Pub Date : 2023-10-31DOI: 10.32587/jnic.2023.00591.e1
W. Florez-Perdomo, Ebtesam Abdulla, L. Moscote-Salazar, S. Raj, Vishal Chavda, Amit Agrawal
{"title":"Erratum: Decompressive Laparotomy as a Treatment Option for Refractory Intracranial Hypertension in Patients With Traumatic Brain Injury: A Systematic Review","authors":"W. Florez-Perdomo, Ebtesam Abdulla, L. Moscote-Salazar, S. Raj, Vishal Chavda, Amit Agrawal","doi":"10.32587/jnic.2023.00591.e1","DOIUrl":"https://doi.org/10.32587/jnic.2023.00591.e1","url":null,"abstract":"","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139308763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2022.00556
Christian Bennet, T. Scalea, Sayuri P. Jinadasa
We report a case of locked in syndrome after direct injury to the ventral pons following penetrating trauma. Locked in syndrome is a devastating and rare neurologic disorder that most commonly occurs after cerebrovascular accident involving the basilar artery. Traumatic etiology is rare but in previously reported cases has involved blunt vascular injury as the immediate cause. We present a case of a young male who suffered a penetrating wound to the pons that resulted in locked in syndrome. The diagnosis was confirmed by thorough physical examination, CT and MR imaging, and digital subtraction angiography. Locked in syndrome is an exceptionally rare entity in trauma. Prompt diagnosis requires careful physical examination and high clinical suspicion after appropriate mechanism of injury.
{"title":"Locked in Syndrome After Penetrating Traumatic Brain Injury","authors":"Christian Bennet, T. Scalea, Sayuri P. Jinadasa","doi":"10.32587/jnic.2022.00556","DOIUrl":"https://doi.org/10.32587/jnic.2022.00556","url":null,"abstract":"We report a case of locked in syndrome after direct injury to the ventral pons following penetrating trauma. Locked in syndrome is a devastating and rare neurologic disorder that most commonly occurs after cerebrovascular accident involving the basilar artery. Traumatic etiology is rare but in previously reported cases has involved blunt vascular injury as the immediate cause. We present a case of a young male who suffered a penetrating wound to the pons that resulted in locked in syndrome. The diagnosis was confirmed by thorough physical examination, CT and MR imaging, and digital subtraction angiography. Locked in syndrome is an exceptionally rare entity in trauma. Prompt diagnosis requires careful physical examination and high clinical suspicion after appropriate mechanism of injury.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124739764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00612
J. Yu, J. Choi, K. Whang, J. Oh
Background: Intravascular embolization is an effective treatment option for cases of trauma induced massive maxillofacial bleeding (MFB). However, a viable guideline for endovascular treatment of MFB has not been established yet. This article investigates on parameters to distinguish suitable candidates of endovascular embolization among trauma victims with MFB, and discusses factors related to the clinical outcomes. Methods: From January 2015 to December 2018, 24 massive MFB patients underwent tranas-femoral angiography, and 16 of them proceeded with endovascular embolization (embolization group) while the other 8 patients only received angiography as no extravasation was observed (non-embolization group). We compared laboratory values (hemoglobin, pH, lactate, base excess) and clinical factors (blood pressure, age, initial GCS, time interval from trauma to intervention) related to the massive blood loss between the 16 of embolization group and the 8 of non-embolization group. The treatment results of angiographic intervention and mortality related factors were also compared to investigate factors related to treatment outcome.Results: Compared with non-embolization group, the patients of embolization group has a trend of lower hemoglobin (7.9 ± 3.6 g/dL vs 11.6 ± 2.3 g/dL, p = 0.047), lower base excess (-14.73 vs -6.9, p = 0.002), and lower systolic & diastolic blood pressure (100.5mmHg vs 59.9mmHg, 66.0 mmHg vs 30.9mmHg, respectively, p < 0.05). The overall mortality rate was 66.7% (87.5% in embolization group, 25% in non-embolization group). In the embolization group, there was no significant difference in all clinical and laboratory values between survivors and non-survivors. Conclusion: This study suggests initial hemoglobin, base-excess and low blood pressure as possible indicators to distinguish potential beneficiaries of facial embolization among MFB victims. However, it failed to find the viable prognosis factors to predict the clinical outcome of the embolization. Larger-scale prospective studies are needed in the future.
背景:血管内栓塞是创伤性颌面部大出血(MFB)的有效治疗方法。然而，血管内治疗MFB的可行指南尚未建立。本文探讨了在创伤性MFB患者中区分合适的血管内栓塞候选人的参数，并讨论了与临床结果相关的因素。方法:2015年1月至2018年12月，对24例大面积MFB患者行股动脉造影，其中16例行血管内栓塞(栓塞组)，8例因未见外渗仅行血管造影(非栓塞组)。我们比较了栓塞组16例和非栓塞组8例与大出血相关的实验室值(血红蛋白、pH、乳酸、碱性过剩)和临床因素(血压、年龄、初始GCS、创伤至干预时间间隔)。并比较血管造影介入治疗结果及死亡率相关因素，探讨影响治疗结果的相关因素。结果:与未栓塞组相比，栓塞组患者血红蛋白降低(7.9±3.6 g/dL vs 11.6±2.3 g/dL, p = 0.047)，基础过量降低(-14.73 vs -6.9, p = 0.002)，收缩压和舒张压降低(100.5mmHg vs 59.9mmHg, 66.0 mmHg vs 30.9mmHg, p < 0.05)。总死亡率为66.7%(栓塞组87.5%，非栓塞组25%)。在栓塞组中，幸存者和非幸存者之间的所有临床和实验室值均无显著差异。结论:本研究提示，初始血红蛋白、碱基过剩和低血压可能是区分面部栓塞患者潜在受益者的指标。然而，没有找到可行的预后因素来预测栓塞的临床结果。未来需要更大规模的前瞻性研究。
{"title":"The Role of Angiographic Interventions in Life-Threatening Traumatic Maxillofacial Bleeding","authors":"J. Yu, J. Choi, K. Whang, J. Oh","doi":"10.32587/jnic.2023.00612","DOIUrl":"https://doi.org/10.32587/jnic.2023.00612","url":null,"abstract":"Background: Intravascular embolization is an effective treatment option for cases of trauma induced massive maxillofacial bleeding (MFB). However, a viable guideline for endovascular treatment of MFB has not been established yet. This article investigates on parameters to distinguish suitable candidates of endovascular embolization among trauma victims with MFB, and discusses factors related to the clinical outcomes. Methods: From January 2015 to December 2018, 24 massive MFB patients underwent tranas-femoral angiography, and 16 of them proceeded with endovascular embolization (embolization group) while the other 8 patients only received angiography as no extravasation was observed (non-embolization group). We compared laboratory values (hemoglobin, pH, lactate, base excess) and clinical factors (blood pressure, age, initial GCS, time interval from trauma to intervention) related to the massive blood loss between the 16 of embolization group and the 8 of non-embolization group. The treatment results of angiographic intervention and mortality related factors were also compared to investigate factors related to treatment outcome.Results: Compared with non-embolization group, the patients of embolization group has a trend of lower hemoglobin (7.9 ± 3.6 g/dL vs 11.6 ± 2.3 g/dL, p = 0.047), lower base excess (-14.73 vs -6.9, p = 0.002), and lower systolic & diastolic blood pressure (100.5mmHg vs 59.9mmHg, 66.0 mmHg vs 30.9mmHg, respectively, p < 0.05). The overall mortality rate was 66.7% (87.5% in embolization group, 25% in non-embolization group). In the embolization group, there was no significant difference in all clinical and laboratory values between survivors and non-survivors. Conclusion: This study suggests initial hemoglobin, base-excess and low blood pressure as possible indicators to distinguish potential beneficiaries of facial embolization among MFB victims. However, it failed to find the viable prognosis factors to predict the clinical outcome of the embolization. Larger-scale prospective studies are needed in the future.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133772513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00605
Sofia Carolina Granados-Mendoza, W. Florez-Perdomo, Vishal Chavda, Bingwei Lu, Tariq Janjua, A. Agrawal, L. Moscote-Salazar
Background SARS-CoV-2 induced respiratory illness is increasingly being recognized to be associated with neurological manifestations including an increase in the incidence of strokes, particularly those induced by large vessel occlusion (LVO). Given this, the aim of present study was to determine the influence of SARS-CoV-2 i.e. Coronavirus disease-19 (COVID-19) on mortality, neurological outcomes, and treatment response in patients with stroke due to large vessel occlusion induced by COVID-19.Methods A search of randomized controlled trials (RCTs), prospective and retrospective cohort studies was conducted through PUBMED, SCOPUS, MEDLINE, EMBASE, the Central Cochrane Registry of Controlled Trials, and CINAHL databases. The statistical analysis was performed using the relative risk with the Mantel-Haenszel methodology for dichotomous variables with a fixed-effects model. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the publications and ROBINS-I tool was used to evaluate the risk of bias across the studies.Results Six retrospective observational cohort and case-control studies involving 1000 patients with LVO were included. The group of COVID 19 patients with LVO had a greater risk of mortality(OR= 7.09, [95% CI: 4.6-10.91], I2= 0%, p = <0.00001), fewer rates of treatment success(OR 0.15 [95% CI 0.08-0.29], I2 = 49%, p = <0.00001), and lower favorable outcomes (OR 0.39 [95% CI 0.16-0.96], I2 = 63%, p = 0.04) than COVID 19 negative patients with LVO.Conclusion The findings from present systematic review suggest that patients with COVID 19 and LVO stroke have higher mortality and poorer outcomes than COVID 19 negative patients with LVO stroke.
背景:人们越来越认识到SARS-CoV-2引起的呼吸系统疾病与神经系统症状有关，包括中风发病率的增加，特别是由大血管闭塞(LVO)引起的中风。鉴于此，本研究的目的是确定SARS-CoV-2即冠状病毒病-19 (COVID-19)对COVID-19所致大血管闭塞卒中患者的死亡率、神经预后和治疗反应的影响。方法通过PUBMED、SCOPUS、MEDLINE、EMBASE、Central Cochrane Registry of controlled trials和CINAHL数据库检索随机对照试验(RCTs)、前瞻性和回顾性队列研究。统计分析采用固定效应模型的Mantel-Haenszel方法对二分类变量进行相对风险分析。纽卡斯尔-渥太华量表(NOS)用于评估出版物的质量，ROBINS-I工具用于评估所有研究的偏倚风险。结果纳入6项回顾性观察队列和病例对照研究，共涉及1000例LVO患者。与COVID - 19阴性LVO患者相比，COVID - 19组LVO患者的死亡风险更高(OR= 7.09， [95% CI: 4.6-10.91]， I2= 0%， p = <0.00001)，治疗成功率更低(OR 0.15 [95% CI 0.08-0.29]， I2= 49%， p = <0.00001)，良好预后更低(OR 0.39 [95% CI 0.16-0.96]， I2= 63%， p = 0.04)。结论本系统评价结果提示，与COVID - 19阴性的LVO脑卒中患者相比，COVID - 19合并LVO脑卒中患者死亡率更高，预后更差。
{"title":"Large-Vessel Occlusion Stroke Associated with Covid-19: A Systematic Review and Meta-Analysis of Outcomes","authors":"Sofia Carolina Granados-Mendoza, W. Florez-Perdomo, Vishal Chavda, Bingwei Lu, Tariq Janjua, A. Agrawal, L. Moscote-Salazar","doi":"10.32587/jnic.2023.00605","DOIUrl":"https://doi.org/10.32587/jnic.2023.00605","url":null,"abstract":"Background SARS-CoV-2 induced respiratory illness is increasingly being recognized to be associated with neurological manifestations including an increase in the incidence of strokes, particularly those induced by large vessel occlusion (LVO). Given this, the aim of present study was to determine the influence of SARS-CoV-2 i.e. Coronavirus disease-19 (COVID-19) on mortality, neurological outcomes, and treatment response in patients with stroke due to large vessel occlusion induced by COVID-19.Methods A search of randomized controlled trials (RCTs), prospective and retrospective cohort studies was conducted through PUBMED, SCOPUS, MEDLINE, EMBASE, the Central Cochrane Registry of Controlled Trials, and CINAHL databases. The statistical analysis was performed using the relative risk with the Mantel-Haenszel methodology for dichotomous variables with a fixed-effects model. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the publications and ROBINS-I tool was used to evaluate the risk of bias across the studies.Results Six retrospective observational cohort and case-control studies involving 1000 patients with LVO were included. The group of COVID 19 patients with LVO had a greater risk of mortality(OR= 7.09, [95% CI: 4.6-10.91], I2= 0%, p = <0.00001), fewer rates of treatment success(OR 0.15 [95% CI 0.08-0.29], I2 = 49%, p = <0.00001), and lower favorable outcomes (OR 0.39 [95% CI 0.16-0.96], I2 = 63%, p = 0.04) than COVID 19 negative patients with LVO.Conclusion The findings from present systematic review suggest that patients with COVID 19 and LVO stroke have higher mortality and poorer outcomes than COVID 19 negative patients with LVO stroke.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117234643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2022.00535
Ebtesam Abdulla, A. Agrawal, R. Cincu, Tariq Janjua, L. Moscote-Salazar
{"title":"Cooperative Sedation in Moderate Traumatic Brain Injury: A Tool for Neurocritical Care Management","authors":"Ebtesam Abdulla, A. Agrawal, R. Cincu, Tariq Janjua, L. Moscote-Salazar","doi":"10.32587/jnic.2022.00535","DOIUrl":"https://doi.org/10.32587/jnic.2022.00535","url":null,"abstract":"","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114670070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00640
Da Ham Kim, Jiwoong Oh
Background: This study aimed to analyze the catabolic phases of patients with traumatic brain injury (TBI) by performing the Nitrogen Balance Test (NB Test).Methods: This single-centered, retrospective study included data from 292 patients who underwent NB tests from 2019 to 2022 and categorized them as TBI and Non-TBI groups. The basic clinical factors (gender, age, and initial GCS), critical care factors (APACHE, SOFA, and ICU stay days), and outcomes (GOS). The trend of the NB test was investigated in all groups and analyzed the statistical correlation of the NB test was with severity, critical care factors, and outcomes. Results: A total of 52 patients were found to have TBI. The 26 out of 52 TBI patients underwent the second NB test 1 week after the first NB test. The deficiency of protein calculated was 24.375 g. There was a significant statistical difference of NB test patterns between the non-TBI and TBI patients.Conclusion: Physicians should be aware of the catabolic phases of acute TBI events indicating notable protein loss in the patients. Therefore, we should consider the additional supply of protein when managing TBI patients.
{"title":"Analysis of Nitrogen Balance Test in Patients With Traumatic Brain Injury","authors":"Da Ham Kim, Jiwoong Oh","doi":"10.32587/jnic.2023.00640","DOIUrl":"https://doi.org/10.32587/jnic.2023.00640","url":null,"abstract":"Background: This study aimed to analyze the catabolic phases of patients with traumatic brain injury (TBI) by performing the Nitrogen Balance Test (NB Test).Methods: This single-centered, retrospective study included data from 292 patients who underwent NB tests from 2019 to 2022 and categorized them as TBI and Non-TBI groups. The basic clinical factors (gender, age, and initial GCS), critical care factors (APACHE, SOFA, and ICU stay days), and outcomes (GOS). The trend of the NB test was investigated in all groups and analyzed the statistical correlation of the NB test was with severity, critical care factors, and outcomes. Results: A total of 52 patients were found to have TBI. The 26 out of 52 TBI patients underwent the second NB test 1 week after the first NB test. The deficiency of protein calculated was 24.375 g. There was a significant statistical difference of NB test patterns between the non-TBI and TBI patients.Conclusion: Physicians should be aware of the catabolic phases of acute TBI events indicating notable protein loss in the patients. Therefore, we should consider the additional supply of protein when managing TBI patients.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121034254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00619
Dong-Wook Lee, J. Kim, D. Lim, D. Park
Background: Hemorrhagic Moyamoya disease (MMD) is a common subtype of MMD in adult patients, especially in East Asian countries. To our knowledge, current studies regarding factors affecting the prognosis in patients with hemorrhagic MMD is lacking. This study aimed to determine the potential prognostic factors for hemorrhagic MMD.Methods: This retrospective study reviewed patients with hemorrhagic MMD diagnosed at our hospital between June 2011 and June 2021. Patient outcome was measured at discharge using the extended Glasgow outcome scale (GOSE). Prognostic factors were assessed by multivariate logistic regression analysis.Results: Patients discharged with worst outcomes (GOSE 1 and 2) had significantly lower initial Glasgow coma scale (GCS) scores (5.9 ± 3.1 vs. 10.3 ± 3.7; P = 0.002) and were associated with more severe intraventricular hemorrhage (IVH) (P = 0.007), and IVH-related hydrocephalus requiring extraventricular drain (EVD) insertion was more common (n = 12 vs. n = 7; P = 0.001). The multivariate analysis showed that IVH-related hydrocephalus requiring EVD placement (OR 8.256, 95% CI 0.996–68.450; P = 0.016) and low initial GCS scores (OR 0.644; 95% CI 0.465–0.892; P = 0.008) were independent risk factors for unfavorable outcomes (GOSE 1–4) in patients with hemorrhagic MMD.Conclusion: This study analyzed several potential prognostic factors for patients with hemorrhagic MMD. Low initial GCS scores and IVH-related hydrocephalus requiring EVD insertion were related to unfavorable outcomes.
背景:出血性烟雾病(MMD)是一种常见的成人烟雾病亚型，特别是在东亚国家。据我们所知，目前关于出血性烟雾病患者预后影响因素的研究还很缺乏。本研究旨在确定出血性烟雾病的潜在预后因素。方法:本回顾性研究回顾了2011年6月至2021年6月在我院诊断的出血性烟雾病患者。出院时使用扩展格拉斯哥预后量表(GOSE)测量患者预后。采用多因素logistic回归分析评估预后因素。结果:最差结局(GOSE 1和2)出院的患者初始格拉斯哥昏迷评分(GCS)评分显著降低(5.9±3.1 vs. 10.3±3.7;P = 0.002)，并与更严重的脑室内出血(IVH)相关(P = 0.007)， IVH相关的脑积水需要脑室外引流(EVD)插入更为常见(n = 12 vs. n = 7;P = 0.001)。多因素分析显示，ivh相关性脑积水需要放置EVD (OR 8.256, 95% CI 0.996-68.450;P = 0.016)和较低的初始GCS评分(OR 0.644;95% ci 0.465-0.892;P = 0.008)是出血性烟雾病患者不良结局(GOSE 1-4)的独立危险因素。结论:本研究分析了出血性烟雾病患者的几个潜在预后因素。较低的初始GCS评分和ivh相关的脑积水需要植入EVD与不良结果相关。
{"title":"Analysis of Prognostic Factors in Patients with Hemorrhagic Moyamoya Disease","authors":"Dong-Wook Lee, J. Kim, D. Lim, D. Park","doi":"10.32587/jnic.2023.00619","DOIUrl":"https://doi.org/10.32587/jnic.2023.00619","url":null,"abstract":"Background: Hemorrhagic Moyamoya disease (MMD) is a common subtype of MMD in adult patients, especially in East Asian countries. To our knowledge, current studies regarding factors affecting the prognosis in patients with hemorrhagic MMD is lacking. This study aimed to determine the potential prognostic factors for hemorrhagic MMD.Methods: This retrospective study reviewed patients with hemorrhagic MMD diagnosed at our hospital between June 2011 and June 2021. Patient outcome was measured at discharge using the extended Glasgow outcome scale (GOSE). Prognostic factors were assessed by multivariate logistic regression analysis.Results: Patients discharged with worst outcomes (GOSE 1 and 2) had significantly lower initial Glasgow coma scale (GCS) scores (5.9 ± 3.1 vs. 10.3 ± 3.7; P = 0.002) and were associated with more severe intraventricular hemorrhage (IVH) (P = 0.007), and IVH-related hydrocephalus requiring extraventricular drain (EVD) insertion was more common (n = 12 vs. n = 7; P = 0.001). The multivariate analysis showed that IVH-related hydrocephalus requiring EVD placement (OR 8.256, 95% CI 0.996–68.450; P = 0.016) and low initial GCS scores (OR 0.644; 95% CI 0.465–0.892; P = 0.008) were independent risk factors for unfavorable outcomes (GOSE 1–4) in patients with hemorrhagic MMD.Conclusion: This study analyzed several potential prognostic factors for patients with hemorrhagic MMD. Low initial GCS scores and IVH-related hydrocephalus requiring EVD insertion were related to unfavorable outcomes.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"18 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132609649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00626
Yoon-Hee Choo, Jae Hyun Kim, Hee-Won Jung, Moinay Kim, Hanwool Jeon, E. Ha, Jiwoong Oh, Youngbo Shim, Seung Bin Kim, Han-Gil Jung, S. Park, Jung Ook Kim, Junhyung Kim, H. Kim, Seungjoo Lee
Neurocritical care has emerged as a specialized field addressing the complex needs of patients with acute neurological disorders, such as stroke, brain tumor and traumatic brain injury. The clinical management of these patients necessitates precise, individualized nutritional support due to the significant variability in neurological deficits and resting energy expenditure (REE) based on factors including stroke phase, type (hemorrhagic or ischemic), and intracranial pressure and activity of neuronal cells. This emphasizes the need for accurate, patient-specific nutritional recommendations, achievable through indirect calorimetry. Traditional predictive equations may not accurately capture the diverse nutritional requirements of neurocritical patients. Indirect calorimetry offers a more reliable, personalized approach to determining patients' nutritional needs, crucial for this heterogeneous population. Furthermore, clinical practice often inadequately addresses nutritional needs in neurocritical patients, highlighting the importance of optimizing nutritional support to enhance patient outcomes. Indirect calorimetry also plays a critical role in assessing patients with non-normal body temperatures. Hypothermia affects the body's metabolic rate and overall energy expenditure, making it challenging to evaluate energy requirements during hypothermia treatment. Indirect calorimetry can provide more accurate assessments under such conditions. In conclusion, employing indirect calorimetry in neurocritical care is essential for accurate, individualized nutritional support. By accounting for factors such as stroke type, location, intracranial pressure and body temperature, indirect calorimetry offers valuable insights and improved patient care, emphasizing its indispensability in managing neurocritical patients.
{"title":"Clinical Application and Significance of Indirect Calorimetry in Neurocritical Care","authors":"Yoon-Hee Choo, Jae Hyun Kim, Hee-Won Jung, Moinay Kim, Hanwool Jeon, E. Ha, Jiwoong Oh, Youngbo Shim, Seung Bin Kim, Han-Gil Jung, S. Park, Jung Ook Kim, Junhyung Kim, H. Kim, Seungjoo Lee","doi":"10.32587/jnic.2023.00626","DOIUrl":"https://doi.org/10.32587/jnic.2023.00626","url":null,"abstract":"Neurocritical care has emerged as a specialized field addressing the complex needs of patients with acute neurological disorders, such as stroke, brain tumor and traumatic brain injury. The clinical management of these patients necessitates precise, individualized nutritional support due to the significant variability in neurological deficits and resting energy expenditure (REE) based on factors including stroke phase, type (hemorrhagic or ischemic), and intracranial pressure and activity of neuronal cells. This emphasizes the need for accurate, patient-specific nutritional recommendations, achievable through indirect calorimetry. Traditional predictive equations may not accurately capture the diverse nutritional requirements of neurocritical patients. Indirect calorimetry offers a more reliable, personalized approach to determining patients' nutritional needs, crucial for this heterogeneous population. Furthermore, clinical practice often inadequately addresses nutritional needs in neurocritical patients, highlighting the importance of optimizing nutritional support to enhance patient outcomes. Indirect calorimetry also plays a critical role in assessing patients with non-normal body temperatures. Hypothermia affects the body's metabolic rate and overall energy expenditure, making it challenging to evaluate energy requirements during hypothermia treatment. Indirect calorimetry can provide more accurate assessments under such conditions. In conclusion, employing indirect calorimetry in neurocritical care is essential for accurate, individualized nutritional support. By accounting for factors such as stroke type, location, intracranial pressure and body temperature, indirect calorimetry offers valuable insights and improved patient care, emphasizing its indispensability in managing neurocritical patients.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"62 18","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114052567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2023.00591
William Florez-Perdo, Ebtesam Abdulla, L. Moscote-Salazar, S. Raj, Vishal Chavda, A. Agrawal
Background: Researchers investigated the role of decompressive laparotomy as a novel technique to improve the outcome of refractory intracranial hypertension in patients with severe Traumatic brain injury (TBI). In this paper, we conduct a systematic review of the literature and discuss the existing information on the role of decompressive laparotomy in patients with severe TBI. Methods: A search for RCT, not RCT, prospective and retrospective cohort studies will be carried out through electronic databases. The strategy comprised topic headings (MeSH) such as "Decompressive laparotomy," "traumatic brain damage," "Neurocritical care," and "intracranial hypertension," as well as text words related to Booleans terms. The following data were retrieved individually and separately: mortality, functional independence (modified Rankin scale 0 to 2, or Glasgow Prognostic Scale with a score of 4 or above), and intracranial pressure value before and after Decompressive laparotomy. Results: Following a thorough text review, ten articles were examined for confidentiality, one of which is a narrative review, two of which did not cover traumatic brain injury and one of which included thoracic and neck trauma, and six of which were included for qualitative and quantitative analysis. Among the six trials considered, 46 patients with TBI and intracranial hypertension were evaluated and treated with hyperosmolar treatment and/or Decompressive Craniectomy with Decompressive laparotomy. The Glasgow Outcome Scale was used to evaluate neurological prognosis and functional competence. Conclusions: According to the findings, 8% of the patients were in a chronic vegetative state, 37.93% had severe disability, 33.45% had moderate disability, and the majority (64.3%) were able to return to work with limitations. The remaining 20.6% had mild disability or good functional recovery.
{"title":"Decompressive Laparotomy as a Treatment Option for Refractory Intracranial Hypertension in Patients With Traumatic Brain Injury: A Systematic Review","authors":"William Florez-Perdo, Ebtesam Abdulla, L. Moscote-Salazar, S. Raj, Vishal Chavda, A. Agrawal","doi":"10.32587/jnic.2023.00591","DOIUrl":"https://doi.org/10.32587/jnic.2023.00591","url":null,"abstract":"Background: Researchers investigated the role of decompressive laparotomy as a novel technique to improve the outcome of refractory intracranial hypertension in patients with severe Traumatic brain injury (TBI). In this paper, we conduct a systematic review of the literature and discuss the existing information on the role of decompressive laparotomy in patients with severe TBI. Methods: A search for RCT, not RCT, prospective and retrospective cohort studies will be carried out through electronic databases. The strategy comprised topic headings (MeSH) such as \"Decompressive laparotomy,\" \"traumatic brain damage,\" \"Neurocritical care,\" and \"intracranial hypertension,\" as well as text words related to Booleans terms. The following data were retrieved individually and separately: mortality, functional independence (modified Rankin scale 0 to 2, or Glasgow Prognostic Scale with a score of 4 or above), and intracranial pressure value before and after Decompressive laparotomy. Results: Following a thorough text review, ten articles were examined for confidentiality, one of which is a narrative review, two of which did not cover traumatic brain injury and one of which included thoracic and neck trauma, and six of which were included for qualitative and quantitative analysis. Among the six trials considered, 46 patients with TBI and intracranial hypertension were evaluated and treated with hyperosmolar treatment and/or Decompressive Craniectomy with Decompressive laparotomy. The Glasgow Outcome Scale was used to evaluate neurological prognosis and functional competence. Conclusions: According to the findings, 8% of the patients were in a chronic vegetative state, 37.93% had severe disability, 33.45% had moderate disability, and the majority (64.3%) were able to return to work with limitations. The remaining 20.6% had mild disability or good functional recovery.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130379747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.32587/jnic.2022.00577
A. Haldar, Bharti Raj, V. Maurya, Mohamad Yunus, Rakesh Mishra, A. Agrawal
Trauma is a leading cause of morbidity and mortality amongst females of childbearing age, and traumatic brain injury (TBI) carries a significant proportion of share amongst trauma of all kinds. Trauma during pregnancy has a twofold impact on the patient and the foetus, who, most of the time, remains unnoticed. Understanding and managing altered maternal physiology in the background of TBI is a challenge and requires close monitoring to avoid any unwanted outcome. The challenges initiate right from the resuscitation following trauma to the rehabilitation of these patients with TBI during pregnancy. Good collaboration with the interdisciplinary departments is the backbone to avoid teratogenicity, a better pregnancy outcome and prevention of expected complications in these complex clinical scenarios.
{"title":"Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy","authors":"A. Haldar, Bharti Raj, V. Maurya, Mohamad Yunus, Rakesh Mishra, A. Agrawal","doi":"10.32587/jnic.2022.00577","DOIUrl":"https://doi.org/10.32587/jnic.2022.00577","url":null,"abstract":"Trauma is a leading cause of morbidity and mortality amongst females of childbearing age, and traumatic brain injury (TBI) carries a significant proportion of share amongst trauma of all kinds. Trauma during pregnancy has a twofold impact on the patient and the foetus, who, most of the time, remains unnoticed. Understanding and managing altered maternal physiology in the background of TBI is a challenge and requires close monitoring to avoid any unwanted outcome. The challenges initiate right from the resuscitation following trauma to the rehabilitation of these patients with TBI during pregnancy. Good collaboration with the interdisciplinary departments is the backbone to avoid teratogenicity, a better pregnancy outcome and prevention of expected complications in these complex clinical scenarios.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131178808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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