Neurocritical care
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Prognostic determination of patients in coma after resuscitation from cardiac arrest is both common and difficult. We explored clinical and electrophysiological testing to determine their associations with favorable and poor outcomes. ⋯ It seems unlikely that any single test will prove to have 100% predictive value for outcome; further studies combining clinical, EEG, and SSEP testing are warranted.
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Weaning patients with myasthenic crisis (MC) from mechanical ventilation is often difficult, and the ideal time for extubation is often uncertain. However, little is known about the risk of extubation failure and the factors that may affect its occurrence. The goals of this study were to assess the risk of extubation failure in patients with MC and to determine which clinical variables may predict unsuccessful extubation. ⋯ Extubation failure may often complicate MC. Older age and development of pulmonary complications during mechanical ventilation increase the risk of extubation failure.
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Paroxysmal sympathetic storm (PSS) is a rare syndrome characterized by episodic hypertension, hyperhydrosis, hyperthermia, tachycardia, tachypnea, and extensor posturing. ⋯ These observations underscore the importance of central opioid receptors and nonselective beta-adrenergic antagonists in modulating catecholamine pathways.
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Comparative Study
Percutaneous dilational tracheostomy in neurosurgical patients.
Tracheostomy is often performed in patients requiring long-term mechanical ventilation after severe neurological injury. Percutaneous dilational tracheostomy (PDT) is an alternative to traditional surgical tracheostomy (TST) for creating a tracheostomy. We compared these techniques in neurosurgical patients and assessed the impact on cost and clinical course. ⋯ PDT appears to have a low incidence of complications in neurosurgical patients and may shorten the length of hospitalization and the overall cost compared with TST.
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It is unclear whether patients or subpopulations of patients might benefit from EEG monitoring. ⋯ Our study suggests that CEEG monitoring may be more valuable for detection of seizures in patients with ASBLs than in patients with metabolic encephalopathies.