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 limiting arterial partial pressure of O2 (PO2) reduction. METHODS:We performed a multicenter study assessing consecutive apnea tests in 14 intensive care units (ICUs) in two cities utilizing differing protocols. In one city, O2 catheters are placed and arterial blood gases (ABGs) performed at intervals determined by the attending physician. In the other city, a resuscitation bag with CPAP valve is attached to the endotracheal tube, and ABGs performed every 3-5 min. We assessed arterial PO2, partial pressure of carbon dioxide (PCO2), pH, and blood pressure at the beginning and termination of each apnea test. RESULTS:Thirty-six apnea tests were performed using an O2 catheter and 50 with a CPAP valve. One test per group was aborted because of physiological instability. There were no significant differences in the degree of PO2 reduction (-59 vs. -32 mmHg, p = 0.72), rate of PCO2 rise (3.2 vs. 3.9 mmHg per min, p = 0.22), or pH decline (-0.02 vs. -0.03 per min, p = 0.06). Performance of ABGs at regular intervals was associated with shorter test duration (10 vs. 7 min, p < 0.0001), smaller PCO2 rise (30 vs. 26 mmHg, p = 0.0007), and less pH reduction (-0.20 vs. -0.17, p = 0.0012). Lower pH at completion of the apnea test was associated with greater blood pressure decline (p = 0.006). CONCLUSION:Both methods of O2 supplementation are associated with similar changes in arterial PO2 and PCO2. Performance of ABGs at regular intervals shortens apnea test duration and may avoid excessive pH reduction and consequent hemodynamic effects.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Kramer AH,Couillard P,Bader R,Dhillon P,Kutsogiannis DJ,Doig CJdoi
10.1007/s12028-017-0380-0subject
Has Abstractpub_date
2017-08-01 00:00:00pages
60-67issue
1eissn
1541-6933issn
1556-0961pii
10.1007/s12028-017-0380-0journal_volume
27pub_type
杂志文章,多中心研究abstract:BACKGROUND:Plateau waves are common in traumatic brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal brain monitoring in head injur...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9918-y
更新日期:2014-08-01 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:Decompressive hemicraniectomy (DHC) has proven efficacious for the treatment of malignant middle cerebral artery infarction (mMCAI) only in patients less than 60 years. This study aimed to assess the effectiveness of DHC in patients up to 80. METHODS:This is a prospective, randomized, controlled trail compa...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s12028-012-9703-3
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Impaired cerebrovascular reactivity (CR) has been reported to be associated with adverse outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, CR may be determined using different paradigms and it is unclear, which measurement method most suitable reflects the clinical course or is abl...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-009-9287-8
更新日期:2010-04-01 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:BACKGROUND:The effects of induced hypertension (IH) on cerebral perfusion after subarachnoid hemorrhage (SAH) are unclear. The objectives of this investigation are to: (1) determine whether there are differences in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) measured with compute...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-017-0379-6
更新日期:2017-08-01 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: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: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: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:INTRODUCTION:Robotic tele-presence (RTP) is a form of mobile telemedicine, which enables a direct face-to-face rapid response by the physician, instead of the traditional telephonic paradigm. We hypothesized that a model of RTP for after-hour ICU rounds and emergencies would be associated with improved ICU nurse satisf...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9712-2
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:To propose a novel definition for hydrocephalus growth and to further describe the association between hydrocephalus growth and poor outcome among patients with intracerebral hemorrhage (ICH). METHODS:We analyzed consecutive patients who presented within 6 h after ICH ictus between July 2011 and ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01140-w
更新日期:2020-11-10 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: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-...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-016-0313-3
更新日期:2017-04-01 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: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:This study compares the effect of mild and severe cerebral ischemia on neuronal damage and neurogenesis. METHODS:Sixteen Sprague-Dawley rats, anesthetized with 0.8 vol% halothane in O(2)/air, were subjected to forebrain ischemia by bilateral common carotid artery occlusion plus hemorrhagic hypotension (mean...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-008-9121-8
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Clinical recognition of acute bacterial meningitis (ABM) and its early prognostication would guide the degree of intensive treatment required. We aimed to study the clinical features and factors associated with death in patients with community acquired ABM. METHODS:Adult patients with clinically suspected c...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9396-4
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Stroke is common after aneurysmal subarachnoid hemorrhage (aSAH). Transcranial Doppler ultrasound (TCD) monitoring is often employed to identify vasospasm and allow intervention to avoid infarction. The required duration of monitoring has not been established. We aim to determine if 10 days of TCD monitoring...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-011-9564-1
更新日期:2011-12-01 00:00:00
abstract:INTRODUCTION:To describe a new device meant for rapid endovascular thrombectomy of intracranial arteries of various sizes and its first clinical use. METHODS:A device with oriented microfilaments was constructed that consists of a core wires compound surrounded by a dense palisade of perpendicular-oriented stiff polya...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:5:2:134
更新日期:2006-01-01 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:We hypothesized that the degree of preserved functional connectivity within the DMN during the first week after cardiopulmonary arrest (CPA) would be associated with functional outcome at hospital discharge. METHODS:Initially comatose CPA survivors with indeterminate prognosis at 72 h were enrolled. Sevente...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-014-9953-3
更新日期:2014-06-01 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:Despite the recognized deleterious effects of hyperthermia on critically ill neurological patients, few investigations have studied hyperthermia after an ischemic stroke in the intensive care unit (ICU) setting. METHODS:Acute ischemic stroke patients admitted to the ICU were assigned to one of three group...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-008-9056-0
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:Patients with acute neurological illness may be hypercatabolic. The Harris-Benedict Equation (HBE) is used to estimate energy needs in acute stroke. A "stress factor" for stroke does not exist, and it is not known if the HBE accurately estimates the energy expenditure needs in acute ischemic or hemorrhagic...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:1:3:331
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Takotsubo syndrome is a reversible neuromyocardial failure that has been thought to be related to an acute catecholamine toxicity of the myocardium brought upon by a stressful event. The neurocritical care unit population is particularly vulnerable for this condition given the acute presentation of neurologi...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-008-9075-x
更新日期:2008-01-01 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: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/OBJECTIVE:In recent years, the noble gas argon (Ar) has been extensively studied for its organ protection properties. While mounting in vitro and in vivo evidence indicates that argon provides neuroprotection in ischemic brain injury, its neuroprotective potential in traumatic brain injury (TBI) has not been...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01104-0
更新日期:2020-09-21 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