Abstract:
:Severe intracranial hypertension (IH) in the setting of fulminant hepatic failure (FHF) carries a high mortality and is a challenging disease for the critical care provider. Despite considerable improvements in the understanding of the pathophysiology of cerebral edema during liver failure, therapeutic maneuvers that are currently available to treat this disease are limited. Orthotopic liver transplantation is currently the only definitive therapeutic strategy that improves outcomes in patients with FHF. However, many patients die prior to the availability of donor organs, often because of cerebral herniation. Currently, two important theories prevail in the understanding of the pathophysiology of IH during FHF. Ammonia and glutamine causes cytotoxic cerebral injury while cerebral vasodilation caused by loss of autoregulation increases intracranial pressure (ICP) and predisposes to herniation. Although ammonia-reducing strategies are limited in humans, modulation of cerebral blood flow seems promising, at least during the early stages of hepatic encephalopathy. ICP monitoring, transcranial Doppler, and jugular venous oximetry offer valuable information regarding intracranial dynamics. Induced hypothermia, hypertonic saline, propofol sedation, and indomethacin are some of the newer therapies that have been shown to improve survival in patients with severe IH. In this article, we review the pathophysiology of IH in patients with FHF and outline various therapeutic strategies currently available in managing these patients in the critical care setting.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Raghavan M,Marik PEdoi
10.1385/NCC:4:2:179subject
Has Abstractpub_date
2006-01-01 00:00:00pages
179-89issue
2eissn
1541-6933issn
1556-0961pii
NCC:4:2:179journal_volume
4pub_type
杂志文章,评审abstract:BACKGROUND:The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-009-9227-7
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction. METHODS:Case reports and literature review. RESULTS:A 57-year-o...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-017-0406-7
更新日期:2018-06-01 00:00:00
abstract:INTRODUCTION:Dynamic testing of cerebral pressure autoregulation is more practical than static testing for critically ill patients. The process of cuff deflation is innocuous in the normal subject, but the systemic and cerebral effects of cuff deflation in severely head-injured patients have not been studied. The purpo...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:4:2:127
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty. AIM:To formulat...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01185-x
更新日期:2021-01-25 00:00:00
abstract:BACKGROUND:This study investigated if cerebral blood flow (CBF) regulation by changes of the arterial partial pressure of carbon dioxide (PaCO2) can be used therapeutically to increase CBF and improve neurological outcome after subarachnoid hemorrhage (SAH). METHODS:In 12 mechanically ventilated poor-grade SAH-patient...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-016-0246-x
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND AND PURPOSE:In patients with subarachnoid hemorrhage (SAH), higher hemoglobin (HGB) has been associated with better outcomes, but packed red blood cell (PRBC) transfusions with worse outcomes. We performed a prospective pilot trial of goal HGB after SAH. METHODS:Forty-four patients with SAH and high risk fo...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-010-9424-4
更新日期:2010-12-01 00:00:00
abstract::Prophylactic use of hypervolemia and hypertension is believed to present an option to decrease the incidence of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and improve neurologic outcome. A Medline literature search was conducted to review available evidence regarding volume management after subarac...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-011-9593-9
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:An increasing number of patients receive antiplatelet therapy. Patients exposed to surgery while receiving platelet inhibitors hold an increased bleeding risk. Especially in neurosurgery and neurocritical care patients, bleeding and hematoma expansion are feared complications as even minor blee...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-020-01055-6
更新日期:2020-08-04 00:00:00
abstract:BACKGROUND:In patients with spontaneous intracerebral hemorrhage (ICH), pre-hospital markers of disease severity might be useful to potentially triage patients to undergo early interventions. OBJECTIVE:Here, we tested whether loss of consciousness (LOC) at the onset of ICH is associated with intraventricular hemorrhag...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01180-2
更新日期:2021-01-21 00:00:00
abstract:BACKGROUND:The correlation between noninvasive (oscillometric) blood pressure (NBP) and intra-arterial blood pressure (IAP) in critically ill patients receiving vasoactive medications in a Neurocritical Care Unit has not been systematically studied. The purpose of this study is to examine the relationship between simul...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0521-0
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. METHODS:This retrospective, multicenter, observational study identified 400 ICU p...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究
doi:10.1007/s12028-016-0343-x
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Diagnosis of intensive care unit acquired weakness (ICUAW) is challenging. Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01148-2
更新日期:2020-11-24 00:00:00
abstract:BACKGROUND:Delayed neurological deficit (DND) is the most important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH) whose aneurysms have been secured. However, the methods currently used to predict the development of DND, such as trans-cranial Doppler or levels biochemical markers in blo...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-014-0089-2
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome. METHODS:This is a retrospective analysis of data from a pros...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-015-0138-5
更新日期:2015-12-01 00:00:00
abstract:INTRODUCTION:The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis i...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0019-7
更新日期:2007-01-01 00:00:00
abstract::Acute liver failure (ALF), the abrupt loss of liver function in a patient without previous liver disease, remains a highly mortal condition. Patients with ALF often succumb to their liver injury after the development of cerebral edema, resulting in intracranial hypertension and brain herniation. While the management o...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-008-9090-y
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:Airembolism without obvious trauma or surgery is rare. METHODS:Case report. RESULTS:Four years after resection of a non-small cell lung cancer, a 57-year-old man presented with recurrent episodes of sudden onset neurological deficits. Head computer tomographic (CT) scans suggested air embolism, and furth...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-008-9073-z
更新日期:2008-01-01 00:00:00
abstract::Diagnosis of an intracranial aneurysm during pregnancy is a rare event requiring multidisciplinary care for successful management. The knowledge base for the anesthesiologist involves principles of both obstetric and neuroanesthesia, as well as critical care. This article reports such a case and discusses the relevant...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:4:1:018
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Altered mental status and more subtle cognitive and personality changes after traumatic brain injury (TBI) are pervasive problems in patients who survive initial injury. MRI is not necessarily part of the diagnostic evaluation of these patients. METHODS:Case report with relevant image and review of the li...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-012-9699-8
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Seizures are a common complication after intracerebral hemorrhage (ICH) but there is a substantial lack of information on the long-term incidence in ICH survivors and whether post-ICH seizures affect functional long-term outcome. METHODS:Over a five-year period 464 consecutive patients with spontaneous ICH ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-014-9968-9
更新日期:2014-10-01 00:00:00
abstract:INTRODUCTION:Point-of-care ultrasound of the optic nerve sheath diameter (ONSD) to diagnose increased intracranial pressure (ICP) is of great interest in various clinical scenarios. Yet, the lack of examination standardization has made clinical utility difficult. We compare three ultrasound ocular plane views (inferior...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00881-7
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Therapeutic hypothermia (i.e., temperature management) is an effective option for improving survival and neurological outcome after cardiac arrest and is potentially useful for the care of the critically ill neurological patient. We analyzed the feasibility of a device to control the temperature of the brain...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-016-0257-7
更新日期:2016-12-01 00:00:00
abstract:INTRODUCTION:No proven treatments exist for intracerebral hemorrhage (ICH). Carefully selected patients may benefit from surgery, and an international multicenter trial is ongoing. We sought to determine how many patients in a population-based ICH cohort would have been eligible for surgery using the Surgical Trial in ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-9045-8
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Improvements in technology play an important role in caring for critically ill patients. One example is the advance in ventilator design to facilitate triggering of mechanical breaths. Minimal changes in circuit flow unrelated to respiratory effort can trigger a ventilator breath and may mislead caregivers i...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9491-6
更新日期:2011-04-01 00:00:00
abstract:INTRODUCTION:Status epilepticus remains a life-threatening condition that afflicts both adults and children which although occurs in patients with epilepsy, often presents as new-onset seizure activity also. Refractory status epilepticus poses a management challenge for neurological and neurosurgical teams. CASE REPOR...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0038-4
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Oral anticoagulants have been associated with greater hematoma expansion in patients with intracerebral hemorrhage (ICH). The purpose of this study was to determine whether the reported use of antiplatelet agents also results in greater hematoma expansion. METHODS:Retrospective review of patients with spont...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-009-9290-0
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:To investigate the effects of hyperbaric oxygen (HBO) on brain damage and autophagy levels in a rat model of middle cerebral artery occlusion. METHODS:Neurologic injury and infarcted areas were evaluated according to the modified neurological severity score and 2,3,5-triphenyltetrazolium chloride staining. ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0577-x
更新日期:2019-02-01 00:00:00
abstract:INTRODUCTION:Liver transplant (LT) recipients are at significant risk for the development of neurological complications, such as altered mental status and seizures, in the postoperative period. Identifying accurate predictors of these events may allow optimal selection and preparation of candidates, and minimize risk a...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-9020-4
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:It is controversial whether a low cerebral blood flow (CBF) simply reflects the severity of injury or whether ischemia contributes to the brain's injury. It is also not clear whether posttraumatic cerebral hypoperfusion results from intracranial hypertension or from pathologic changes of the cerebral vascula...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:1:1:69
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:The management of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) can be often complicated by the presence of stunned myocardium and left ventricular failure. Vasopressors and inotropes are commonly used to optimize mean arterial pressure (MAP) and cerebral perfusion pressure (...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-010-9358-x
更新日期:2010-08-01 00:00:00