Articles: neurocritical-care.
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Eur J Trauma Emerg Surg · Jan 2025
Dose-dependent association of hyperoxia and decreased favorable outcomes in mechanically ventilated patients with traumatic brain injury, a retrospective cohort study.
In patients with traumatic brain injury (TBI), adequate oxygenation is crucial to optimize survival and neurological outcome. However, supranormal oxygen partial pressure (PaO2) only leads to minor increase in cerebral oxygen delivery but can cause numerous pathophysiological disturbances. Therefore, we aimed to study effects of hyperoxia on patient outcome and identify optimum PaO2 ranges. ⋯ In this cohort, hyperoxia within 72 h after admission was dose-dependently associated with an unfavorable neurological outcome after 3-6 months.
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Eur J Trauma Emerg Surg · Jan 2025
Effects of early propranolol administration on mortality from severe, traumatic brain injury: a retrospective propensity score-matched registry study.
The role of beta-blockers in severe, traumatic brain injury (TBI) management is debated. Severe TBI may elicit a surge of catecholamines, which has been associated with increased morbidity and mortality. We hypothesize administering propranolol, a non-selective beta-blocker, within 48 h of TBI will reduce patient mortality within 30 days of injury. The TriNetX database was leveraged to determine if administering a propranolol within 48 h of severe TBI improves outcomes within 30 days of injury. ⋯ The results of this study demonstrate significantly reduced mortality within 30 days of injury and fewer neurosurgical interventions, seizures, and episodes of cardiac arrest in severe TBI patients who received propranolol within 48 h of injury.
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Acute ischemic stroke with medium and large vessel occlusion is a leading cause of morbidity and mortality, in which timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. Effective analgosedation and hemodynamic management during MT are critical to patient outcomes and typically managed by anesthesia. Because of inconsistent anesthesia support at our institution, we implemented a dedicated neurocritical care rapid response team (NCC-RRT) to manage these aspects of care. The primary outcome of our study was door-to-groin puncture time, before and after the implementation of the NCC-RRT. Secondary outcomes included door-to-recanalization time, patient disposition status, and the need for emergent anesthesia support. ⋯ The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.