Neurocritical Care最新文献

Background: Traumatic brain injury (TBI) is a global health problem, and its mechanisms can be divided into primary and secondary damage. Secondary injuries play a significant role in TBI outcomes. Recent studies have shown that semaglutide, a novel glucose-dependent hypoglycemic agent, inhibits neuroinflammation and cell death in some neurodegenerative diseases. However, the association between semaglutide level and TBI remains unclear. Therefore, this study aimed to investigate the neuroprotective effects of semaglutide in patients with TBI.

Method: In total, 60 C57 male mice were randomly divided into three groups: SHAM, TBI, and SEMAGLUTIDE (operation + 50 nmol/kg/day semaglutide). Behavioral tests, immunofluorescence, and western blotting were performed 72 h after impact.

Results: Semaglutide reduced neuronal apoptosis, downregulated Bax expression, and increased Bcl-2 expression after TBI. Additionally, in the downstream apoptosis pathway, semaglutide regulated proteins associated with caspase-dependent and caspase-independent pathways, with the caspase-dependent pathway being the major one. Moreover, the activation of M1 microglia was also inhibited by semaglutide, which may be related to its protective effects.

Conclusions: Semaglutide inhibited apoptosis, increased neuronal survival rate, and inhibited M1 microglial activation to improve cognitive function in TBI mice. This neuroprotective effect of semaglutide may be regionally and time dependent.

Trial registration number: 202204008 Trial registration date: 2022Y12M3D.

Objectives: Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at high risk of secondary ischemia, and timely insight into cerebral metabolism may improve clinical management. Cerebral microdialysis offers continuous metabolic monitoring but is invasive, focal, and confined to specialized centers. Peripheral blood and cerebrospinal fluid (CSF) could provide less invasive, more accessible surrogates for assessing cerebral metabolic status. This study aimed to evaluate glucose and lactate dynamics across blood, CSF, and brain parenchyma in patients with severe aSAH.

Patients and methods: A total of 39 patients with aSAH undergoing multimodal neuromonitoring were retrospectively analyzed. Glucose and lactate levels from plasma, CSF, and cerebral microdialysis were matched within 90-min intervals relative to each microdialysis measurement. Associations were analyzed using linear mixed-effects models.

Results: Plasma (p < 0.001) and CSF (p < 0.001) glucose levels were significantly associated with cerebral glucose concentrations. Moderate correlations were observed between plasma-brain (r = 0.54) and plasma-CSF (r = 0.55), while CSF-brain correlation was weaker (r = 0.36). For lactate, significant associations were found between CSF and brain (p = 0.04; r = 0.24) and between plasma and CSF (p < 0.001; r = 0.33), but plasma-brain lactate showed no significant relationship. The plasma-brain glucose association weakened slightly over time (p = 0.008) and strengthened during episodes of low brain tissue oxygenation (pbtO₂ < 15 mm Hg; p = 0.01). Insulin had no effect on glucose relationships but significantly attenuated the plasma-brain lactate association (p < 0.001). The presence of metabolic crisis (lactate/pyruvate ratio > 40) strengthened the CSF-brain lactate association (p = 0.04). CSF cell count had no significant effect.

Conclusions: In severe aSAH, glucose and lactate levels in blood and CSF reflect cerebral values in a compartment- and metabolite-specific manner, but with high variability influenced by clinical conditions. These findings suggest that blood and CSF provide only limited information about cerebral metabolism, highlighting the complementary value of cerebral microdialysis for individualized, brain-targeted monitoring.

Stroke-associated pneumonia (SAP) is a frequent and severe complication following stroke. Recently, several machine learning (ML) models have been developed to predict SAP. We aimed to evaluate the predictive performance of these models in SAP prediction. We searched PubMed, Embase, Scopus, and Web of Science up to 18 June 2025, for studies developing ML, deep learning (DL), or neural network (NN) models for SAP prediction. The pooled estimates of area under the curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR) were calculated using the R program. A total of 27 studies were included, with a prevalence of SAP at 18.9%. Most models were ML based (77.8%), and clinical data were the most common input (77.8%). The pooled AUC was 0.84 [95% (CI): 0.80-0.87], and the pooled ACC was 0.80 (95% CI: 0.76-0.84). SEN and SPE were 0.73 (95% CI: 0.63-0.81) and 0.85 (95% CI: 0.77-0.90), respectively. The pooled DOR was 15.4 (95% CI: 10.2-23.3), and the summary receiver operating characteristic (SROC) curve showed an AUC of 0.853 with a false positive rate of 0.153 (95% CI: 0.096-0.235). No significant differences were found between ischemic and hemorrhagic subgroups. ML-based models demonstrated promising performance in predicting SAP and can help physicians through the early identification of high-risk cases. However, further external validation and integration into clinical workflows are required before widespread clinical adoption.

Introduction: There has been a surge in attention to ethical controversies associated with organ donation in the USA. The Neurocritical Care Society (NCS) Ethics Committee sought to understand member experiences and attitudes related to organ donation in the USA.

Methods: We designed a survey of members who practice in the USA and have interacted with an organ procurement organization (OPO)/potential donor. The survey was disseminated by NCS from 1 June 2025 to 1 September 2025. Free-text responses were reviewed to identify themes.

Results: Of 2204 NCS members in the USA, there were 71 respondents who completed the survey and 37 respondents who provided free-text comments. Experiences and attitudes varied, but 59% of respondents indicated that they generally think that communication between the OPO and patient surrogates about donation after brain death/death by neurologic criteria seems appropriate, and 34% indicated that they generally think that communication between the OPO and patient surrogates regarding donation after cardiac death/death by circulatory-respiratory criteria (DCD) seems appropriate. Themes included (1) the need to improve education for the treatment team about organ donation; (2) blurred boundaries between patient care and care directed toward organ donation; (3) misalignment between OPOs and treatment team priorities; (4) loss of trust between patient surrogates and the treatment team based on interactions with OPOs; (5) suboptimal timing of communication between OPOs and patient surrogates; (6) concerns regarding a potential lack of transparency, empathy, and cultural sensitivity in communication between OPOs and patient surrogates; (7) opportunities for improvement in preoperative care before donation and palliation after extubation for DCD; and (8) changes in willingness to donate organs based on interactions with OPOs.

Conclusions: Although the results from this survey reflect the experience and attitudes of a small percentage of NCS members in the USA, they indicate that there are opportunities for improvement in organ donation processes. Survey results will guide the NCS Ethics Committee in supporting members navigating ethical controversies related to organ donation.

Background: Cognitive morbidities persist after pediatric critical care. However, a significant gap exists related to measuring cognitive outcomes in this patient population due to heterogeneity in presentations and objective measures. This study's purpose was to develop a psychometrically sound coding system to summarize clinically generated and performance-based neuropsychological outcomes to be used for research.

Methods: The work was conducted in two stages: (1) Cognitive Status Scale (CSS) development and (2) a retrospective pilot test in a clinically referred sample of post-critical-care youth aged 6-19 years (N = 110) to explore preliminary psychometric properties of the CSS.

Results: Principal components analysis supported the CSS structure (capturing 59% of the total explained variance). Internal consistency (α = 0.82) and interrater reliability (r = 0.92) were good. Within the full sample, criterion-related validity was demonstrated as the CSS total composite score from long-term evaluation and was significantly correlated with abbreviated performance-based cognitive outcomes from the acute recovery phase (Neurocognitive Index, r = 0.74). Divergent validity was shown via significant differences on the CSS total composite score between known clinical groups (≥ 3 Functional Status Scale [FFS] change = 30.23 vs. ≤ 2 FFS change = 50.94, t = 4.10, p ≤ 0.001, d = 0.91) and across CSS clinical indicators (F_3,106 = 8.4495, p =  < 0.001, η² = 0.194). Bivariate correlations showed a significant association in the expected direction between the CSS total composite score and the Functional Status Scale total score (r =  - 0.44, p ≤ 0.001), as well as a significant association in the expected direction between the CSS total composite score and the Behavior Rating Inventory of Executive Function, Second Edition General Executive Composite (r =  - 0.29, p = 0.010).

Conclusions: Primary evidence shows the CSS to be a reliable and valid measure for summarizing a clinically administered battery of cognitive assessments. Easy-to-generate metrics of performance-based cognition are essential to progress the state of the science germane to cognitive outcomes post pediatric critical care.

Background: Low-field portable magnetic resonance imaging (pMRI) systems have been approved for clinical use, but their feasibility, efficacy, and most appropriate clinical application in children are unknown. The objective of this study was to evaluate the diagnostic accuracy of pMRI in detecting acute brain injury (ABI) in critically ill children compared to conventional MRI (cMRI) and or computed tomography (CT).

Methods: This prospective diagnostic accuracy study included children (1 month to < 18 years) admitted between May 2021 and June 2022 who underwent pMRI scans within a 24-h window of standard neuroimaging (CT or cMRI). pMRI images were assessed for quality of images and interpreted for findings by two independent pediatric radiologists blinded to the findings of the standard imaging modalities. Diagnostic accuracy was assessed using sensitivity, specificity, and agreement statistics.

Results: pMRI scans were successfully completed in 83% of the cases (73 of 88 patients) with a median scan time of 48 min (interquartile range 43-54 min), with no patient- or machine-related adverse event. Neuroimaging indications were seizures in 38 (52.1%), unexplained encephalopathy in 29 (39.7%), and focal neurologic deficits in 19 (26%) patients. Radiological findings of pMRI included edema in 28 (38.4%), hydrocephalus in 12 (16.4%), infarction in 13 (17.8%), midline shift in 12 (16.4%), and intraparenchymal hemorrhage in 7 (9.6%). The pMRI demonstrated good agreement with cMRI and CT scans for detecting edema (87% agreement, κ = 0.7), hydrocephalus (94% agreement, κ = 0.8) and intraparenchymal hemorrhage (87% agreement, κ = 0.6). Compared to cMRI, pMRI showed 72% agreement (κ = 0.41, P = 0.0002), with 98% specificity and 73% sensitivity for hydrocephalus. Overall agreement between the two observers for pMRI was 90% (κ = 0.81, P < 0.001). Image quality was adequate for T1-weighted (n = 58, 79.5%), T2-weighted (n = 61, 83.6%), diffusion-weighted imaging (DWI) (n = 49, 67.1%), and apparent diffusion coefficient (n = 48, 65.8%) sequences. The highest number of uninterpretable images were for the DWI sequence (n = 9, 12.3%).

Conclusions: pMRI is a safe and feasible bedside imaging modality that shows promising results in diagnosing ABI in children.

Background: Minimally invasive surgery (MIS) for large supratentorial intracerebral hemorrhage (ICH) addresses primary brain injury by reducing mass effect, causing midline shift (MLS). We investigated the relationship between MIS, MLS, and functional outcomes in a large clinical trial.

Methods: We conducted a post hoc analysis of patients with qualified computed tomography (CT) images from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation trial. The exposure was MLS at the pineal gland (PG) and septum pellucidum (SP) on CT scans at diagnosis, end of treatment (EOT), and hospital discharge. The primary outcome was 30-day mortality. Secondary outcomes were mortality and modified Rankin scale score at day 365. We performed multivariable logistic regression and mediation analyses, adjusted for demographics, ICH characteristics, and treatment.

Results: Participants had a median age of 62 years and a median ICH volume of 44 mL, and 61% were male. Thirty-day mortality was 12%. MLS on EOT CT was significantly lower in surgical patients compared with medical patients. EOT MLS in day 30 surgical survivors was also significantly lower compared with that in medically treated survivors and nonsurvivors. The odds of 30-day mortality on adjusted analyses were significantly increased by 1 mm in MLS at both the PG and SP (PG: odds ratio 1.22, 95% confidence interval 1.06-1.41; SP: odds ratio 1.22, 95% confidence interval 1.10-1.36). Thresholds of MLS change < 3 mm (SP) and < 5 mm (PG) were associated with mortality reduction. The association of MIS with 30-day mortality was mediated fully by change in either the SP or PG MLS from diagnostic to EOT CT. Change in MLS was significantly associated with one-year mortality and, for SP, with one-year good functional outcome (modified Rankin scale scores 0-3).

Conclusions: MIS for ICH significantly reduces MLS. This reduction in MLS significantly mediates reduction in 30-day mortality with MIS and is associated with both short-term and long-term outcomes.