Neurocritical care
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Cerebral autoregulation is an essential mechanism for maintaining cerebral blood flow stability. The phenomenon of transtentorial intracranial pressure (ICP) gradient after neurosurgical operations, complicated by edema and intracranial hypertension in the posterior fossa, has been described in clinical practice but is still underinvestigated. The aim of the study was to compare autoregulation coefficients (i.e., pressure reactivity index [PRx]) in two compartments (infratentorial and supratentorial) during the ICP gradient phenomenon. ⋯ A high degree of correlation was established between the autoregulation coefficient PRx in two compartments in the presence of transtentorial ICP gradient and persistent intracranial hypertension in the posterior fossa. Cerebral autoregulation, according to the PRx coefficient in both spaces, was similar.
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Multicenter Study Observational Study
Ketamine Use in the Intubation of Critically Ill Children with Neurological Indications: A Multicenter Retrospective Analysis.
Ketamine has traditionally been avoided for tracheal intubations (TIs) in patients with acute neurological conditions. We evaluate its current usage pattern in these patients and any associated adverse events. ⋯ This retrospective cohort study did not demonstrate an association between procedural ketamine use and increased risk of peri-intubation hypoxemia and hemodynamic instability in patients intubated for neurological indications.
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Observational Study
Clinical, Imaging Characteristics and Outcome of Intracerebral Hemorrhage Caused by Structural Vascular Lesions.
The objective of this study was to investigate the clinical, imaging, and outcome characteristics of intracerebral hemorrhage (ICH) caused by structural vascular lesions. ⋯ Compared with primary ICH, ICH due to vascular lesions has smaller hematoma volume and less severe neurological deficit at presentation and better functional outcomes.
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The outcome of patients with acute ischemic stroke who require mechanical ventilation has been poor. Intubation due to a reversible condition could be associated with better 1-year survival. ⋯ The indication for intubation seems to significantly affect outcome. Functional outcome at 3 months is often poor, but a great majority of 1-year survivors are able to live at home.
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Large intracerebral hemorrhages (ICHs) are associated with significant morbidity and mortality. Patient transfer to higher level centers is common, but care in these centers rarely demonstrably improves morbidity or reduces mortality. Patients may rapidly progress to brain death, but a large number die shortly after transferring because of withdrawal of life-sustaining treatment (WOLST). This outcome may result in poor resource use and unnecessary cost to patients, families, and institutions. We sought to determine clinical and radiographic predictors of early death or WOLST that may alter potential transfer. ⋯ Early death or WOLST after ICH within 24 h of presentation was most associated with DNR/DNI code status, warfarin use, ICH score, and lower level of consciousness at presentation. These characteristics may be used by clinicians to guide conversations prior to transfer to tertiary care centers.