Abstract：
BACKGROUND:Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, to predict outcome of post-CA coma in comparison to standard PLR, EEG, and somato-sensory evoked potentials (SSEP). METHODS:We prospectively studied over a 1-year period (June 2012-June 2013) 50 consecutive comatose CA patients treated with TH (33 °C, 24 h). Quantitative PLR (expressed as the % of pupillary response to a calibrated light stimulus) and standard PLR were measured at day 1 (TH and sedation; on average 16 h after CA) and day 2 (normothermia, off sedation: on average 46 h after CA). Neurological outcome was assessed at 90 days with Cerebral Performance Categories (CPC), dichotomized as good (CPC 1-2) versus poor (CPC 3-5). Predictive performance was analyzed using area under the ROC curves (AUC). RESULTS:Patients with good outcome [n = 23 (46 %)] had higher quantitative PLR than those with poor outcome [n = 27; 16 (range 9-23) vs. 10 (1-30) % at day 1, and 20 (13-39) vs. 11 (1-55) % at day 2, both p < 0.001]. Best cut-off for outcome prediction of quantitative PLR was <13 %. The AUC to predict poor outcome was higher for quantitative than for standard PLR at both time points (day 1, 0.79 vs. 0.56, p = 0.005; day 2, 0.81 vs. 0.64, p = 0.006). Prognostic accuracy of quantitative PLR was comparable to that of EEG and SSEP (0.81 vs. 0.80 and 0.73, respectively, both p > 0.20). CONCLUSIONS:Quantitative PLR is more accurate than standard PLR in predicting outcome of post-anoxic coma, irrespective of temperature and sedation, and has comparable prognostic accuracy than EEG and SSEP.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Suys T,Bouzat P,Marques-Vidal P,Sala N,Payen JF,Rossetti AO,Oddo Mdoi
10.1007/s12028-014-9981-zsubject
Has Abstractpub_date
2014-10-01 00:00:00pages
300-8issue
2eissn
1541-6933issn
1556-0961journal_volume
21pub_type
杂志文章abstract：OBJECTIVES:Prophylactic treatment with antiepileptic drugs is common practice following subarachnoid hemorrhage (SAH) and traumatic brain injury. However, commonly used antiepileptic drugs have multiple drug interactions, require frequent monitoring of serum levels, and are associated with adverse effects that may prom...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1385/NCC:5:1:71
更新日期：2006-01-01 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
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abstract：BACKGROUND:In the postpartum patient, sudden depression of consciousness may be caused by a number of etiologies and can result in serious consequences. Rapid, accurate diagnosis allows for specific treatments that optimize outcome, but diagnosis can be challenging in this population. We present a case of postpartum he...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-012-9742-9
更新日期：2012-12-01 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:Fever control plays a key role in therapy of patients with acute brain injury. The infusion of cold saline could serve as an alternative or additional method for targeted temperature management. However, it is difficult to estimate the amount of fluid required to achieve normothermia merely on the basis of b...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-018-0588-7
更新日期：2019-02-01 00:00:00
abstract：PURPOSE:The objective of our trial was to obtain more comprehensive data on the risks and benefits of kinetic therapy in intensive care patients with intracerebral pathology. METHODS:Standardized data of prone positioning in our NeuroIntensive Care Unit were collected from 2007 onward. A post hoc analysis of all avail...
journal_title：Neurocritical care
pub_type： 临床试验,杂志文章
doi：10.1007/s12028-014-0004-x
更新日期：2014-10-01 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:Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventi...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-020-00932-4
更新日期：2020-10-01 00:00:00
abstract：BACKGROUND:In several instances, the diagnosis of brain death has been questioned due to the presence of movements. This case report and review of the literature illustrates the spectrum of movements that have been encountered in brain death. METHODS:A case report and review of the literature on movements seen in brai...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1385/NCC:3:2:122
更新日期：2005-01-01 00:00:00
abstract：INTRODUCTION:Recent and on going clinical research trials may indicate that the incidence of vasospasm is less in patients treated with lumbar drains following SAH than with patients treated with external ventricular drainage (EVD) alone. These studies have sparked interest in the more aggressive use of LDs in patients...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-007-0047-3
更新日期：2007-01-01 00:00:00
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journal_title：Neurocritical care
pub_type： 杂志文章,评审
doi：10.1007/s12028-010-9363-0
更新日期：2010-08-01 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：: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 ...
journal_title：Neurocritical care
pub_type： 杂志文章,评审
doi：10.1385/NCC:4:2:179
更新日期：2006-01-01 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
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journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-016-0370-7
更新日期：2017-08-01 00:00:00
abstract：BACKGROUND:Physiological reactions of the stress hormone cortisol include hyperglycemia, hypertension, and endothelium dysfunction. In patients with aneurysmal subarachnoid hemorrhage (SAH), hyperglycemia, hypertension, and endothelium dysfunction are associated with the occurrence of delayed cerebral ischemia (DCI). T...
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pub_type： 杂志文章,随机对照试验
doi：10.1007/s12028-010-9331-8
更新日期：2010-06-01 00:00:00
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journal_title：Neurocritical care
pub_type： 杂志文章,评审
doi：10.1007/s12028-014-0024-6
更新日期：2014-12-01 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:This prospective study of an innovative non-invasive ultrasonic cerebrovascular autoregulation (CA) monitoring method is based on real-time measurements of intracranial blood volume (IBV) reactions following changes in arterial blood pressure. In this study, we aimed to determine the clinical applicability o...
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doi：10.1007/s12028-018-0569-x
更新日期：2019-02-01 00:00:00
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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
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journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1385/NCC:1:4:461
更新日期：2004-01-01 00:00:00
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journal_title：Neurocritical care
pub_type： 杂志文章,评审
doi：10.1007/s12028-013-9872-8
更新日期：2014-02-01 00:00:00
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journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-016-0274-6
更新日期：2016-12-01 00:00:00
abstract：BACKGROUND:There is no uniform definition for cerebral microdialysis (CMD) probe location with respect to focal brain lesions, and the impact of CMD-probe location on measured molecule concentrations is unclear. METHODS:We retrospectively analyzed data of 51 consecutive subarachnoid hemorrhage patients with CMD-monito...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-019-00713-8
更新日期：2020-02-01 00:00:00
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journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-018-0653-2
更新日期：2019-06-01 00:00:00
abstract：INTRODUCTION:Several studies have been performed to assess the prognostic value of early neurological and neurophysiological findings in patients with postanoxic coma, but they have not led to precise, generally accepted, prognostic rules. This study was performed to assess whether it is possible to create a prognostic...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-008-9178-4
更新日期：2009-01-01 00:00:00
abstract：INTRODUCTION:A 38-year-old man with severe head trauma complicated by paroxysmal severe intracranial pressure elevation associated with tachypnea, tachycardia, diaphoresis, and extensor posturing was diagnosed as suffering from paroxysmal autonomic instability with dystonia (PAID). These events were unresponsive to sta...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1007/s12028-007-0066-0
更新日期：2007-01-01 00:00:00
abstract：INTRODUCTION:Delayed ischemic neurologic deficits secondary to vasospasm are a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Treatment of vasospasm after SAH is associated with complications, and reliable techniques for evaluating effects of treatment of vasospasm in such patients are warr...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1385/ncc:6:1:40
更新日期：2007-01-01 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：INTRODUCTION:Effective treatment for severe ischemic stroke continues to be largely an unmet medical need. Using a nonvascular (paravascular cerebrospinal fluid) pathway to provide oxygen and nutrients to ischemic tissues may be a means of treating this disease. The primary objective of this study was to evaluate the s...
journal_title：Neurocritical care
pub_type： 杂志文章
doi：10.1385/NCC:5:1:21
更新日期：2006-01-01 00:00:00
