Pub Date : 2023-04-30DOI: 10.32587/jnic.2022.00563
Daulat Singh, Jitender Chaturvedi, Rakesh Mishra, V. Maurya, R. Cincu, Mohamad Yunus, L. Moscote-Salazar, A. Agrawal
There is increasing role of routine laboratory parameters in identifying neuroinflammation in various neurological disorders. This has led to the need to identify reliable, accessible, and cost-effective biomarkers that can help predict the outcome following injury to the brain. The parameters of interest include a neutrophil-to-lymphocyte ratio (NLR), red cell width distribution (RDW), red cell width (RDW)-to-platelet ratio (RPR), and NLR times RPR (NLTRP). The aim of the present systematic review and meta-analysis is to evaluate the prognostic value of Red Cell Distribution Width to Platelet Count Ratio (RPR) in various neuropsychiatric disorders. The studies that reported "Red Cell Distribution Width to Platelet Count Ratio" and "Outcome" in neurological conditions and the full text was published in English were included in the systematic review and if the studies two or more than two a further metanalysis was performed. Two investigators performed the literature search that included PubMed, COCHRANE, SCOPUS, and ScienceDirect (from inception to June 8th 2022). The full text of the shortlisted articles was reviewed, and the articles were included based on our inclusion and exclusion criteria. Search resulted in 293 records, and after removing the duplicates, total five studies were found to be eligible to be included in the systematic review. After analysing the full text, five studies were excluded; out of these four studies described only red cell width distribution but did not mention the details of red cell width distribution-to-platelet distribution ratio and one study had methodology like described in another article (with smaller sample size and the same source of data) by same authors. Haematological parameters are promising predictor of mortality for acute TBI, overall survival (OS) in Glioma, affective disorders, predicting outcome in deep seated ICH.
{"title":"A Scoping Review of Role of Red Cell Width Distribution-To-Platelet Count Ratio in Neurological Disorders","authors":"Daulat Singh, Jitender Chaturvedi, Rakesh Mishra, V. Maurya, R. Cincu, Mohamad Yunus, L. Moscote-Salazar, A. Agrawal","doi":"10.32587/jnic.2022.00563","DOIUrl":"https://doi.org/10.32587/jnic.2022.00563","url":null,"abstract":"There is increasing role of routine laboratory parameters in identifying neuroinflammation in various neurological disorders. This has led to the need to identify reliable, accessible, and cost-effective biomarkers that can help predict the outcome following injury to the brain. The parameters of interest include a neutrophil-to-lymphocyte ratio (NLR), red cell width distribution (RDW), red cell width (RDW)-to-platelet ratio (RPR), and NLR times RPR (NLTRP). The aim of the present systematic review and meta-analysis is to evaluate the prognostic value of Red Cell Distribution Width to Platelet Count Ratio (RPR) in various neuropsychiatric disorders. The studies that reported \"Red Cell Distribution Width to Platelet Count Ratio\" and \"Outcome\" in neurological conditions and the full text was published in English were included in the systematic review and if the studies two or more than two a further metanalysis was performed. Two investigators performed the literature search that included PubMed, COCHRANE, SCOPUS, and ScienceDirect (from inception to June 8th 2022). The full text of the shortlisted articles was reviewed, and the articles were included based on our inclusion and exclusion criteria. Search resulted in 293 records, and after removing the duplicates, total five studies were found to be eligible to be included in the systematic review. After analysing the full text, five studies were excluded; out of these four studies described only red cell width distribution but did not mention the details of red cell width distribution-to-platelet distribution ratio and one study had methodology like described in another article (with smaller sample size and the same source of data) by same authors. Haematological parameters are promising predictor of mortality for acute TBI, overall survival (OS) in Glioma, affective disorders, predicting outcome in deep seated ICH.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"44 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":"121966590","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.2023.00633
J. Ha, Sangpyung Lee, Seonghwan Kim, Kyoungsoo Ryou, T. Park, Jiyoung Kim, Bonghyun Jeong, Jin-Ah Beak
Background: Cerebral vasospasm is a prevalent complication in traumatic brain injury (TBI), particularly in cases of traumatic subarachnoid hemorrhage (T-SAH), for which monitoring and treatment policies remain undefined.Methods: A study was conducted on 49 T-SAH patients with multiple traumas to investigate cerebral vasospasm following T-SAH. Participants underwent transcranial doppler (TCD) and brain CT angiography (CTA) upon hospitalization and subsequent follow-up within seven days. Vasospasm was diagnosed through a comprehensive evaluation of TCD, CTA, and symptoms, with risk factors analyzed accordingly. The initial clinical status was assessed using the Glasgow Coma Scale (GCS), modified Fisher scale (mFS), and Hunt-Hess grade (HHG), while examining various factors to identify underlying risks and evaluating overall body damage via the Injury Severity Score (ISS).Results: Cerebral vasospasm was confirmed in 19 out of the total 49 patients, which is 38.8%. Furthermore, the characteristics that had a statistically significant correlation with the vasospasm group were low GCS (p=0.03, odd ratio=0.592) and high ISS (p=0.022, odd ratio=1.124). Moreover, patients with vasospasm exhibited worse prognoses based on the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS).Conclusion: These findings suggest that T-SAH patients with severe initial brain and systemic damage or neurological deficits should undergo active monitoring using modalities such as TCD and CTA, followed by treatment to prevent and manage vasospasm.
{"title":"Cerebral Vasospasm After Traumatic Subarachnoid Hemorrhage and Its Risk Factor: Combined Periodic Follow Up of Transcranial Doppler and CT Angiography","authors":"J. Ha, Sangpyung Lee, Seonghwan Kim, Kyoungsoo Ryou, T. Park, Jiyoung Kim, Bonghyun Jeong, Jin-Ah Beak","doi":"10.32587/jnic.2023.00633","DOIUrl":"https://doi.org/10.32587/jnic.2023.00633","url":null,"abstract":"Background: Cerebral vasospasm is a prevalent complication in traumatic brain injury (TBI), particularly in cases of traumatic subarachnoid hemorrhage (T-SAH), for which monitoring and treatment policies remain undefined.Methods: A study was conducted on 49 T-SAH patients with multiple traumas to investigate cerebral vasospasm following T-SAH. Participants underwent transcranial doppler (TCD) and brain CT angiography (CTA) upon hospitalization and subsequent follow-up within seven days. Vasospasm was diagnosed through a comprehensive evaluation of TCD, CTA, and symptoms, with risk factors analyzed accordingly. The initial clinical status was assessed using the Glasgow Coma Scale (GCS), modified Fisher scale (mFS), and Hunt-Hess grade (HHG), while examining various factors to identify underlying risks and evaluating overall body damage via the Injury Severity Score (ISS).Results: Cerebral vasospasm was confirmed in 19 out of the total 49 patients, which is 38.8%. Furthermore, the characteristics that had a statistically significant correlation with the vasospasm group were low GCS (p=0.03, odd ratio=0.592) and high ISS (p=0.022, odd ratio=1.124). Moreover, patients with vasospasm exhibited worse prognoses based on the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS).Conclusion: These findings suggest that T-SAH patients with severe initial brain and systemic damage or neurological deficits should undergo active monitoring using modalities such as TCD and CTA, followed by treatment to prevent and manage vasospasm.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"68 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":"128584023","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 : 2022-10-31DOI: 10.32587/jnic.2022.00570
H. Choi, J. Yeon, Seunghoon Lee
Secondary hemifacial spasm (HFS) occurs by a conflict between the facial nerve and intracranial pathology, such as cerebellopontine angle tumor or vascular abnormality like arteriovenous malformation (AVM) or aneurysm. HFS caused by AVM is rare, and optimal combination of treatment options has not been established. AVM treatment with or without microvascular decompression (MVD) of the facial nerve was provided in the previous studies, and the outcomes in terms of spasm relief have been successful. Here, we report a case of HFS caused by cerebellar AVM. HFS symptom disappeared after AVM nidus removal without MVD of the facial nerve.
{"title":"Hemifacial Spasm Caused by Cerebellar Arteriovenous Malformation and Spasm-Relief after Nidus Removal","authors":"H. Choi, J. Yeon, Seunghoon Lee","doi":"10.32587/jnic.2022.00570","DOIUrl":"https://doi.org/10.32587/jnic.2022.00570","url":null,"abstract":"Secondary hemifacial spasm (HFS) occurs by a conflict between the facial nerve and intracranial pathology, such as cerebellopontine angle tumor or vascular abnormality like arteriovenous malformation (AVM) or aneurysm. HFS caused by AVM is rare, and optimal combination of treatment options has not been established. AVM treatment with or without microvascular decompression (MVD) of the facial nerve was provided in the previous studies, and the outcomes in terms of spasm relief have been successful. Here, we report a case of HFS caused by cerebellar AVM. HFS symptom disappeared after AVM nidus removal without MVD of the facial nerve.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129995297","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 : 2022-10-31DOI: 10.32587/jnic.2022.00542
V. Maurya, Rakesh Mishra, L. Moscote-Salazar, Tariq Janjua, R. Cincu, A. Agrawal
The golden hour is the time following an injury during which appropriate medical attention carries the highest likelihood of a better outcome. The concept of a golden hour was probably derived from the French Military’s World war I data for the care of trauma victims, but it is suitable for all types of acute emergencies. During these golden sixty minutes, the health care providers must focus on eliminating or mitigating the effect of critical events. If not timely addressed, these essential steps carry a maximum threat to the victim’s life by causing irreversible damage to vital organs. The major challenge in applying intervention during the golden hour is correctly identifying the correctable step in the victim at the earliest. Training individuals about basic life support is the first challenge to delivering care at the scene of an accident/ or event or during transport. The advances in the diagnostic modality and the faster means of transportation have been a major driving force in decreasing mortality during the early hours following the incident. In the present review, we attempt to draw attention to the importance of golden hour and emphasize that team-building and quality improvement are crucial to providing better outcomes.
{"title":"Neurotrauma Care, “Golden Hour” or “Golden Sixty Minutes”","authors":"V. Maurya, Rakesh Mishra, L. Moscote-Salazar, Tariq Janjua, R. Cincu, A. Agrawal","doi":"10.32587/jnic.2022.00542","DOIUrl":"https://doi.org/10.32587/jnic.2022.00542","url":null,"abstract":"The golden hour is the time following an injury during which appropriate medical attention carries the highest likelihood of a better outcome. The concept of a golden hour was probably derived from the French Military’s World war I data for the care of trauma victims, but it is suitable for all types of acute emergencies. During these golden sixty minutes, the health care providers must focus on eliminating or mitigating the effect of critical events. If not timely addressed, these essential steps carry a maximum threat to the victim’s life by causing irreversible damage to vital organs. The major challenge in applying intervention during the golden hour is correctly identifying the correctable step in the victim at the earliest. Training individuals about basic life support is the first challenge to delivering care at the scene of an accident/ or event or during transport. The advances in the diagnostic modality and the faster means of transportation have been a major driving force in decreasing mortality during the early hours following the incident. In the present review, we attempt to draw attention to the importance of golden hour and emphasize that team-building and quality improvement are crucial to providing better outcomes.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117180549","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 : 2022-10-31DOI: 10.32587/jnic.2022.00521
Ji Hong Kim, Dong Hwan Kim, Hyun Park, D. Kang, C. Lee, Jin-Myung Jung, Insung Park, Kyeong-O Go
Ventriculitis has a poor prognosis, and treatment is technically challenging. We describe a case of ventriculitis in which bilateral continuous extraventricular lavage was performed and review the previously published literature on the treatment of ventriculitis using extra-ventricular drainage (EVD). A 75-year-old woman lost consciousness while undergoing intravenous meropenem treatment for a submandibular abscess. Contrast-enhanced brain magnetic resonance imaging (MRI) revealed ventriculitis and fluid collection with diffusion restriction at both occipital horns of the lateral ventricles and third ventricle that indicate empyema. She was referred to the neurosurgery department for an emergent operation. An extra-ventricular drainage catheter was inserted bilaterally at Kocher’s point. Since ventriculitis was disseminated from the submandibular abscess and intravenous meropenem as empirical antibiotics had been administered, meropenem-mixed saline was continuously dripped through one EVD catheter intraoperatively, and approximately 1 L of saline with antibiotics was drained until grossly clear fluid flowed through the other EVD catheter. MRI was performed 28 days postoperatively, and diffusion-weighted images showed a decrease in restriction, and the cerebrospinal fluid profile appeared to have improved. The ventriculoperitoneal shunt was performed 34 days after EVD lavage due to secondary hydrocephalus. Three months later, the patient was available for cane-gait and is currently undergoing follow-up without neurological complications. Continuous intraoperative lavage through bilateral EVD is relatively simple and maintains more aseptic conditions during the procedure. Although ventriculitis is fetal in patients, bilateral extraventricular lavage can be a relatively safe and effective conventional administration of antibiotics for ventriculitis.
{"title":"Intraventricular Lavage Via Bilateral Extraventricular Lavage: A Case Report and Literatures Review","authors":"Ji Hong Kim, Dong Hwan Kim, Hyun Park, D. Kang, C. Lee, Jin-Myung Jung, Insung Park, Kyeong-O Go","doi":"10.32587/jnic.2022.00521","DOIUrl":"https://doi.org/10.32587/jnic.2022.00521","url":null,"abstract":"Ventriculitis has a poor prognosis, and treatment is technically challenging. We describe a case of ventriculitis in which bilateral continuous extraventricular lavage was performed and review the previously published literature on the treatment of ventriculitis using extra-ventricular drainage (EVD). A 75-year-old woman lost consciousness while undergoing intravenous meropenem treatment for a submandibular abscess. Contrast-enhanced brain magnetic resonance imaging (MRI) revealed ventriculitis and fluid collection with diffusion restriction at both occipital horns of the lateral ventricles and third ventricle that indicate empyema. She was referred to the neurosurgery department for an emergent operation. An extra-ventricular drainage catheter was inserted bilaterally at Kocher’s point. Since ventriculitis was disseminated from the submandibular abscess and intravenous meropenem as empirical antibiotics had been administered, meropenem-mixed saline was continuously dripped through one EVD catheter intraoperatively, and approximately 1 L of saline with antibiotics was drained until grossly clear fluid flowed through the other EVD catheter. MRI was performed 28 days postoperatively, and diffusion-weighted images showed a decrease in restriction, and the cerebrospinal fluid profile appeared to have improved. The ventriculoperitoneal shunt was performed 34 days after EVD lavage due to secondary hydrocephalus. Three months later, the patient was available for cane-gait and is currently undergoing follow-up without neurological complications. Continuous intraoperative lavage through bilateral EVD is relatively simple and maintains more aseptic conditions during the procedure. Although ventriculitis is fetal in patients, bilateral extraventricular lavage can be a relatively safe and effective conventional administration of antibiotics for ventriculitis.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131130250","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 : 2022-10-31DOI: 10.32587/jnic.2022.00549
K. Lee, J. Kim, D. Park
BackgroundPentothal coma therapy (PCT) and targeted temperature management (TTM) are considered the most aggressive medical care for patients with severe traumatic brain injury (TBI). However, there is very little comparison between these two options. We compared the survival rates and complications between the two treatments.MethodsNineteen patients who received treatment for PCT or TTM after severe TBI between March 2018 and April 2022 were retrospectively enrolled. Medical records were reviewed, including general information, neurologic status, treatment courses, survival rate, and complications. Patients were divided into two groups according to the treatment modalities (PCT vs. TTM), and comparison analyses were conducted.ResultsThe survival rate in the TTM group was 33.3% (3/9), which was higher than that in the PCT group (1/10, 10%). However, this difference was not significant (p = 0.213). In terms of complications, there were no statistically significant differences in hemodynamic instability, cardiovascular disability, hepatic dysfunction, renal dysfunction, pneumonia, urinary tract infection, hyperkalemia, hypokalemia, coagulopathy, or hyperglycemia. Commonly observed complications included hypokalemia in the TTM group (100% in the TTM group vs 70% in the PCT group; p = 0.073) and hyperkalemia in the PCT group (50% in the PCT group vs 11.1% in the TTM group; p = 0.069).ConclusionSevere TBI patients treated with TTM has non-significantly lower mortality than them with PCT (66.7% vs. 90%); however, complications of hypokalemia can be frequently observed (100%). Further study was necessary to evaluate the efficacy and safety of TTM.
背景喷妥昏迷治疗(PCT)和靶向温度管理(TTM)被认为是对严重创伤性脑损伤(TBI)患者最积极的医疗护理。然而，这两种选择之间几乎没有可比性。我们比较了两种治疗方法的生存率和并发症。方法回顾性纳入2018年3月至2022年4月期间接受PCT或TTM治疗的19例重度TBI患者。回顾医疗记录，包括一般信息、神经系统状况、疗程、存活率和并发症。根据治疗方式将患者分为两组(PCT vs. TTM)，进行比较分析。结果TTM组患者生存率为33.3%(3/9)，高于PCT组(1/ 10,10 %)。然而，这种差异不显著(p = 0.213)。在并发症方面，两组在血流动力学不稳定、心血管功能障碍、肝功能障碍、肾功能障碍、肺炎、尿路感染、高钾血症、低钾血症、凝血功能障碍、高血糖等方面差异无统计学意义。常见的并发症包括TTM组低钾血症(TTM组为100%，PCT组为70%;p = 0.073)和高钾血症(PCT组50% vs TTM组11.1%;P = 0.069)。结论TTM治疗重型TBI患者的死亡率低于PCT治疗(66.7% vs. 90%);然而，低钾血症的并发症可以经常观察到(100%)。还需要进一步的研究来评价中药的疗效和安全性。
{"title":"Comparison Between Complications of Pentothal Coma Therapy and Targeted Temperature Management in Traumatic Brain Injury Patients","authors":"K. Lee, J. Kim, D. Park","doi":"10.32587/jnic.2022.00549","DOIUrl":"https://doi.org/10.32587/jnic.2022.00549","url":null,"abstract":"BackgroundPentothal coma therapy (PCT) and targeted temperature management (TTM) are considered the most aggressive medical care for patients with severe traumatic brain injury (TBI). However, there is very little comparison between these two options. We compared the survival rates and complications between the two treatments.MethodsNineteen patients who received treatment for PCT or TTM after severe TBI between March 2018 and April 2022 were retrospectively enrolled. Medical records were reviewed, including general information, neurologic status, treatment courses, survival rate, and complications. Patients were divided into two groups according to the treatment modalities (PCT vs. TTM), and comparison analyses were conducted.ResultsThe survival rate in the TTM group was 33.3% (3/9), which was higher than that in the PCT group (1/10, 10%). However, this difference was not significant (p = 0.213). In terms of complications, there were no statistically significant differences in hemodynamic instability, cardiovascular disability, hepatic dysfunction, renal dysfunction, pneumonia, urinary tract infection, hyperkalemia, hypokalemia, coagulopathy, or hyperglycemia. Commonly observed complications included hypokalemia in the TTM group (100% in the TTM group vs 70% in the PCT group; p = 0.073) and hyperkalemia in the PCT group (50% in the PCT group vs 11.1% in the TTM group; p = 0.069).ConclusionSevere TBI patients treated with TTM has non-significantly lower mortality than them with PCT (66.7% vs. 90%); however, complications of hypokalemia can be frequently observed (100%). Further study was necessary to evaluate the efficacy and safety of TTM.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125413869","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 : 2022-10-31DOI: 10.32587/jnic.2022.00493
C. Yoon, H. Choi, J. Ryu
Background: To evaluate whether the obesity paradox exists in neurocritically ill patients.Methods: This was a retrospective, observational study of patient admitted to the neurosurgical intensive care unit (ICU) from January 2013 to December 2019. The subjects were classified into two groups: the non-obese group (body mass index [BMI] < 25 kg/m2) and the overweighted or obese group (BMI ≥ 25 kg/m2). The primary endpoint was in-hospital mortality. Results: A total of 527 patients were included in this study. The mean BMI was 23.7 ± 3.6 kg/m2. Of all neurosurgical patients, 157 patients were overweighted or obese. There were no significant differences in in-hospital mortality, 28-day mortality, and ICU mortality between the two groups (all p > 0.05). BMI on ICU admission was similar between survivors and non-survivors at discharge (p = 0.596). In the multivariable analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, invasive intracranial pressure (ICP) monitoring, and use of more than one hyperosmolar agent were identified to be significantly associated with in-hospital mortality. However, BMI on ICU admission, and serum albumin level were not associated with in-hospital mortality. The obesity demonstrated a borderline significance relationship with the probability of in-hospital mortality (p=0.073). Conclusions: In this study, BMI on ICU admission, and serum albumin level demonstrated a lack of significant association with in-hospital mortality. Clinical factors including APHCHE II score, ICP monitoring, and hyperosmolar therapy were identified to be associated with prognosis in neurocritically ill patients. Eventually, the impact of the obesity paradox on these patients remains unclear.
{"title":"Association of Obesity With Clinical Outcomes in Neurocritically Ill Patients","authors":"C. Yoon, H. Choi, J. Ryu","doi":"10.32587/jnic.2022.00493","DOIUrl":"https://doi.org/10.32587/jnic.2022.00493","url":null,"abstract":"Background: To evaluate whether the obesity paradox exists in neurocritically ill patients.Methods: This was a retrospective, observational study of patient admitted to the neurosurgical intensive care unit (ICU) from January 2013 to December 2019. The subjects were classified into two groups: the non-obese group (body mass index [BMI] < 25 kg/m2) and the overweighted or obese group (BMI ≥ 25 kg/m2). The primary endpoint was in-hospital mortality. Results: A total of 527 patients were included in this study. The mean BMI was 23.7 ± 3.6 kg/m2. Of all neurosurgical patients, 157 patients were overweighted or obese. There were no significant differences in in-hospital mortality, 28-day mortality, and ICU mortality between the two groups (all p > 0.05). BMI on ICU admission was similar between survivors and non-survivors at discharge (p = 0.596). In the multivariable analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, invasive intracranial pressure (ICP) monitoring, and use of more than one hyperosmolar agent were identified to be significantly associated with in-hospital mortality. However, BMI on ICU admission, and serum albumin level were not associated with in-hospital mortality. The obesity demonstrated a borderline significance relationship with the probability of in-hospital mortality (p=0.073). Conclusions: In this study, BMI on ICU admission, and serum albumin level demonstrated a lack of significant association with in-hospital mortality. Clinical factors including APHCHE II score, ICP monitoring, and hyperosmolar therapy were identified to be associated with prognosis in neurocritically ill patients. Eventually, the impact of the obesity paradox on these patients remains unclear.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"08 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129203697","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 : 2022-10-31DOI: 10.32587/jnic.2022.00528
Myung-Han Ryu, S. Suh, Min-Seok Lee, Yoon-Soo Lee, Jeong-Ho Lee, S. Cho
Background: Acute subdural hematoma (SDH) often leads to serious neurological deterioration or death. Patients with acute SDH are recommended decompressive craniectomy (DC) if their brain edema is severe. We investigated the association with early mortality through postoperative radiological studies after surgery.Methods: We retrospectively reviewed 31 out of 85 patients that underwent DC due to acute SDH at our neurosurgical department in January 2011–December 2020. The effect of decompression was estimated through comparison with preoperative and postoperative midline shift (MS) in brain computed tomography (CT). Brain edema was represented as an increased value, measured by comparing the lateral displaced parenchymal diameter with the normal brain diameter.Results: Of the total 31 patients, 15 died during hospitalization (group A) and 16 had the same or improved neurological status (group B). The reduction rate of MS was shown as higher in group B than in group A; it was significantly different between the two groups. The difference between the two values (DBD) was calculated by measuring the brain diameter of the operative site after DC and normal brain diameter for the progress of brain edema. The difference value of MS (DMS) was greater than DBD for 33.3% and 81.3% of group A and B patients, respectively. Conclusion: A lower MS reduction rate or higher DBD than DMS increases a patient’s early mortality rate. Therefore, early mortality in acute SDH patients who underwent DC could be predicted through analysis of postoperative brain CT.
{"title":"Postoperative Radiological Factors Associated with Early Mortality after Decompressive Craniectomy in Acute Subdural Hematoma","authors":"Myung-Han Ryu, S. Suh, Min-Seok Lee, Yoon-Soo Lee, Jeong-Ho Lee, S. Cho","doi":"10.32587/jnic.2022.00528","DOIUrl":"https://doi.org/10.32587/jnic.2022.00528","url":null,"abstract":"Background: Acute subdural hematoma (SDH) often leads to serious neurological deterioration or death. Patients with acute SDH are recommended decompressive craniectomy (DC) if their brain edema is severe. We investigated the association with early mortality through postoperative radiological studies after surgery.Methods: We retrospectively reviewed 31 out of 85 patients that underwent DC due to acute SDH at our neurosurgical department in January 2011–December 2020. The effect of decompression was estimated through comparison with preoperative and postoperative midline shift (MS) in brain computed tomography (CT). Brain edema was represented as an increased value, measured by comparing the lateral displaced parenchymal diameter with the normal brain diameter.Results: Of the total 31 patients, 15 died during hospitalization (group A) and 16 had the same or improved neurological status (group B). The reduction rate of MS was shown as higher in group B than in group A; it was significantly different between the two groups. The difference between the two values (DBD) was calculated by measuring the brain diameter of the operative site after DC and normal brain diameter for the progress of brain edema. The difference value of MS (DMS) was greater than DBD for 33.3% and 81.3% of group A and B patients, respectively. Conclusion: A lower MS reduction rate or higher DBD than DMS increases a patient’s early mortality rate. Therefore, early mortality in acute SDH patients who underwent DC could be predicted through analysis of postoperative brain CT.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131899656","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 : 2022-10-31DOI: 10.32587/jnic.2022.00514
Ebtesam Abdulla, Tariq Janjua, A. Agrawal, L. Moscote-Salazar, Mario Contreras-Arrieta, E. Cortecero-Sabalza, Winston Eduardo Cárdenas Chávez
The systemic inflammatory response syndrome (SIRS) consists of an inflammatory phenomenon as a response of the immune system against infections, as well as non-infectious injuries, which includes manifestations that affect multiple organs, among which hyperthermia or hypothermia, leukopenia or leukocytosis, tachycardia, and tachypnea. SIRS accompanies different acute brain and spinal cord injuries, including subarachnoid hemorrhage, intracerebral hemorrhage, spinal cord trauma, traumatic brain injury, and status epilepticus. We suggest a new term for this condition neurogenically originated systemic inflammatory response syndrome (NoSIRS). NIRS can be considered a new syndrome associated with pathological neurological conditions. However, more research is needed to figure out the true severity of this clinical picture and also figure out the best way to treat this condition.
{"title":"Neurogenically Originated Inflammatory Response Syndrome: Role in the Neurocritical Patient","authors":"Ebtesam Abdulla, Tariq Janjua, A. Agrawal, L. Moscote-Salazar, Mario Contreras-Arrieta, E. Cortecero-Sabalza, Winston Eduardo Cárdenas Chávez","doi":"10.32587/jnic.2022.00514","DOIUrl":"https://doi.org/10.32587/jnic.2022.00514","url":null,"abstract":"The systemic inflammatory response syndrome (SIRS) consists of an inflammatory phenomenon as a response of the immune system against infections, as well as non-infectious injuries, which includes manifestations that affect multiple organs, among which hyperthermia or hypothermia, leukopenia or leukocytosis, tachycardia, and tachypnea. SIRS accompanies different acute brain and spinal cord injuries, including subarachnoid hemorrhage, intracerebral hemorrhage, spinal cord trauma, traumatic brain injury, and status epilepticus. We suggest a new term for this condition neurogenically originated systemic inflammatory response syndrome (NoSIRS). NIRS can be considered a new syndrome associated with pathological neurological conditions. However, more research is needed to figure out the true severity of this clinical picture and also figure out the best way to treat this condition.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129789923","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 : 2022-04-30DOI: 10.32587/jnic.2021.00437
L. Moscote-Salazar, Tariq Janjua, Y. Picón-Jaimes, I. Lozada‐Martínez, C. Barros, Maximiliano Paez-Nova, A. Agrawal
Traumatic brain injury is an important cause of disability, especially in the young population. According to Center for Disease Control and prevention data, there has been an increase in cases in the last 2 decades, despite the notable development of preventive technologies and the development of management guides. Clinical inertia is a concept where late initiation or lack of intensification of treatment in a patient and the failure to achieve the goals established from the beginning. This can be defined in the management term as therapeutic inertia. This concept is well known in pathologies such as hypertension and diabetes, in which we do not reach the therapeutic goal, and this carries the risk of deterioration of the patient. It is known that therapeutic inertia occurs in half of the cases due to failures by the clinicians, in 30% associated with the patient himself, and 20% due to the characteristics of the health care system. The burden of brain trauma injury leads to multiple Swiss cheese breakthroughs with clinical inertia is one of the unknown factors. To better understand the element of clinical inertia and traumatic brain injury management, a brief visit to the process of traumatic brain injury will be helpful. Traumatic brain injury management starts in the field, followed by a transit time to the trauma bay. In trauma bay, most of the level trauma centers already have a trauma team present to receive traumatic brain injury. Here things can get complicated. The patient needs to have 2 levels of trauma reviews including imaging studies, a neurosurgical consult, and further management. Some patients go to the operating room but mostly end up in the trauma intensive care for at least 72 hours before a major neurosurgical procedure is performed. After 72 hours, the neurocritical care management has different phases: acute phase, stabilization phase/non-survival phase, and discharge planning. All these phases lead to multiple areas of clinical inertia. This clinical inertia is related to progression of care, change of shifts, the arrival of new admits, and major disasters like the present Covid-19 pandemic. Looking at the progression of care in traumatic brain injury patients, multiple steps can be reviewed, and a stage is set to reduce the risk of clinical inertia (Fig. 1).
{"title":"Clinical Inertia: The Care Gap between Clinical Guidelines and Clinical Practice in Neurotrauma","authors":"L. Moscote-Salazar, Tariq Janjua, Y. Picón-Jaimes, I. Lozada‐Martínez, C. Barros, Maximiliano Paez-Nova, A. Agrawal","doi":"10.32587/jnic.2021.00437","DOIUrl":"https://doi.org/10.32587/jnic.2021.00437","url":null,"abstract":"Traumatic brain injury is an important cause of disability, especially in the young population. According to Center for Disease Control and prevention data, there has been an increase in cases in the last 2 decades, despite the notable development of preventive technologies and the development of management guides. Clinical inertia is a concept where late initiation or lack of intensification of treatment in a patient and the failure to achieve the goals established from the beginning. This can be defined in the management term as therapeutic inertia. This concept is well known in pathologies such as hypertension and diabetes, in which we do not reach the therapeutic goal, and this carries the risk of deterioration of the patient. It is known that therapeutic inertia occurs in half of the cases due to failures by the clinicians, in 30% associated with the patient himself, and 20% due to the characteristics of the health care system. The burden of brain trauma injury leads to multiple Swiss cheese breakthroughs with clinical inertia is one of the unknown factors. To better understand the element of clinical inertia and traumatic brain injury management, a brief visit to the process of traumatic brain injury will be helpful. Traumatic brain injury management starts in the field, followed by a transit time to the trauma bay. In trauma bay, most of the level trauma centers already have a trauma team present to receive traumatic brain injury. Here things can get complicated. The patient needs to have 2 levels of trauma reviews including imaging studies, a neurosurgical consult, and further management. Some patients go to the operating room but mostly end up in the trauma intensive care for at least 72 hours before a major neurosurgical procedure is performed. After 72 hours, the neurocritical care management has different phases: acute phase, stabilization phase/non-survival phase, and discharge planning. All these phases lead to multiple areas of clinical inertia. This clinical inertia is related to progression of care, change of shifts, the arrival of new admits, and major disasters like the present Covid-19 pandemic. Looking at the progression of care in traumatic brain injury patients, multiple steps can be reviewed, and a stage is set to reduce the risk of clinical inertia (Fig. 1).","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129820348","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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