Abstract:
BACKGROUND:The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS:The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed. RESULTS:Fifteen patients completed the crossover study. Total ketones were increased 81 μM ([38 135], p < 0.001) when blood glucose was targeted to tight (4.4-6.1 mM) compared with loose glycemic control (6.7-8.3 mM), corresponding to a 60 % increase. There was a significant decrease in total nutritional provisions (p = 0.006) and a significant increase in insulin dose (p = 0.008). CONCLUSIONS:Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Wolahan SM,Prins ML,McArthur DL,Real CR,Hovda DA,Martin NA,Vespa PM,Glenn TCdoi
10.1007/s12028-016-0313-3subject
Has Abstractpub_date
2017-04-01 00:00:00pages
239-246issue
2eissn
1541-6933issn
1556-0961pii
10.1007/s12028-016-0313-3journal_volume
26pub_type
杂志文章,随机对照试验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:BACKGROUND:Cerebral blood flow (CBF) measurements are helpful in managing patients with traumatic brain injury (TBI), and testing the cerebrovascular reactivity to CO(2) provides information about injury severity and outcome. The complexity and potential hazard of performing CBF measurements limits routine clinical use...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9727-8
更新日期:2014-02-01 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:Brain tissue hypoxia (PbtO2 < 20 mmHg) is common after subarachnoid hemorrhage (SAH) and associated with poor outcome. Recent data suggest that brain oxygen optimization is feasible and reduces the time spent with PbtO2 < 20 mmHg from 45 to 16% in patients with severe traumatic brain injury. Here, we intende...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00753-0
更新日期:2019-10-01 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: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: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: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: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: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: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: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:OBJECTIVE:Identification of patients with posterior fossa infarction at risk for neurological deterioration remains a challenge. MRI-based assessments of MCA infarction can predict poor outcome. Similar quantitative imaging measures after cerebellar stroke have not been studied. We tested the hypothesis that MRI-based ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9886-2
更新日期:2013-12-01 00:00:00
abstract:INTRODUCTION:Hydrocephalus with normal intracranial pressure has rarely been reported to result in herniation. METHODS:Case report. RESULTS:A 52-year-old man became acutely comatose with extensor posturing and ventriculomegaly 17 days after experiencing a primary ventricular hemorrhage. An external ventricular drain ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:2:2:172
更新日期:2005-01-01 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: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:Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. METHODS:Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our insti...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00886-2
更新日期:2020-08-01 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
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:OBJECTIVE:Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-014-9962-2
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Nosocomial pneumonia (NP) is a frequent complication among spontaneous intracerebral hemorrhage (sICH) patients. This study was aimed at identifying in-hospital risk factors that predispose sICH patients to NP. METHODS:We identified 591 consecutive sICH subjects admitted to six tertiary care hospitals betwe...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究
doi:10.1007/s12028-014-0065-x
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Case reports suggest lacosamide may have a role in status epilepticus (SE). The purpose of this case series is to describe the use of lacosamide in refractory SE (RSE) at our institution. METHODS:Observational study of all patients admitted to the neurosciences intensive care unit with RSE who received at l...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9501-8
更新日期:2011-06-01 00:00:00
abstract::We now recognize that the main breathing generator resides principally in the medulla oblongata. Vivisectionists-specifically, Julien Legallois-discovered "the respiratory center." Cutting through the brainstem stops respiration but not if the medulla remains intact and the brain is sliced in successive portions. Pier...
journal_title:Neurocritical care
pub_type: 历史文章,杂志文章
doi:10.1007/s12028-019-00686-8
更新日期:2019-08-01 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: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: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:Rapid diagnosis and proper management of intracerebral hemorrhage (ICH) play a crucial role in the outcome. Prediction of the outcome with a high degree of accuracy based on admission data including imaging information can potentially influence clinical decision-making practice. METHODS:We conducted a retro...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00783-8
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Infection is common following stroke and is independently associated with worse outcome. Clinical studies suggest that infections occur more frequently in those individuals with stroke-induced immunologic dysfunction. This study sought to explore the contribution of immunomodulatory cytokines and hormones to...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9490-7
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Hematoma expansion after acute intracerebral hemorrhage occurs most frequently in patients presenting within 3 h of symptom onset. However, the majority of patients present outside this window or with an unknown onset time. We investigated the prevalence of hematoma expansion in these patients and assessed t...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9765-2
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:In comatose post-cardiac arrest patients, a serum neuron-specific enolase (NSE) level of >33 μg/L within 72 h was identified as a reliable marker for poor outcome in a large Dutch study (PROPAC), and this level was subsequently adopted in an American Academy of Neurology practice parameter. Later studies rep...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9867-5
更新日期:2013-10-01 00:00:00