Neurocritical care
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Comparative Study
Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus.
Hydrocephalus may develop either early in the course of aneurysmal subarachnoid hemorrhage (SAH) or after the first 2 weeks. Because the amount of SAH is a predictor of hydrocephalus, the two available aneurysmal treatments, clipping or coiling, may lead to differences in the need for cerebrospinal fluid (CSF) diversion, as only surgery permits clot removal. ⋯ One-third of patients admitted with aneurysmal SAH require temporary or permanent CSF diversion. Permanent shunting was found to be associated with coiling in our patient population.
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Randomized Controlled Trial Multicenter Study
Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury.
To compare a restrictive versus a liberal transfusion strategy in patients with moderate to severe closed head injury following multiple trauma in 13 Canadian intensive care units (ICUs). ⋯ We were unable to detect significant improvements in mortality with a liberal as compared to restrictive transfusion strategy in critically ill trauma victims with moderate to severe head injury.
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The treatment of anemia in critically ill patients has changed significantly in the past decade with a major shift toward restrictive blood-transfusion strategy. There is a paucity of studies regarding the approach toward anemia in the neurological critical care population. ⋯ Recent studies have shown a mixed response in the local oxygen saturations and patient outcomes after blood transfusion in neurological critically ill patients. Although there is little reason to suspect that restrictive transfusion protocols would be detrimental, further studies are needed to determine optimal transfusion threshold in this population.
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Cerebrovascular disease and trauma are leading causes of death in the United States. In addition to the initial insult to the brain, disturbances of cerebral oxygenation and metabolism underlie many of the secondary pathophysiological processes that increase both morbidity and mortality. ⋯ New technologies capable of offering continuous and quantitative assessment of cerebral oxygenation may improve clinical outcomes. In this article, we review the physiological principles of cerebral metabolism, cerebral blood flow and their metabolic coupling, and cerebral oxygenation, with particular emphasis on variables that could be monitored and managed in an intensive care unit setting.
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Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers, electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac dysfunction after SAH remain controversial. The aim of this study was to determine the prevalence of LV regional wall motion abnormalities (RWMA) after SAH and to quantify the independent effects of specific demographic and clinical variables in predicting the development of RWMA. ⋯ RWMA were frequent after SAH. High-grade SAH, an elevation in cTi levels, a history of prior stimulant drug use, and tachycardia are independent predictors of RWMA.