Abstract:
BACKGROUND:Target blood pressure (BP) in stable (non-hypotensive) patients with acute isolated blunt traumatic intracranial hemorrhage (TICH) is unknown. To address this issue, our study correlated BP with radiological volumetric progression (RP) and neurological deterioration (ND) in these patients. METHODS:A retrospective review of hemodynamically stable adults (n = 184) with isolated TICH not requiring emergent surgery consecutively admitted to a Level I trauma center. BPs before admission computed tomography (CT) scan (CT1) and between CT1 and a follow-up CT (CT2) were correlated with TICH volume and Glasgow Coma Scale (GCS) during these time periods. Predictors for deterioration were studied. Primary outcomes were increased measured TICH and decreased GCS at the CT1-CT2 interval. RESULTS:Age (57 years), % male (73), ISS (17), % falls (77), comorbidities (1.2/pt), and % anticoagulation (20) were similar in patients with or without RP (n = 107, 58%) or ND (n = 34, 18%). By univariate analysis, RP patients had an average systolic (SBP), diastolic (DBP), and mean BP (MAP) similar to non-RP patients; whereas ND patients compared to non-ND patients had a higher mean admission DBP (p < 0.02) and MAP (p < 0.04), a higher mean admission peak MAP (p < 0.01) and DBP (p < 0.01), a higher CT1-CT2 interval peak DBP (p < 0.01) and peak MAP (p < 0.01), and a lower CT1-CT2 nadir SBP (p < 0.04). Spearman rank correlation test did not show association among average SBP, MAP, DBP, absolute or % change in BPs, and absolute or % change in TICH volumes in any phase. Multivariate analysis identified higher nadir admission SBP [adjusted odds ratio (AOR) 1.29 per 10 mmHg increase] and lower peak MAP during the CT1-CT2 period (AOR 0.71 per 10 mmHg decrease) as independent predictors of RP, and a peak DBP in the CT1-CT2 interval (AOR 1.48) as an independent predictor of ND. Other predictors of ND included bilateral admission TICH (AOR 3.31) and increased injury volume (AOR 1.36), while the number of comorbidities/patient (AOR 4.34), bilateral injury (AOR 3.12), and midline shift (AOR 4.34) predicted RD. CONCLUSIONS:A comprehensive dynamic analysis correlating repeated BP determinations with quantifiable repeated parameters of TICH deterioration (injury volume and GCS) did not demonstrate a clinically relevant protective target BP value. Current practices of BP control in this specific group of patients should be further investigated. LEVEL OF EVIDENCE III:Prognostic, Level II study.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Bugaev N,Al-Hazmi M,Allcorn M,Arabian SS,Riesenburger R,Safain M,Burke S,Colangelo A,Rabinovici Rdoi
10.1007/s12028-014-9957-zsubject
Has Abstractpub_date
2014-08-01 00:00:00pages
58-66issue
1eissn
1541-6933issn
1556-0961journal_volume
21pub_type
杂志文章abstract:BACKGROUND:Apnea testing is an essential step in the clinical diagnosis of brain death. Current international guidelines recommend placement of an oxygen (O2) insufflation catheter into the endotracheal tube to prevent hypoxemia, but use of a continuous positive airway pressure (CPAP) valve may be more effective at lim...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究
doi:10.1007/s12028-017-0380-0
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Currently, continuous electroencephalographic monitoring (cEEG) is the only available diagnostic tool for continuous monitoring of brain function in intensive care unit (ICU) patients. Yet, the exact relevance of routinely applied ICU cEEG remains unclear, and information on the implementation of cEEG, espec...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0525-9
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:There are some intracranial insults which are associated with cardiac abnormalities. Studies of these abnormalities have never been carried out in elective intracranial neurosurgery for the removal of brain tumors. Our prospective study aims at quantifying serum cardiac troponin T (cTnT) and N-terminal pro-b...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9684-2
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH). METHODS:Between July 20...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0644-3
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Long-term studies of survivors of acute respiratory distress syndrome (ARDS) have reported neuromuscular, quality of life, and neuropsychological impairments. This study aims to determine if development of ARDS was associated with neuromuscular weakness and depression at 6-month following hospital discharge ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-014-0087-4
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:Infection is the most common complication of external ventricular drain (EVD) placement. National trends in the annual incidence of meningitis among patients with traumatic brain injury (TBI) who have undergone EVD placement have not been reported. METHODS:The Nationwide Inpatient Sample was used ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0656-z
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:The objectives of this study were to determine effects of severe traumatic brain injury (TBI) on cerebrospinal fluid (CSF) concentrations of myelin basic protein (MBP) and to assess relationships between clinical variables and CSF MBP concentrations. METHODS:We measured serial CSF MBP concentrations in chil...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-012-9767-0
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To determine the clinical characteristics and outcomes of patients with neurogenic stress cardiomyopathy (NSC) among patients admitted to our neuroscience intensive care unit (NICU). METHODS:Following institutional review board approval, consecutive adult patients admitted to the NICU between 2009 and 2013 w...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-017-0412-9
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Abusive head trauma (AHT) is a common condition in children. Little is known in this condition regarding the frequency of seizures, the factors associated with increased risk of seizures, or the association of seizures with outcome. We sought to determine frequency and risks for in-hospital seizures after AH...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9468-5
更新日期:2011-08-01 00:00:00
abstract::This review examines the available data on the use of osmotic agents in patients with head injury and ischemic stroke, summarizes the physiological effects of osmotic agents, and presents the leading hypotheses regarding the mechanism by which they reduce ICP. Finally, it addresses the validity of the following common...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1385/NCC:1:2:219
更新日期:2004-01-01 00:00:00
abstract::In the original article, Figure 5 has incorrect EEG images and the corrected version is shown below. ...
journal_title:Neurocritical care
pub_type: 杂志文章,已发布勘误
doi:10.1007/s12028-020-00981-9
更新日期:2020-08-01 00:00:00
abstract::Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordisc, Danemark) has been approved for the treatment of patients with hemophilia with inhibitors, further indications, at least in some countries, include the treatment of factor VII deficiency and Glanzmann thrombasthenia refractory to conventional therapy. A...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-007-0006-z
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:This prospective consecutive double-blinded randomized study investigated the effect of prostacyclin on pressure reactivity (PR) in severe traumatic brain injured patients. Other aims were to describe PR over time and its relation to outcome. METHODS:Blunt head trauma patients, Glasgow coma scale ≤8, age 15...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-014-0030-8
更新日期:2015-02-01 00:00:00
abstract:INTRODUCTION:Cerebral vasospasm in aneurysmal subarachnoid hemorrhage (SAH) is associated with poor outcome. The safety and feasibility of continuous high-dose intravenous magnesium sulfate (MgSO4) for the prevention of cerebral vasospasm and ischemic cerebral injury has not been well studied. METHODS:Patients present...
journal_title:Neurocritical care
pub_type: 临床试验,杂志文章
doi:10.1385/NCC:3:1:016
更新日期:2005-01-01 00:00:00
abstract::Neuromuscular disorders increasingly are recognized as a complication in patients in the intensive care unit (ICU) and represent a common cause of prolonged ventilator dependency. The distinct syndromes of critical illness myopathy, prolonged neuromuscular blockade, and critical illness polyneuropathy (CIP) may arise ...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1385/NCC:3:3:195
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Intra-arterial (IA) nicardipine is often used to treat cerebral vasospasm associated with subarachnoid hemorrhage (SAH). While hypotension has been noted to be a dose-limiting side effect of intravenous infusions, this has seldom been reported for IA administration. METHODS:We reviewed a consecutive series ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-011-9537-4
更新日期:2011-12-01 00:00:00
abstract:INTRODUCTION:Delayed posthypoxic demyelination may rarely complicate an episode of severe hypoxia, with or without exposure to carbon monoxide. Following recovery from initial coma, progressive neurologic deterioration ensues with outcomes ranging from death to full recovery. Delayed posthypoxic demyelination is hypoth...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0044-6
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Recombinant activated Factor VII (rFVIIa) has recently gained popularity for rapid reversal of coagulopathy during operative neurosurgery. Patients undergoing chronic subdural hematoma (CSDH) or epidural hematoma (EDH) evacuation often have their coagulation status judged by preoperative international normal...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0040-x
更新日期:2007-01-01 00:00:00
abstract::Advanced hemodynamic monitoring is necessary for many patients with acute brain and/or spinal cord injury. Optimizing cerebral and systemic physiology requires multi-organ system function monitoring. Hemodynamic manipulations are cardinal among interventions to regulate cerebral perfusion pressure and cerebral blood f...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-011-9568-x
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Animal studies suggested that cerebral mitochondrial cardiolipin phospholipids were released after severe traumatic brain injury (TBI), contributing to the pathogenesis of thromboembolism. OBJECTIVES:To determine the incidence of anti-cardiolipin antibodies after severe TBI and whether this was related to t...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01026-x
更新日期:2020-06-18 00:00:00
abstract::Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including both intravenous thrombolysis and endovascular approaches to thrombus removal. Extensive study has demonstrated that rapid, protocolized, assessment and treatment is essential to improving neurological ou...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-017-0449-9
更新日期:2017-09-01 00:00:00
abstract:INTRODUCTION:Levetiracetam (LEV) is used in the setting of acute brain injury for seizure treatment or prophylaxis but its safety and efficacy in this setting is unknown. METHOD:We retrospectively analyzed the patterns of use and safety/efficacy of LEV in 379 patients treated in the neuroscience intensive care unit (N...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0042-8
更新日期:2007-01-01 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:A pretruncal subarachnoid hemorrhage has been accepted as a "benign" entity. Here we present two patients with delayed cerebral infarction following pretruncal subarachnoid hemorrhage. METHODS:Case report. RESULTS:Two patients with possible delayed cerebral infarction after pretruncal subarachnoid hemorrha...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9403-9
更新日期:2011-04-01 00:00:00
abstract:INTRODUCTION:Bacterial meningitis is associated with a high mortality and a high incidence of neurological sequelae. Parainfectious vasculitis leading to ischemic brain damage is a known complication of bacterial meningitis but its treatment is uncertain. METHODS AND RESULTS:We report the case of a 53-year-old man wit...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:4:3:237
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Subarachnoid hemorrhage (SAH) is a devastating disease. Nimodipine is the only medical treatment shown to improve outcome of SAH patients. Human albumin (ALB) may exert neuroprotection in SAH. However, current usage of ALB in SAH is not known. We conducted an international survey of clinicians involved in th...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9942-y
更新日期:2014-04-01 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:Fever in neurocritical care patients is common and has a negative impact on neurological outcome. The purpose of this prospective observational study was (1) to evaluate the practicability of cooling with newly developed neck pads in the daily setting of neurointensive care unit (NICU) patients and (2) to ev...
journal_title:Neurocritical care
pub_type: 临床试验,杂志文章
doi:10.1007/s12028-010-9451-1
更新日期:2011-08-01 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:During late pregnancy and the puerperium cerebral venous and sinus thrombosis (CVST) is a rare but important cause of stroke. Despite adequate anticoagulation some patients deteriorate, which may warrant the use of more aggressive treatment modalities. CASE REPORT:A 29-year-old pregnant woman (29th week of ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9389-3
更新日期:2011-08-01 00:00:00