Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2021
ReviewAlbumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies.
Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.
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J Neurosurg Anesthesiol · Oct 2021
Meta AnalysisHemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.
Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. ⋯ The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=-169 mL; 95% CI=-1463 to 1126 mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring-guided management on aSAH outcomes.
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J Neurosurg Anesthesiol · Oct 2021
Observational StudyCorrelation Between Brain Trauma Foundation Guidelines and Published Severe Traumatic Brain Injury Research.
Four editions of the Brain Trauma Foundation's (BTF) evidence-based guidelines have been published to guide clinical management after severe traumatic brain injury (TBI) and increase TBI research. We reviewed the association between published clinical severe TBI research and BTF guideline year of publication and guideline chapter topics. Using PubMed, we searched for peer-reviewed articles on severe TBI research published between 1975 and 2019. ⋯ The 3 most highly published guideline chapter topic areas were ventilator-associated pneumonia (r2=0.70), hyperosmolar therapy (r2=0.47), and decompressive craniectomy (r2=0.41). In summary, the TBI research output increased over time and was associated with BTF guideline release. However, the increase in published TBI research was not consistent between serial editions of the BTF guidelines, and many studies did not incorporate high-quality prospective research designs.