Neurocritical care
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Temperature management using endovascular catheters is an established therapy in neurointensive care. Nonetheless, several case series have reported a high rate of thrombosis related to the use of endovascular hypothermia catheters. ⋯ The frequency of thrombosis related to temperature management catheters is extremely high (90 %). Furthermore, ultrasonography has a very low sensibility to detect cava vein thrombosis (16.7 %). The real meaning of our findings is unknown, but other temperature control systems could be a safer option. More studies are needed to confirm our findings.
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Although hydrocephalus is often treated with permanent cerebrospinal fluid (CSF) shunting during hospitalization for acute aneurysmal subarachnoid hemorrhage (SAH), little is known about the development of delayed hydrocephalus. ⋯ Delayed hydrocephalus after SAH occurs rarely overall, but in a substantial proportion of patients who required temporary ventriculostomy during the initial hospitalization. These results support vigilant surveillance of patients after removal of a temporary ventriculostomy, given the potential of delayed hydrocephalus to impair recovery or even result in clinical deterioration following SAH.
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There is conflicting data on the relationship between anemia and outcomes in patients with traumatic brain injuries (TBI). The objective of this study was to determine if the proportion of time and area under the hemoglobin-time curve of ≥90 g/L are independently associated with 6-month functional outcomes. ⋯ In patients with severe TBI, increased area under the curve and percentage of time that the hemoglobin concentration was ≥90 g/L, were associated with improved neurologic outcomes.
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Guidelines recommend cerebral perfusion pressure (CPP) values of 50-70 mmHg and intracranial pressure lower than 20 mmHg for the management of acute traumatic brain injury (TBI). However, adequate individual targets are still poorly addressed, since patients have different perfusion thresholds. Bedside assessment of cerebral autoregulation may help to optimize individual CPP-guided treatment. ⋯ Targeted individual CPP management at the bedside using cerebrovascular pressure reactivity seems feasible. Large deviation from CPPopt seems to be associated with adverse outcome. The COx-CPPopt methodology using non-invasive CO (NIRS) warrants further evaluation.
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Troponin and brain natriuretic peptide (BNP) levels are predictors of mortality following subarachnoid hemorrhage (SAH). Prior studies used strict cutoffs for BNP elevation; however, normal levels of BNP are increased in older persons and women. We explored the association of troponin elevation and BNP elevation adjusted for sex and age with 30-day mortality. ⋯ Elevated troponin was an independent predictor of 30-day mortality following SAH; however, when adjusted for age and sex, elevations in BNP did not have this association.