Neurocritical care
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Comparative Study
A comparison of nicardipine and labetalol for acute hypertension management following stroke.
Evaluate the ease of use and tolerability of labetalol (L) and nicardipine (N) for hypertension management in patients with acute stroke. ⋯ Nicardipine offers an alternative to labetalol with similar tolerability and appears to provide a smoother blood pressure control compared to labetalol.
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To assess the impact of blood glucose, coagulopathy, seizures and prior statin and aspirin use on clinical outcome following intracerebral hemorrhage (ICH). ⋯ The significant association of prior statin use with decreased mortality warrants prospective evaluation of the use of statins following ICH.
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The vast majority of patients with intracerebral hemorrhage (ICH) are admitted to an intensive care unit (ICU). Patients admitted to ICUs have a high risk of developing nosocomial infections, while complicating infection appears to be associated with a longer ICU stay. An increased length of ICU stay translates directly into increased costs. The aim of this study was to assess the impact of a complicating infection on the length of ICU stay in patients with ICH. ⋯ Complicating infection was an independent predictor of a prolonged ICU stay in patients with ICH.
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Hyperammonemia causes brain edema and high intracranial pressure (ICP) in acute liver failure (ALF) by accumulation of glutamine in brain. Since a high-level glutamine may compromise mitochondrial function, the aim of this study was to determine if the lactate-pyruvate ratio is associated with a rise in the glutamine concentration and ICP. ⋯ ICP and the cerebral glutamine concentration in patients with ALF correlate to the lactate-pyruvate ratio. Since CPP was sufficient in all patients the rise in lactate-pyruvate ratio indicates that accumulation of glutamine compromises mitochondrial function and causes intracranial hypertension.
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Benzodiazepine treatment of life-threatening gamma-hydroxybutyrate (GHB) withdrawal is frequently unsatisfactory. Animal studies suggest strongly that treatment with GABA(B) agonists, such as baclofen, will be a more effective strategy. ⋯ Baclofen, a GABA(B) agonist, may be a useful agent in the treatment of severe GHB withdrawal.