Articles: neurocritical-care.
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Critical care clinics · Oct 2014
ReviewAdverse Neurologic Effects of Medications Commonly Used in the Intensive Care Unit.
Adverse drug effects often complicate the care of critically ill patients. Therefore, each patient's medical history, maintenance medication, and new therapies administered in the intensive care unit must be evaluated to prevent unwanted neurologic adverse effects. Optimization of pharmacotherapy in critically ill patients can be achieved by considering the need to reinitiate home medications, and avoiding drugs that can decrease the seizure threshold, increase sedation and cognitive deficits, induce delirium, increase intracranial pressure, or induce fever. Avoiding medication-induced neurologic adverse effects is essential in critically ill patients, especially those with neurologic injury.
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Observational Study
Electroencephalographic sleep elements and outcome in acute encephalopathic patients: a 4-year cohort study.
Acute encephalopathy in hospitalized patients is common and associated with high mortality. Preservation of physiological sleep has been associated with favorable outcomes in acute brain injury. It is hypothesized that electroencephalographic presence of sleep elements is associated with good outcome in encephalopathic adults. ⋯ Whilst EEG sleep elements were detected more frequently in patients with favorable outcome, only K-complexes were significantly and independently associated with good outcome in intensive care unit patients with acute encephalopathy, findings that need to be confirmed in larger prospective studies.
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Review Meta Analysis
The effectiveness of specialist neuroscience care in severe traumatic brain injury: a systematic review.
UK trauma services are currently undergoing reconfiguration, but the optimum management pathway for head-injured patients is uncertain. We therefore performed a systematic review to assess the effects of routine inter-hospital transfer and specialist neuroscience care on mortality and disability in patients with non-surgical severe traumatic brain injury injured nearest to a non-specialist acute hospital. ⋯ There is limited evidence supporting a strategy of secondary transfer of severe non-surgical traumatic brain injury patients to specialist neuroscience centres. Randomised controlled trials powered to detect clinically plausible treatment effects should be considered to definitively investigate effectiveness.
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Journal of critical care · Aug 2014
ReviewAutomated pupillometer for monitoring the critically ill patient: A critical appraisal.
Abnormalities in the pupillary light reflex are an important prognostic indicator for patients in the intensive care unit (ICU). Manual pupillary examination is confounded by interobserver discrepancies and errors in detecting a reflex under certain conditions. The automated pupillometer is a computer-based infrared digital video device that can obtain objective measurements of pupillary size and reactivity. ⋯ Pupillometric measurements had better precision and reproducibility compared with the manual pupillary examination. Based on these data, we conclude that pupillometry monitoring can serve as an important tool in the ICU. Further large scale studies on patients in the neurocritical care unit and medical ICU are needed to support the routine use of automated pupillometry.