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JAMA Neurology (06/15/20) doi: 10.1001/jamaneurol.2020.1310 Hawryluk, Gregory W. J.; Jessica L. Nielson; Huie, J. Russell; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2767085 To better understand the association between intracranial pressure (ICP) and outcome, researchers conducted a prospective observational study involving 523 ICP-monitored patients. The study was conducted over a 6-year period at a single level I trauma center. Participants included 383 patients with a traumatic brain injury, with or without craniectomy, and 140 with another indication for ICP monitoring. Using a computer system to prospectively and automatically ...
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Circulation: Cardiovascular Quality and Outcomes (06/11/20) doi: 10.1161/CIRCOUTCOMES.120.006938 Khot, Umesh N.; Reimer, Andrew P.; Brown, Abigail; et al. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006938 New research shows a reduction in emergency transfers for serious cardiovascular and neurologic diseases coinciding with the COVID-19 pandemic. A team from the Cleveland Clinic, in Cleveland, OH, compared daily emergency transfers for patients experiencing ST-elevation myocardial infarction (STEMI), acute stroke, and aortic emergencies before and after a COVID-related state of emergency was declared in Ohio. The early weeks of the pandemic ...
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By J. Javier Provencio, J. Claude Hemphill, et. al. on behalf of the Neurocritical Care Society Curing Coma Campaign First Online: 23 June 2020 Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the “grand challenge” of improving the management of patients with coma and decreased ...
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By Charles E. Mahan First Online: 22 June 2020 Dear Editor, I read with interest the article evaluating ANDEXXA (coagulation factor Xa [recombinant], inactivated-zhzo; andexanet alfa [US-adopted name]) for formulary addition by Peled et al. [1]. However, many statements in the publication require further clarification, which I address below. Standard of Care Peled et al. state that no studies compare andexanet alfa to the standard of care, four-factor prothrombin complex concentrates (4F-PCCs). However, 4F-PCCs are not the standard of care for direct oral anticoagulant (DOAC)-associated bleeding, nor are they Food and Drug Administration (FDA)-approved ...
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By Kiran J. K. Rikhraj, Michael D. Wood, Ryan L. Hoiland, Sharanjit Thiara, Donald E. G. Griesdale & Mypinder S. Sekhon First Online: 22 June 2020 Abstract The use of cerebral autoregulation monitoring to identify patient-specific optimal mean arterial pressure (MAPOPT) has emerged as a technique to augment cerebral oxygen delivery in post-cardiac arrest patients. Our systematic review aims to determine (a) the average MAPOPT in these patients, (b) the feasibility of identifying MAPOPT, (c) the brain tissue oxygenation levels when MAP is within proximity to the MAPOPT and (d) the relationship between neurological outcome and MAPOPT-targeted resuscitation ...
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By Shankar Kalgudi & Kwok M. Ho First Online: 18 June 2020 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 the severity of TBI and development of venous thromboembolism. Methods Serial anti-cardiolipin antibodies, antithrombin levels, viscoelastic testing, and coagulation parameters were measured on admission, day-1, and between day-5 and day-7 in patients with severe TBI requiring ...
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By Qian Liu, Wenjuan Zhao, Yonghong Xing, Yan Hong & Guanen Zhou First Online: 18 June 2020 Background and Aims The relationship between serum lipid level and clinical outcome after spontaneous intracerebral hemorrhage (ICH) remains controversial. We sought to evaluate the association of serum lipid levels with clinical outcomes in patients with ICH. Methods Data on consecutive patients hospitalized with spontaneous ICH were prospectively collected from May 2005 to May 2018 and retrospectively analyzed. Following clinical and demographic data, age and gender, risk factors, serum lipid levels [total cholesterol, triglycerides (TG), low-density ...
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By Karen Perrin, Anu Vats, Aater Qureshi, Jeannette Hester, Angela Larson, Alfeil Felipe, Andressa Sleiman, Jacqueline Baron-Lee & Katharina Busl First Online: 17 June 2020 Background/Objective Catheter-associated urinary tract infections (CAUTIs) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2–5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. Despite the heightened risk of CAUTI occurrence for the neuro-critically ill, there is little data on specific characteristics of CAUTIs and risk factors among this population. The ...
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By Ariane Lewis, Elizabeth Kitamura & Aasim I. Padela First Online: 17 June 2020 Background We sought to evaluate how Muslim allied healthcare professionals view death by neurologic criteria (DNC). Methods We recruited participants from two listservs of Muslim American health professionals to complete an online survey questionnaire. Survey items probed views on DNC and captured professional and religious characteristics. Comparative statistical analyses were performed after dichotomizing the sample based on religiosity, and Chi-squared, Fisher’s exact tests, likelihood ratios and the Kruskal–Wallis test were used to assess differences between ...
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By Stefan Wolf First Online: 16 June 2020 Cerebral autoregulation is a well-identified therapeutic target after traumatic brain injury (TBI) in current guidelines and recommendations [1,2,3]. It represents an independent predictor for worse outcome, besides demographic and injury severity factors known on admission [4]. Targeting cerebral autoregulation may facilitate to individualize treatment in terms of precision medicine [5]. One way suggested is to identify an individual threshold for lowering of intracranial pressure (ICP) [6, 7], another one to determine the optimal cerebral perfusion pressure (CPP) for a specific patient [8, 9]. Besides well-known ...
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By Khalil S. Husari, Emily L. Johnson & Eva K. Ritzl First Online: 15 June 2020 Background To assess the acute and long-term outcomes for patients with lateralized rhythmic delta activity (LRDA) compared to patients with lateralized periodic discharges (LPDs). Methods A single-center retrospective study examining consecutive patients older than 10 years who had LRDA, LPDs, or both on continuous electroencephalographic (cEEG) between 12/01/2015 and 12/31/2017. Outcomes included inpatient mortality, functional outcome at follow-up, inpatient electrographic seizures, and the presence of new epilepsy at follow-up. Patients were classified into 4 ...
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By Savina Sahgal, Aneesha Yande, Bradford B. Thompson, Emily P. Chen, Angela Fagerlin, Lewis B. Morgenstern & Darin B. Zahuranec First Online: 15 June 2020 Background/Objective Surrogate decision makers for patients with intracerebral hemorrhage (ICH) are frequently asked to make difficult decisions on use of life-sustaining treatments. We explored ICH surrogate satisfaction with decision making and experience of decision regret using validated measures in a prospective multicenter study. Methods Cases of non-traumatic ICH were enrolled from three hospitals (September 2015–December 2016), and surrogate decision makers were invited to complete ...
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By Michael S. Wolf, Jaskaran Rakkar, Christopher M. Horvat, Dennis W. Simon, Patrick M. Kochanek, Gilles Clermont & Robert S. B. Clark First Online: 15 June 2020 Background and Aims Intracranial compliance refers to the relationship between a change in intracranial volume and the resultant change in intracranial pressure (ICP). Measurement of compliance is useful in managing cardiovascular and respiratory failure; however, there are no contemporary means to assess intracranial compliance. Knowledge of intracranial compliance could complement ICP and cerebral perfusion pressure (CPP) monitoring in patients with severe traumatic brain injury (TBI) ...
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By Keshav Goyal, Gaurav Singh Tomar, Kangana Sengar, Gyaninder Pal Singh, Richa Aggarwal, Kapil Dev Soni, Purva Mathur, Shweta Kedia & Hemanshu Prabhakar First Online: 23 June 2020 Background Traumatic brain injury (TBI) is associated with majority of trauma deaths, and objective tools are required to understand the severity of injury. The application of a biomarker like procalcitonin (PCT) in TBI may allow for assessment of severity and thus aid in prognostication and correlation with mortality and outcome. Aims The primary objective is to determine the correlation between PCT concentrations with TBI outcomes (mainly in terms of mortality) at ...
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By Katharina M. Busl, Ariane Lewis & Panayiotis N. Varelas First Online: 10 June 2020 Abstract Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT. We conducted a systematic scoping review to answer these questions by searching the literature on AT in English language available in PubMed or EMBASE since 1980. Pediatric or animal studies were excluded. A total ...
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By Afshin A. Divani, Xi Liu, Alexander Petersen, Simona Lattanzi, Craig S. Anderson, Wendy Ziai, Michel T. Torbey, Tom J. Moullaali, Michael L. James, Alibay Jafarli, Stephan A. Mayer, Jose I. Suarez, J. Claude Hemphill & Mario Di Napoli First Online:  10 June 2020 Background Early systolic blood pressure (SBP) reduction is believed to improve outcome after spontaneous intracerebral hemorrhage (ICH), but there has been a limited assessment of SBP trajectories in individual patients. We aimed to determine the prognostic significance of SBP trajectories in ICH. Methods We collected routine data on spontaneous ICH patients from two healthcare systems ...
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Title: Academic Neuroscience Nursing Company: Dartmouth-Hitchcock Description: Our Neuroscience Units offer nurses a diverse patient population which provides an excellent learning environment and the opportunity for professional development. Our robust new hire program sets each nurse up for success and allows the opportunity for nurses to “cross-train” within neurosciences to broaden their career. Our nurses have the opportunity to practice in three distinct units: Neurosciences/ENT Unit A 21-bed general medical-surgical level unit specializing in caring for patients with stroke, epilepsy, brain and/or spinal cord tumors/injuries, ...
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Date Begin: 7/1/21 Title: Neurocritical Care Fellowship Company: Henry Ford Health System Department: Neurology Position: Neurocritical Care Fellow Expertise: Neurology, IM, CCM, Neurosurgery Region: Detroit, Michigan Salary Range: Based on PGY level Description: Academic 700+ bed center. 16-bed neurointensive care unit. Fellows cover only one campus. Focus on integrated multi-modality monitoring. New fellow-oriented didactic series that includes lectures, journal clubs and M&M conferences. Copious hands-on procedure practice. Broad choice of electives. Fellowship offered for 24 months and 12 months for candidates having already ...
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By Swarna Rajagopalan, neurocritical care attending/assistant professor of Neurology and Neurosurgery, West Virginia University Hospital, Morgantown, WV Intensivists and healthcare professionals work tirelessly around the clock as the COVID-19 pandemic ravages throughout the world. This article includes heartfelt perspectives and challenges faced by colleagues on the frontlines and explores coping strategies as we tackle this pandemic together. Challenges I listened to my close friend, an infectious disease attending physician, on Facetime in April 2020, as she described her new day-to-day in New York City. “This is death like we’ve never seen before,” ...
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By Leonardo Lorente, María M. Martín, Antonia Pérez-Cejas, Agustín F. González-Rivero, Rafael Sabatel, Luis Ramos, Mónica Argueso, Jordi Solé-Violán, Juan J. Cáceres, Alejandro Jiménez & Victor García-Marín  First Online: 09 June 2020 Background Apoptotic cell death leads to secondary brain injury after spontaneous intracerebral hemorrhage (SIH). There is an association between serum caspase-3 levels and late mortality (at 6 months) in patients with SIH in basal ganglia. The new objective of this study was to determine whether there exists an association between serum caspase-3 levels and early mortality (at 30 days) in patients with SIH at different ...
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