications including hyponatremia and cerebral edema is critical.
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Adequate identification of the severity of status epilepticus (SE) contributes to individualized treatment. The scales most widely used for this purpose are: Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) and modified Rankin Scale STESS (mRSTESS). The aim of this study was to evaluate the performance of the STESS, EMSE and mRSTESS scales to predict high disability and hospital mortality at discharge (HD/HM). ⋯ All of the evaluated scales (STESS, mRSTESS, and EMSE) were shown to be useful in predicting HD/HM. EMSE was observed to be the most effective of the scales, with relative similarities among the variants.