Articles: neurocritical-care.
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Epilepsy & behavior : E&B · Aug 2015
ReviewCan anesthetic treatment worsen outcome in status epilepticus?
Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. ⋯ However, there are still more questions than answers, and current evidence for the adverse effects of anesthetic drugs in patients with status epilepticus remains too limited to advocate a change of treatment algorithms. In this overview, the rationale and the conflicting clinical implications of anesthetic drugs in patients with treatment-refractory status epilepticus are discussed, and remaining questions are elaborated. This article is part of a Special Issue entitled "Status Epilepticus".
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Hypertonic saline infusion in traumatic brain injury increases the incidence of pulmonary infection.
We aimed to investigate the incidence of electrolyte abnormalities, acute kidney injury (AKI), deep venous thrombosis (DVT) and infections in patients with traumatic brain injury (TBI) treated with hypertonic saline (HTS) as osmolar therapy. We retrospectively studied 205 TBI patients, 96 with HTS and 109 without, admitted to the surgical/trauma intensive care unit between 2006 and 2012. Hemodynamics, electrolytes, length of stay (LOS), acute physiological assessment and chronic health evaluation II (APACHE II), injury severity scores (ISS) and mortality were tabulated. ⋯ HTS did not result in increased blood pressure, DVT, AKI or neurological benefits. HTS significantly increased the odds for all infections, most specifically pulmonary infections, in patients with GCS<8. Due to these findings, HTS in TBI should be administered with caution regardless of acuity.
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Review Meta Analysis
Therapeutic Hypothermia for Refractory Status Epilepticus.
Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure control. ⋯ Oxford level 4, GRADE D evidence exists to support the use of therapeutic hypothermia to control seizures in RSE. Further prospective study is warranted.
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Crit Care Nurs Clin North Am · Jun 2015
ReviewAdvances in cerebral monitoring for the patient with traumatic brain injury.
A brief overview of the most common invasive and noninvasive monitoring tools collectively referred to using the term "multimodal monitoring" is provided. Caring for the critically ill patient with traumatic brain injury requires careful monitoring to prevent or reduce secondary brain injury. Concurrent to the growth of the subspecialty of neurocritical care, there has been a concerted effort to discover novel mechanisms to monitor the physiology of brain injury. The past 2 decades have witnessed an exponential growth in neurologic monitoring in terms of intracranial pressure, blood flow, metabolism, oxygenation, advanced neuroimaging, and electrophysiology.
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Continuous electroencephalography (cEEG) is important for treatment guidance in status epilepticus (SE) management, but its role in clinical outcome prediction is unclear. Our aim is to determine which cEEG features give independent outcome information after correction for clinical predictor. ⋯ After adjustment for relevant clinical findings, including SE severity and etiology, cEEG background information (posterior dominant rhythm and sleep patterns) is more predictive for clinical outcome after SE than are rhythmic and periodic patterns or seizures.