Neurocritical care
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Continuous electroencephalography (cEEG) monitoring is becoming increasingly used in neurologic and non-neurologic intensive care units (ICUs). Non-convulsive seizures (NCSz) and periodic discharges (PDs) are commonly seen in critically ill patients. ⋯ IIC patterns are associated with pathophysiologic changes that closely resemble those of seizures. Here we make the argument that, rather than feature description on EEG, associated changes in brain physiology should dictate management choices.
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The Harvard criteria for the definition of irreversible coma or brain death were a product of a multidisciplinary committee chaired by anesthesiologist Beecher. The Harvard criteria included unreceptivity, unresponsiveness, no movements or breathing, no reflexes with further delineation of brainstem reflexes, and a flat electroencephalogram (repeated after 24 h with no change). The apnea test involved disconnection of the ventilator for 3 min. ⋯ The Harvard criteria (and what followed) have been a bane for bioethicists from day one. This historical vignette explains, criticizes, and celebrates this landmark publication for its courage to tackle the topic. The Harvard criteria resulted in more studies and more criteria gradually complicating matters until the American Academy of Neurology in 1995 provided the necessary simplicity.