Neurocritical care
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Traumatic brain injury (TBI) is a major cause of morbidity and mortality with widespread social, personal, and financial implications for those who survive. TBI is caused by four main events: motor vehicle accidents, sporting injuries, falls, and assaults. Similarly to international statistics, annual incidence reports for TBI in Australia are between 100 and 288 per 100,000. ⋯ Currently, indirect brain oximetry is used for cerebral oxygenation determination, which provides some information regarding global oxygenation levels. A newly developed oximetry technique, has shown promising results for the early detection of cerebral ischemia. ptiO2 monitoring provides a safe, easy, and sensitive method of regional brain oximetry, providing a greater understanding of neurophysiological derangements and the potential for correcting abnormal oxygenation earlier, thus improving patient outcome. This article reviews the current status of bedside monitoring for patients with TBI and considers whether ptiO2 has a role in the modern intensive care setting.
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We evaluated the effect of induced hypothermia on biochemical parameters in patients with severe traumatic brain injury. ⋯ Hypothermia of 33 degrees for 48-72 hours does not appear to increase the risk for coagulopathy and infections, although hypothermic patients exhibited significant increments in inflammatory markers such as C-reactive protein and white blood counts after rewarming.
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The ICH score is a clinical grading scale that is composed of five components related to outcome after nontraumatic intracerebral hemorrhage (ICH): Glasgow Coma Scale score, ICH volume, presence of intraventricular hemorrhage, infratentorial origin, and age. The ICH score accurately risk-stratifies patients in the cohort from which it was developed, but it has not yet been fully externally validated. The purpose of this study was to determine whether the ICH score accurately risk-stratifies patients in an independent cohort. ⋯ The ICH score accurately stratifies outcome in an external patient cohort. Thus, the ICH score is a validated clinical grading scale that can be easily and rapidly applied at ICH presentation. Ascale such as the ICH score could be used to standardize clinical treatment protocols or clinical studies.
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Fever is common and difficult to control in patients with subarachnoid hemorrhage (SAH). We have previously shown an inverse relationship between fever and outcome in patients with SAH. ⋯ We have demonstrated that fever can be safely and effectively controlled in patients with SAH for at least 24 hours using an ICC. Future studies are needed to assess the effect of such sustained therapy on outcome in patients with SAH.
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Clinical Trial
Prediction of intracranial pressure from noninvasive transocular venous and arterial hemodynamic measurements: a pilot study.
Continuous measurement of intracranial pressure (ICP) requires the invasive placement of epidural, parenchymal, or intraventricular devices. For critical single-point assessments, lumbar puncture may not always be practical. An accurate, reliable, portable and noninvasive method to estimate absolute ICP remains an elusive goal. The arteries that perfuse and the vein that drains the orbit are exposed to the ambient ICP while coursing through the cerebrospinal fluid or optic nerve. ⋯ The feasibility to estimate ICP from transocular sonographic and dynamometric data is suggested by these preliminary data. Retinal arterial properties are important in modeling the effect of ICP on the venous outflow pressure. Our pilot results serve as a basis on which to conduct a larger prospective and blinded study.