@article{MTMT:34559957, title = {Prediction of neurocritical care intensity through automated infrared pupillometry and transcranial doppler in blunt traumatic brain injury: the NOPE study}, url = {https://m2.mtmt.hu/api/publication/34559957}, author = {Banco, P. and Taccone, F.S. and Sourd, D. and Privitera, C. and Bosson, J.-L. and Teixeira, T.L. and Adolle, A. and Payen, J.-F. and Bouzat, P. and Gauss, T.}, doi = {10.1007/s00068-023-02435-1}, journal-iso = {EUR J TRAUMA EMERG S}, journal = {EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY}, unique-id = {34559957}, issn = {1863-9933}, year = {2024}, eissn = {1863-9941} } @article{MTMT:34643324, title = {Early-Goal Directed Therapy for Brain-Injured Patients}, url = {https://m2.mtmt.hu/api/publication/34643324}, author = {Brasil, Sergio and Salvagno, Michele and Baggiani, Marta and Taccone, Fabio Silvio}, doi = {10.1007/s40140-024-00615-2}, journal-iso = {CURR ANESTHESIOL REP}, journal = {CURRENT ANESTHESIOLOGY REPORTS}, unique-id = {34643324}, issn = {1523-3855}, keywords = {neuromonitoring; neurocritical care; Therapeutic interventions; early goal-directed therapy; Acute brain injuries; Secondary brain injuries; Neuro-intensive care unit}, year = {2024}, eissn = {2167-6275} } @article{MTMT:34559972, title = {Protocol for a Randomized Trial Comparing Intracranial Pressure Monitor?Based Management of Severe Pediatric Traumatic Brain Injury with Management Based on Imaging and Clinical Examination Without Intracranial Pressure Monitoring}, url = {https://m2.mtmt.hu/api/publication/34559972}, author = {Chesnut, R. and Temkin, N. and Pridgeon, J. and Sulzbacher, S. and Lujan, S. and Videtta, W. and Moya-Barquín, L. and Chaddock, K. and Bonow, R. and Petroni, G. and Guadagnoli, N. and Hendrickson, P. and Ramírez, Cortez G. and Carreazo, N.Y. and Vargas, Aymituma A. and Anchante, D. and Caqui, P. and Ramírez, A. and Munaico, Abanto M. and Ortiz, Chicchon M. and Cenzano, Ramos J. and Mazate-Mazariegos, A. and Castro, Darce M.D.C. and Sierra, Morales R. and Brol, Lopez P. and Menendez, W. and Posadas, Gutierrez S. and Kevin, V. and Mazariegos, A. and De, Leon E. and Rodas, Barrios R.E. and Rodríguez, S. and Flores, S. and Alvarado, O. and Guzman, Flores L.J. and Moisa, Martinez M. and Gonzalez, P.}, doi = {10.1227/neu.0000000000002582}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {94}, unique-id = {34559972}, issn = {0148-396X}, year = {2024}, eissn = {1524-4040}, pages = {65-71} } @article{MTMT:34640246, title = {Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Research Algorithms}, url = {https://m2.mtmt.hu/api/publication/34640246}, author = {Chesnut, Randall and Temkin, Nancy and Pridgeon, James and Sulzbacher, Stephen and Lujan, Silvia and Videtta, Walter and Moya-Barquin, Luis and Chaddock, Kelley and Bonow, Robert H. and Petroni, Gustavo and Guadagnoli, Nahuel and Hendrickson, Peter and Cortez, Grimaldo Ramirez and Carreazo, Nilton Yhuri and Aymituma, Alcides Vargas and Anchante, Daniel and Caqui, Patrick and Ramirez, Alberto and Abanto, Manuel Munaico and Chicchon, Manuel Ortiz and Ramos, Jose Cenzano and Darce, Maria del Carmen Castro and Morales, Roberto Sierra and Lopez, Pedro Brol and Menendez, Willy and Gutierrez, Sofia Posadas and Kevin, Vicente and Mazariegos, Andrea and de Leon, Elie and Barrios, Rodolfo Enrique Rodas and Rodriguez, Sandra and Flores, Sandra and Alvarado, Ovidio and Flores, Luis Jose Guzman and Martinez, Melvin Moisa and Gonzalez, Pablo}, doi = {10.1227/neu.0000000000002760}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {94}, unique-id = {34640246}, issn = {0148-396X}, keywords = {traumatic brain injury; global health; neurocritical care; intracranial pressure monitoring; Treatment algorithms; Consensus-based recommendations; Intracranial hypertension management; Pediatric severe traumatic brain injury}, year = {2024}, eissn = {1524-4040}, pages = {72-79}, orcid-numbers = {Chesnut, Randall/0000-0001-6377-3666} } @article{MTMT:34559958, title = {Long-Term Follow-Up of Critically Ill Patients With Traumatic Brain Injury: From Intensive Care Parameters to Patient and Caregiver-Reported Outcome}, url = {https://m2.mtmt.hu/api/publication/34559958}, author = {Domensino, A.-F. and Tas, J. and Donners, B. and Kooyman, J. and van, der Horst I.C.C. and Haeren, R. and Ariës, M.J.H. and van, Heugten C.}, doi = {10.1089/neu.2022.0474}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, volume = {41}, unique-id = {34559958}, issn = {0897-7151}, year = {2024}, eissn = {1557-9042}, pages = {123-134} } @article{MTMT:34640248, title = {Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study}, url = {https://m2.mtmt.hu/api/publication/34640248}, author = {Robba, Chiara and Battaglini, Denise and Abbas, Abbas and Sarrio, Ezequiel and Cinotti, Raphael and Asehnoune, Karim and Taccone, Fabio S. and Rocco, Patricia R. and Schultz, Marcus J. and Citerio, Giuseppe and Stevens, Robert David and Badenes, Rafael}, doi = {10.1007/s00134-023-07305-3}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, unique-id = {34640248}, issn = {0342-4642}, keywords = {Carbon Dioxide; intensive care; stroke; brain injury; hyperventilation; Critical care; TBI; ICH; SAH; PaCO2; INVASIVE VENTILATION}, year = {2024}, eissn = {1432-1238} } @article{MTMT:34559955, title = {Non-contrast ultrasound image analysis for spatial and temporal distribution of blood flow after spinal cord injury}, url = {https://m2.mtmt.hu/api/publication/34559955}, author = {Routkevitch, D. and Soulé, Z. and Kats, N. and Baca, E. and Hersh, A.M. and Kempski-Leadingham, K.M. and Menta, A.K. and Bhimreddy, M. and Jiang, K. and Davidar, A.D. and Smit, C. and Theodore, N. and Thakor, N.V. and Manbachi, A.}, doi = {10.1038/s41598-024-51281-7}, journal-iso = {SCI REP}, journal = {SCIENTIFIC REPORTS}, volume = {14}, unique-id = {34559955}, issn = {2045-2322}, year = {2024}, eissn = {2045-2322} } @article{MTMT:34643323, title = {Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury: A Propensity Score Matching Analysis Using a Nationwide Inpatient Database in Japan}, url = {https://m2.mtmt.hu/api/publication/34643323}, author = {Shibahashi, Keita and Ohbe, Hiroyuki and Matsui, Hiroki and Yasunaga, Hideo}, doi = {10.1227/neu.0000000000002611}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {94}, unique-id = {34643323}, issn = {0148-396X}, keywords = {CHILDREN; intensive care; traumatic brain injury; Pediatrics; IN-HOSPITAL MORTALITY; Patient outcome; intracranial pressure monitoring}, year = {2024}, eissn = {1524-4040}, pages = {99-107}, orcid-numbers = {Shibahashi, Keita/0000-0001-5651-1449} } @article{MTMT:34559956, title = {Neuro Point-of-Care Ultrasound}, url = {https://m2.mtmt.hu/api/publication/34559956}, author = {Sigman, E.J. and Laghari, F.J. and Sarwal, A.}, doi = {10.1053/j.sult.2023.12.005}, journal-iso = {SEMIN ULTRASOUND CT}, journal = {SEMINARS IN ULTRASOUND CT AND MRI}, unique-id = {34559956}, issn = {0887-2171}, year = {2024}, eissn = {1558-5034} } @inproceedings{MTMT:34559987, title = {Effect of Barbiturate Coma Therapy on Patients with Resistant Intracranial Hypertension: A Meta-Analysis}, url = {https://m2.mtmt.hu/api/publication/34559987}, author = {Abdildin, Y. and Jyeniskhan, N. and Salamat, A. and Tungushpayev, M. and Viderman, D.}, booktitle = {2023 International Conference on Decision Aid Sciences and Applications (DASA)}, doi = {10.1109/DASA59624.2023.10286695}, unique-id = {34559987}, year = {2023}, pages = {485-488} } @article{MTMT:34330741, title = {Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage}, url = {https://m2.mtmt.hu/api/publication/34330741}, author = {Addis, Alberto and Baggiani, Marta and Citerio, Giuseppe}, doi = {10.1007/s12028-023-01752-y}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {39}, unique-id = {34330741}, issn = {1541-6933}, abstract = {Aneurysmal subarachnoid hemorrhage is a medical condition that can lead to intracranial hypertension, negatively impacting patients' outcomes. This review article explores the underlying pathophysiology that causes increased intracranial pressure (ICP) during hospitalization. Hydrocephalus, brain swelling, and intracranial hematoma could produce an ICP rise. Although cerebrospinal fluid withdrawal via an external ventricular drain is commonly used, ICP monitoring is not always consistently practiced. Indications for ICP monitoring include neurological deterioration, hydrocephalus, brain swelling, intracranial masses, and the need for cerebrospinal fluid drainage. This review emphasizes the importance of ICP monitoring and presents findings from the Synapse-ICU study, which supports a correlation between ICP monitoring and treatment with better patient outcomes. The review also discusses various therapeutic strategies for managing increased ICP and identifies potential areas for future research.}, keywords = {review; SUBARACHNOID HEMORRHAGE; Intracranial Pressure}, year = {2023}, eissn = {1556-0961}, pages = {59-69}, orcid-numbers = {Citerio, Giuseppe/0000-0002-5374-3161} } @article{MTMT:34333924, title = {Brain Oxygenation Response to Hypercapnia in Patients with Acute Brain Injury}, url = {https://m2.mtmt.hu/api/publication/34333924}, author = {Anderloni, Marco and Schuind, Sophie and Salvagno, Michele and Donadello, Katia and Peluso, Lorenzo and Annoni, Filippo and Taccone, Fabio Silvio and Bogossian, Elisa Gouvea}, doi = {10.1007/s12028-023-01833-y}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, unique-id = {34333924}, issn = {1541-6933}, abstract = {Background Cerebral hypoxia is a frequent cause of secondary brain damage in patients with acute brain injury. Although hypercapnia can increase intracranial pressure, it may have beneficial effects on tissue oxygenation. We aimed to assess the effects of hypercapnia on brain tissue oxygenation (PbtO(2)).Methods This single-center retrospective study (November 2014 to June 2022) included all patients admitted to the intensive care unit after acute brain injury who required multimodal monitoring, including PbtO(2) monitoring, and who underwent induced moderate hypoventilation and hypercapnia according to the decision of the treating physician. Patients with imminent brain death were excluded. Responders to hypercapnia were defined as those with an increase of at least 20% in PbtO(2) values when compared to their baseline levels.Results On a total of 163 eligible patients, we identified 23 (14%) patients who underwent moderate hypoventilation (arterial partial pressure of carbon dioxide [PaCO2] from 44 [42-45] to 50 [49-53] mm Hg; p < 0.001) during the study period at a median of 6 (4-10) days following intensive care unit admission; six patients had traumatic brain injury, and 17 had subarachnoid hemorrhage. A significant overall increase in median PbtO(2) values from baseline (21 [19-26] to 24 [22-26] mm Hg; p = 0.02) was observed. Eight (35%) patients were considered as responders, with a median increase of 7 (from 4 to 11) mm Hg of PbtO(2), whereas nonresponders showed no changes (from - 1 to 2 mm Hg of PbtO(2)). Because of the small sample size, no variable independently associated with PbtO(2) response was identified. No correlation between changes in PaCO2 and in PbtO(2) was observed.Conclusions In this study, a heterogeneous response of PbtO(2) to induced hypercapnia was observed but without any deleterious elevations of intracranial pressure.}, keywords = {Hypercapnia; brain injury; Cerebral hypoxia; brain tissue oxygenation; Multimodal monitoring}, year = {2023}, eissn = {1556-0961}, orcid-numbers = {Peluso, Lorenzo/0000-0001-6885-5353} } @article{MTMT:34333926, title = {Cerebral autoregulation: every step counts}, url = {https://m2.mtmt.hu/api/publication/34333926}, author = {Ayasse, Timothee and Duranteau, Jacques and Harrois, Anatole and Pochard, Jonas}, doi = {10.1186/s13054-023-04595-3}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {34333926}, issn = {1364-8535}, year = {2023}, eissn = {1466-609X} } @article{MTMT:34559961, title = {Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Hospital Course, Confounders, and Medications}, url = {https://m2.mtmt.hu/api/publication/34559961}, author = {Barra, M.E. and Zink, E.K. and Bleck, T.P. and Cáceres, E. and Farrokh, S. and Foreman, B. and Cediel, E.G. and Hemphill, J.C. and Nagayama, M. and Olson, D.W.M. and Suarez, J.I. and Aiyagari, V. and Akbari, Y. and Al-Mufti, F. and Alexander, S. and Alexandrov, A. and Alkhachroum, A. and Amiri, M. and Appavu, B. and Gebre, M.A. and Bader, M.K. and Badjiata, N. and Balu, R. and Beekman, R. and Beghi, E. and Bell, K. and Beqiri, E. and Berlin, T. and Bodien, Y. and Boerwinkle, V. and Boly, M. and Bonnel, A. and Brown, E. and Carroll, E. and Chou, S. and Citerio, G. and Classen, J. and Condie, C. and Cosmas, K. and Creutzfeldt, C. and Dangayach, N. and DeGeorgia, M. and Der-Nigoghoss, C. and Desai, M. and Diringer, M. and Dullaway, J. and Edlow, B. and Ercole, A. and Estraneo, A. and Falcone, G. and Padayachy, L. and Park, S. and Pergakis, M. and Polizzotto, L. and Pouratian, N. and Spivack, M.P. and Prisco, L. and Provencio, J. and Puybasset, L. and Rasmussen, L. and Rass, V. and Richardson, R. and Shinots, C.R. and Robba, C. and Robertson, C. and Rohaut, B. and Rolston, J. and Rosanova, M. and Rosenthal, E. and Russell, M.B. and Silva, G.S. and Sanz, L. and Sarasso, S. and Sarwal, A. and Schiff, N. and Schnakers, C. and Seder, D. and Shah, V.A. and Shapiro-Rosen, A. and Shapshak, A. and Sharma, K. and Sharshar, T. and Shutter, L. and Sitt, J. and Slomine, B. and Smielewski, P. and Smith, W. and Stamatakis, E. and Steinberg, A. and Ferioli, S. and Fernandez-Esp, D. and Fink, E. and Fins, J. and Frontera, J. and Ganesan, R. and Ghavam, A. and Giacino, J. and Gibbons, C. and Gilmore, E. and Gosseries, O. and Green, T. and Greer, D. and Guanci, M. and Hahn, C. and Hakimi, R. and Hanley, D.F. and Hartings, J. and Hassan, A. and Hinson, H. and Hirsch, K. and Hocker, S. and Hu, P. and Hu, X. and Human, T. and Hwang, D. and Illes, J. and Jaffa, M. and James, M.L. and Janas, A. and Jones, M. and Keller, E. and Keogh, M. and Kim, J. and Kim, K. and Kirsch, H. and Kirschen, M. and Ko, N. and Kondziella, D. and Kreitzer, N. and Stevens, R. and Sussman, B. and Taran, S. and Thibaut, A. and Threlkeld, Z. and Tinti, L. and Toker, D. and Torbey, M. and Trevick, S. and Turgeon, A. and Udy, A. and Varelas, P. and Venkatasubba, C. and Vespa, P. and Videtta, W. and Voss, H. and Vox, F. and Wagner, A. and Wainwright, M. and Whyte, J. and Witherspoon, B. and Yakhind, A. and Zafonte, R. and Zahuranec, D. and Zammit, C. and Zhang, B. and Ziai, W. and Zimmerman, L. and Kromm, J. and Kumar, A. and Kurtz, P. and Laureys, S. and Lawson, T. and Lejeune, N. and Lewis, A. and Liang, J. and Ling, G. and Livesay, S. and Luppi, A. and Madden, L. and Maddux, C. and Mahanes, D. and Mainali, S. and Maldonado, N. and Ribeiro, R.M. and Massimini, M. and Mayer, S. and McCredie, V. and McNett, M. and Mejia-Mantill, J. and Menon, D. and Meyfroidt, G. and Mijangos, J. and Moberg, D. and Moheet, A. and Molteni, E. and Monti, M. and Morrison, C. and Muehlschlegel, S. and Murtaugh, B. and Naccache, L. and Nairon, E. and Natarajan, G. and Newcombe, V. and Nielsen, N. and Noronha-Falc‹, F. and Nyquist, P. and Othman, M. and Owen, A. and Curing, Coma Campaign its contributing members}, doi = {10.1007/s12028-023-01803-4}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {39}, unique-id = {34559961}, issn = {1541-6933}, year = {2023}, eissn = {1556-0961}, pages = {586-592} } @article{MTMT:34559992, title = {Survey on red blood cell transfusion criteria in the intensive care unit}, url = {https://m2.mtmt.hu/api/publication/34559992}, author = {Barrero, J. and Carreño, J.N. and Pomar, Hoyos M. and Vargas, A.}, doi = {10.1016/j.acci.2022.09.003}, journal-iso = {ACTA COLOMB DE CUID INTENSIVO}, journal = {ACTA COLOMBIANA DE CUIDADO iNTENSIVO}, volume = {23}, unique-id = {34559992}, issn = {0122-7262}, year = {2023}, pages = {1-7} } @article{MTMT:33944157, title = {Monitoring of Brain Tissue Oxygen Tension in Cardiac Arrest: a Translational Systematic Review from Experimental to Clinical Evidence}, url = {https://m2.mtmt.hu/api/publication/33944157}, author = {Battaglini, Denise and Bogossian, Elisa Gouvea and Anania, Pasquale and Premraj, Lavienraj and Cho, Sung-Min and Taccone, Fabio Silvio and Sekhon, Mypinder and Robba, Chiara}, doi = {10.1007/s12028-023-01721-5}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, unique-id = {33944157}, issn = {1541-6933}, abstract = {BackgroundCardiac arrest (CA) is a sudden event that is often characterized by hypoxic-ischemic brain injury (HIBI), leading to significant mortality and long-term disability. Brain tissue oxygenation (PbtO(2)) is an invasive tool for monitoring brain oxygen tension, but it is not routinely used in patients with CA because of the invasiveness and the absence of high-quality data on its effect on outcome. We conducted a systematic review of experimental and clinical evidence to understand the role of PbtO(2) in monitoring brain oxygenation in HIBI after CA and the effect of targeted PbtO(2) therapy on outcomes.MethodsThe search was conducted using four search engines (PubMed, Scopus, Embase, and Cochrane), using the Boolean operator to combine mesh terms such as PbtO(2), CA, and HIBI.ResultsAmong 1,077 records, 22 studies were included (16 experimental studies and six clinical studies). In experimental studies, PbtO(2) was mainly adopted to assess the impact of gas exchanges, drugs, or systemic maneuvers on brain oxygenation. In human studies, PbtO(2) was rarely used to monitor the brain oxygen tension in patients with CA and HIBI. PbtO(2) values had no clear association with patients' outcomes, but in the experimental studies, brain tissue hypoxia was associated with increased inflammation and neuronal damage.ConclusionsFurther studies are needed to validate the effect and the threshold of PbtO(2) associated with outcome in patients with CA, as well as to understand the physiological mechanisms influencing PbtO(2) induced by gas exchanges, drug administration, and changes in body positioning after CA.}, keywords = {neuromonitoring; Cardiac arrest; hypoxic-ischemic brain injury; brain tissue oxygenation; brain oxygen tension}, year = {2023}, eissn = {1556-0961}, orcid-numbers = {Anania, Pasquale/0000-0001-8477-9629} } @article{MTMT:34555689, title = {Cerebrospinal fluid analysis of metabolites is not correlated to microdialysis measurements in acute brain injured patients}, url = {https://m2.mtmt.hu/api/publication/34555689}, author = {Bellettieri, Michele Pio Giovanni and Anderloni, Marco and Rass, Verena and Kindl, Philipp and Donadello, Katia and Taccone, Fabio Silvio and Helbok, Raimund and Bogossian, Elisa Gouvea}, doi = {10.1016/j.clineuro.2023.108011}, journal-iso = {CLIN NEUROL NEUROSUR}, journal = {CLINICAL NEUROLOGY AND NEUROSURGERY}, volume = {234}, unique-id = {34555689}, issn = {0303-8467}, abstract = {Background: Cerebral microdialysis (CMD) has become an established bedside monitoring modality but its implementation remains complex and costly and is therefore performed only in a few well-trained academic centers. This study investigated the relationship between cerebrospinal fluid (CSF) and CMD glucose and lactate concentrations.Methods: Two centers retrospective study of prospectively collected data. Consecutive adult (>18 years) acutely brain injured patients admitted to the Intensive Care Unit between 2010 and 2021 were eligible if CSF and CMD glucose and lactate concentrations were concomitantly measured at least once.Results: Of 113 patients being monitored with an external ventricular drainage and CMD, 49 patients (25 from Innsbruck and 24 from Brussels) were eligible for the final analysis, including a total of 96 measurements. Median CMD glucose and lactate concentrations were 1.15 (0.51-1.57) mmol/L and 3.44 (2.24-5.37) mmol/L, respectively; median CSF glucose and lactate concentrations were 4.67 (4.03-5.34) mmol/L and 3.40 (2.85-4.10) mmol/L, respectively. For the first measurements, no correlation between CSF and CMD glucose concentrations (R-2 <0.01; p = 0.95) and CSF and CMD lactate concentrations (R-2 =0.16; p = 0.09) was found. Considering all measurements, the repeated measure correlation analysis also showed no correlation for glucose (r(rm) = -0.01; 95% Confidence Intervals -0.306 to 0.281; p = 0.93) and lactate (r(rm) = -0.11; 95% Confidence Intervals -0.424 to 0.236; p = 0.55).Conclusions: In this study including acute brain injured patients, no correlation between CSF and brain tissue measurements of glucose and lactate was observed. As such, CSF measurements of such metabolites cannot replace CMD findings.}, keywords = {FLOW; physiology; traumatic brain injury; SUBARACHNOID HEMORRHAGE; SUBARACHNOID HEMORRHAGE; interstitial fluid; Clinical Neurology; lumbar; cerebral metabolism}, year = {2023}, eissn = {1872-6968} } @article{MTMT:33937372, title = {Neurological and respiratory effects of lung protective ventilation in acute brain injury patients without lung injury: brain vent, a single centre randomized interventional study}, url = {https://m2.mtmt.hu/api/publication/33937372}, author = {Beqiri, Erta and Smielewski, Peter and Guerin, Claude and Czosnyka, Marek and Robba, Chiara and Bjertnaes, Lars and Frisvold, Shirin K.}, doi = {10.1186/s13054-023-04383-z}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {33937372}, issn = {1364-8535}, abstract = {Introduction Lung protective ventilation (LPV) comprising low tidal volume ( VT) and high positive end-expiratory pressure (PEEP) may compromise cerebral perfusion in acute brain injury (ABI). In patients with ABI, we investigated whether LPV is associated with increased intracranial pressure (ICP) and/or deranged cerebral autoregulation (CA), brain compensatory reserve and oxygenation. Methods In a prospective, crossover study, 30 intubated ABI patients with normal ICP and no lung injury were randomly assigned to receive low VT [6 ml/kg/predicted (pbw)]/at either low (5 -cmH(2)O) or high PEEP (12 -cmH(2)O). Between each intervention, baseline ventilation ( VT 9 ml/kg/pbw and PEEP 5 -cmH(2)O) were resumed. The safety limit for interruption of the intervention was ICP above 22 mmHg for more than 5 min. Airway and transpulmonary pressures were continuously monitored to assess respiratory mechanics. We recorded ICP by using external ventricular drainage or a parenchymal probe. CA and brain compensatory reserve were derived from ICP waveform analysis. Results We included 27 patients (intracerebral haemorrhage, traumatic brain injury, subarachnoid haemorrhage), of whom 6 reached the safety limit, which required interruption of at least one intervention. For those without intervention interruption, the ICP change from baseline to "low VT/low PEEP" and "low VT/high PEEP" were 2.2 mmHg and 2.3 mmHg, respectively, and considered clinically non-relevant. None of the interventions affected CA or oxygenation significantly. Interrupted events were associated with high baseline ICP (p < 0.001), low brain compensatory reserve (p < 0.01) and mechanical power (p < 0.05). The transpulmonary driving pressure was 5 +/- 2 -cmH(2)O in both interventions. Partial arterial pressure of carbon dioxide was kept in the range 34-36 mmHg by adjusting the respiratory rate, hence, changes in carbon dioxide were not associated with the increase in ICP. Conclusions The present study found that most patients did not experience any adverse effects of LPV, neither on ICP nor CA. However, in almost a quarter of patients, the ICP rose above the safety limit for interrupting the interventions. Baseline ICP, brain compensatory reserve, and mechanical power can predict a potentially deleterious effect of LPV and can be used to personalize ventilator settings.}, keywords = {traumatic brain injury; Intracranial Pressure; Positive end-expiratory pressure; Cerebral autoregulation; Acute brain injury; Subarachnoid haemorrhage; Lung protective ventilation; transpulmonary pressure}, year = {2023}, eissn = {1466-609X} } @article{MTMT:33435300, title = {Neurotrauma and Intracranial Pressure Management}, url = {https://m2.mtmt.hu/api/publication/33435300}, author = {Bernard, Francis}, doi = {10.1016/j.ccc.2022.08.002}, journal-iso = {CRIT CARE CLIN}, journal = {CRITICAL CARE CLINICS}, volume = {39}, unique-id = {33435300}, issn = {0749-0704}, keywords = {traumatic brain injury; AUTOREGULATION; Intracranial Pressure; cerebral perfusion pressure; CEREBRAL OXYGENATION; Multimodality monitoring; Lund therapy; Optimization of care}, year = {2023}, eissn = {1557-8232}, pages = {103-121} } @{MTMT:34559908, title = {Head and Brain Trauma}, url = {https://m2.mtmt.hu/api/publication/34559908}, author = {Bertolini, G. and Cattani, L. and Iaccarino, C. and Fornaciari, A. and Picetti, E.}, booktitle = {Textbook of Emergency General Surgery}, doi = {10.1007/978-3-031-22599-4_39}, unique-id = {34559908}, year = {2023}, pages = {581-604} } @article{MTMT:34333928, title = {Considerations for Intracranial Monitoring and Surgery in Severe Traumatic Brain Injury with Temporal Lobe Contusion}, url = {https://m2.mtmt.hu/api/publication/34333928}, author = {Chen, Patrick M. M. and Shah, Ishan and Manning, Conrad and Lekawa, Michael and Chen, Jefferson W. W.}, doi = {10.1007/s12028-023-01756-8}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {39}, unique-id = {34333928}, issn = {1541-6933}, keywords = {traumatic brain injury; Intracranial Pressure; brain tissue oxygenation; Multimodal monitoring; uncal herniation}, year = {2023}, eissn = {1556-0961}, pages = {527-529} } @article{MTMT:34280470, title = {Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations}, url = {https://m2.mtmt.hu/api/publication/34280470}, author = {Chesnut, Randall M. and Aguilera, Sergio and Buki, Andras and Bulger, Eileen M. and Citerio, Giuseppe and Cooper, D. Jamie and Arrastia, Ramon Diaz and Diringer, Michael and Figaji, Anthony and Gao, Guoyi and Geocadin, Romergryko G. and Ghajar, Jamshid and Harris, Odette and Hawryluk, Gregory W. J. and Hoffer, Alan and Hutchinson, Peter and Joseph, Mathew and Kitagawa, Ryan and Manley, Geoffrey and Mayer, Stephan and Menon, David K. and Meyfroidt, Geert and Michael, Daniel B. and Oddo, Mauro and Okonkwo, David O. and Patel, Mayur B. and Robertson, Claudia and Rosenfeld, Jeffrey V. and Rubiano, Andres M. and Sahuquillo, Juain and Servadei, Franco and Shutter, Lori and Stein, Deborah M. and Stocchetti, Nino and Taccone, Fabio Silvio and Timmons, Shelly D. and Tsai, Eve C. and Ullman, Jamie S. and Videtta, Walter and Wright, David W. and Zammit, Christopher}, doi = {10.1227/neu.0000000000002516}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {93}, unique-id = {34280470}, issn = {0148-396X}, abstract = {BACKGROUND:Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed.OBJECTIVE:To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion.METHODS:We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression.RESULTS:Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations.CONCLUSION:Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.}, keywords = {Algorithms; traumatic brain injury; Practice Guidelines; consensus development; Intracranial Hypertension; neurocritical care; intracranial pressure monitoring}, year = {2023}, eissn = {1524-4040}, pages = {399-408}, orcid-numbers = {Citerio, Giuseppe/0000-0002-5374-3161} } @article{MTMT:33917212, title = {Effects of short-term hyperoxemia on cerebral autoregulation and tissue oxygenation in acute brain injured patients}, url = {https://m2.mtmt.hu/api/publication/33917212}, author = {Ciliberti, Pietro and Cardim, Danilo and Giardina, Alberto and Groznik, Matjaz and Ball, Lorenzo and Giovannini, Martina and Battaglini, Denise and Beqiri, Erta and Matta, Basil and Smielewski, Peter and Czosnyka, Marek and Pelosi, Paolo and Robba, Chiara}, doi = {10.3389/fphys.2023.1113386}, journal-iso = {FRONT PHYSIOL}, journal = {FRONTIERS IN PHYSIOLOGY}, volume = {14}, unique-id = {33917212}, abstract = {Introduction: Potential detrimental effects of hyperoxemia on outcomes have been reported in critically ill patients. Little evidence exists on the effects of hyperoxygenation and hyperoxemia on cerebral physiology. The primary aim of this study is to assess the effect of hyperoxygenation and hyperoxemia on cerebral autoregulation in acute brain injured patients. We further evaluated potential links between hyperoxemia, cerebral oxygenation and intracranial pressure (ICP).Methods: This is a single center, observational, prospective study. Acute brain injured patients [traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH)] undergoing multimodal brain monitoring through a software platform (ICM+) were included. Multimodal monitoring consisted of invasive ICP, arterial blood pressure (ABP) and near infrared spectrometry (NIRS). Derived parameters of ICP and ABP monitoring included the pressure reactivity index (PRx) to assess cerebral autoregulation. ICP, PRx, and NIRS-derived parameters (cerebral regional saturation of oxygen, changes in concentration of regional oxy- and deoxy-hemoglobin), were evaluated at baseline and after 10 min of hyperoxygenation with a fraction of inspired oxygen (FiO(2)) of 100% using repeated measures t-test or paired Wilcoxon signed-rank test. Continuous variables are reported as median (interquartile range).Results: Twenty-five patients were included. The median age was 64.7 years (45.9-73.2), and 60% were male. Thirteen patients (52%) were admitted for TBI, 7 (28%) for SAH, and 5 (20%) patients for ICH. The median value of systemic oxygenation (partial pressure of oxygen-PaO2) significantly increased after FiO(2) test, from 97 (90-101) mm Hg to 197 (189-202) mm Hg, p < 0.0001. After FiO(2) test, no changes were observed in PRx values (from 0.21 (0.10-0.43) to 0.22 (0.15-0.36), p = 0.68), nor in ICP values (from 13.42 (9.12-17.34) mm Hg to 13.34 (8.85-17.56) mm Hg, p = 0.90). All NIRS-derived parameters reacted positively to hyperoxygenation as expected. Changes in systemic oxygenation and the arterial component of cerebral oxygenation were significantly correlated (respectively delta PaO2 and delta O(2)Hbi; r = 0.49 (95% CI = 0.17-0.80).Conclusion: Short-term hyperoxygenation does not seem to critically affect cerebral autoregulation.}, keywords = {Intracranial Pressure; brain injury; Cerebral autoregulation; CEREBRAL OXYGENATION; hyperoxygenation}, year = {2023}, eissn = {1664-042X} } @article{MTMT:34559983, title = {Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring}, url = {https://m2.mtmt.hu/api/publication/34559983}, author = {Denchev, K. and Gomez, J. and Chen, P. and Rosenblatt, K.}, doi = {10.1016/j.anclin.2022.11.003}, journal-iso = {ANESTHESIOLOGY CLINICS}, journal = {ANESTHESIOLOGY CLINICS}, volume = {41}, unique-id = {34559983}, issn = {1932-2275}, year = {2023}, pages = {39-78} } @article{MTMT:33430630, title = {Kidney Dysfunction After Traumatic Brain Injury: Pathophysiology and General Management}, url = {https://m2.mtmt.hu/api/publication/33430630}, author = {De Vlieger, Greet and Meyfroidt, Geert}, doi = {10.1007/s12028-022-01630-z}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {38}, unique-id = {33430630}, issn = {1541-6933}, abstract = {Traumatic brain injury (TBI) remains a major cause of mortality and morbidity, and almost half of these patients are admitted to the intensive care unit. Of those, 10% develop acute kidney injury (AKI) and 2% even need kidney replacement therapy (KRT). Although clinical trials in patients with TBI who have AKI are lacking, some general principles in this population may apply. The present review is an overview on the epidemiology and pathophysiology of AKI in patients with TBI admitted to the intensive care unit who are at risk for or who have developed AKI. A cornerstone in severe TBI management is preventing secondary brain damage, in which reducing the intracranial pressure (ICP) and optimizing the cerebral perfusion pressure (CPP) remain important therapeutic targets. To treat episodes of elevated ICP, osmolar agents such as mannitol and hypertonic saline are frequently administered. Although we are currently awaiting the results of a prospective randomized controlled trial that compares both agents, it is important to realize that both agents have been associated with an increased risk of developing AKI which is probably higher for mannitol compared with hypertonic saline. For the brain, as well as for the kidney, targeting an adequate perfusion pressure is important. Hemodynamic management based on the combined use of intravascular fluids and vasopressors is ideally guided by hemodynamic monitoring. Hypotonic albumin or crystalloid resuscitation solutions may increase the risk of brain edema, and saline-based solutions are frequently used but have a risk of hyperchloremia, which might jeopardize kidney function. In patients at risk, frequent assessment of serum chloride might be advised. Maintenance of an adequate CPP involves the optimization of circulating blood volume, often combined with vasopressor agents. Whether individualized CPP targets based on cerebrovascular autoregulation monitoring are beneficial need to be further investigated. Interestingly, such individualized perfusion targets are also under investigation in patients as a strategy to mitigate the risk for AKI in patients with chronic hypertension. In the small proportion of patients with TBI who need KRT, continuous techniques are advised based on pathophysiology and expert opinion. The need for KRT is associated with a higher risk of intracranial hypertension, especially if osmolar clearance occurs fast, which can even occur in continuous techniques. Precise ICP and CPP monitoring is mandatory, especially at the initiation of KRT.}, keywords = {traumatic brain injury; Intracranial Hypertension; acute kidney injury}, year = {2023}, eissn = {1556-0961}, pages = {504-516}, orcid-numbers = {De Vlieger, Greet/0000-0002-6579-6965; Meyfroidt, Geert/0000-0003-4259-3935} } @article{MTMT:33940231, title = {Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33940231}, author = {Dietvorst, Sofie and Depreitere, Bart and Meyfroidt, Geert}, doi = {10.1097/MCC.0000000000001026}, journal-iso = {CURR OPIN CRIT CARE}, journal = {CURRENT OPINION IN CRITICAL CARE}, volume = {29}, unique-id = {33940231}, issn = {1070-5295}, abstract = {Purpose of reviewSevere traumatic brain injury (TBI) remains the most prevalent neurological condition worldwide. Observational and interventional studies provide evidence to recommend monitoring of intracranial pressure (ICP) in all severe TBI patients. Existing guidelines focus on treating elevated ICP and optimizing cerebral perfusion pressure (CPP), according to fixed universal thresholds. However, both ICP and CPP, their target thresholds, and their interaction, need to be interpreted in a broader picture of cerebral autoregulation, the natural capacity to adjust cerebrovascular resistance to preserve cerebral blood flow in response to external stimuli.Recent findingsCerebral autoregulation is often impaired in TBI patients, and monitoring cerebral autoregulation might be useful to develop personalized therapy rather than treatment of one size fits all thresholds and guidelines based on unidimensional static relationships.Today, there is no gold standard available to estimate cerebral autoregulation. Cerebral autoregulation can be triggered by performing a mean arterial pressure (MAP) challenge, in which MAP is increased by 10% for 20 min. The response of ICP (increase or decrease) will estimate the status of cerebral autoregulation and can steer therapy mainly concerning optimizing patient-specific CPP. The role of cerebral metabolic changes and its relationship to cerebral autoregulation is still unclear and awaits further investigation.}, keywords = {traumatic brain injury; Intracranial Pressure; cerebral perfusion pressure; Cerebral autoregulation; patient-centered therapy}, year = {2023}, eissn = {1531-7072}, pages = {85-88} } @{MTMT:34562105, title = {Critical Care Medicine}, url = {https://m2.mtmt.hu/api/publication/34562105}, author = {Di, Matteo M. and Corbella, D.}, booktitle = {Textbook of Emergency General Surgery}, doi = {10.1007/978-3-031-22599-4_13}, unique-id = {34562105}, year = {2023}, pages = {159-181} } @article{MTMT:34559965, title = {An update on pediatric traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/34559965}, author = {Figaji, A.}, doi = {10.1007/s00381-023-06173-y}, journal-iso = {CHILD NERV SYST}, journal = {CHILDS NERVOUS SYSTEM}, volume = {39}, unique-id = {34559965}, issn = {0256-7040}, year = {2023}, eissn = {1433-0350}, pages = {3071-3081} } @article{MTMT:34181758, title = {Transfusion strategies in traumatic brain injury – A clinical debate}, url = {https://m2.mtmt.hu/api/publication/34181758}, author = {Filipovic, M.G. and Luedi, M.M.}, doi = {10.1016/j.jclinane.2023.111233}, journal-iso = {J CLIN ANESTH}, journal = {JOURNAL OF CLINICAL ANESTHESIA}, volume = {90}, unique-id = {34181758}, issn = {0952-8180}, year = {2023}, eissn = {1873-4529} } @article{MTMT:34555686, title = {Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process}, url = {https://m2.mtmt.hu/api/publication/34555686}, author = {Foreman, Brandon and Kapinos, Gregory and Wainwright, Mark S. and Ngwenya, Laura B. and O'Phelan, Kristine H. and LaRovere, Kerri L. and Kirschen, Matthew P. and Appavu, Brian and Lazaridis, Christos and Alkhachroum, Ayham and Maciel, Carolina B. and Amorim, Edilberto and Chang, Jason J. and Gilmore, Emily J. and Rosenthal, Eric S. and Park, Soojin}, doi = {10.1097/CCM.0000000000006016}, journal-iso = {CRIT CARE MED}, journal = {CRITICAL CARE MEDICINE}, volume = {51}, unique-id = {34555686}, issn = {0090-3493}, abstract = {OBJECTIVES: To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM).DESIGN: A three-round Delphi consensus process.SETTING: Electronic surveys and virtual meeting.SUBJECTS: Participants with broad MNM expertise from adult and pediatric intensive care backgrounds.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM-both invasive and noninvasive-for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation.CONCLUSIONS: We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.}, keywords = {MANAGEMENT; MEDICINE; CARE; TRAUMATIC BRAIN-INJURY; society; Precision Medicine; Delphi consensus; neurocritical care; Multimodality monitoring}, year = {2023}, eissn = {1530-0293}, pages = {1740-1753} } @article{MTMT:33944155, title = {Pressure Reactivity Index in Children With Severe Traumatic Brain Injury: Are We Getting Closer to Goldilocks Management?}, url = {https://m2.mtmt.hu/api/publication/33944155}, author = {Friess, Stuart H. H.}, doi = {10.1097/CCM.0000000000005813}, journal-iso = {CRIT CARE MED}, journal = {CRITICAL CARE MEDICINE}, volume = {51}, unique-id = {33944155}, issn = {0090-3493}, keywords = {Pediatrics; Intracranial Pressure; cerebral perfusion pressure; Cerebral autoregulation; Severe traumatic brain injury; Pressure reactivity index}, year = {2023}, eissn = {1530-0293}, pages = {680-682} } @article{MTMT:34333927, title = {Respiratory challenges and ventilatory management in different types of acute brain-injured patients}, url = {https://m2.mtmt.hu/api/publication/34333927}, author = {Frisvold, S. and Coppola, S. and Ehrmann, S. and Chiumello, D. and Guerin, Claude}, doi = {10.1186/s13054-023-04532-4}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {34333927}, issn = {1364-8535}, abstract = {Acute brain injury (ABI) covers various clinical entities that may require invasive mechanical ventilation (MV) in the intensive care unit (ICU). The goal of MV, which is to protect the lung and the brain from further injury, may be difficult to achieve in the most severe forms of lung or brain injury. This narrative review aims to address the respiratory issues and ventilator management, specific to ABI patients in the ICU.}, keywords = {Acute respiratory distress syndrome; Mechanical ventilation; Cerebral autoregulation; Acute brain injury; neurogenic pulmonary edema; Lung protective ventilation}, year = {2023}, eissn = {1466-609X} } @article{MTMT:34288229, title = {Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis}, url = {https://m2.mtmt.hu/api/publication/34288229}, author = {Froese, Logan and Gomez, Alwyn and Sainbhi, Amanjyot Singh and Vakitbilir, Nuray and Marquez, Izabella and Amenta, Fiorella and Stein, Kevin Y. and Zeiler, Frederick A.}, doi = {10.1186/s40635-023-00515-5}, journal-iso = {INTENSIVE CARE MED EXP}, journal = {INTENSIVE CARE MEDICINE EXPERIMENTAL}, volume = {11}, unique-id = {34288229}, abstract = {BackgroundAlthough vasopressor and sedative agents are commonly used within the intensive care unit to mediate systemic and cerebral physiology, the full impact such agents have on cerebrovascular reactivity remains unclear. Using a prospectively maintained database of high-resolution critical care and physiology, the time-series relationship between vasopressor/sedative administration, and cerebrovascular reactivity was interrogated. Cerebrovascular reactivity was assessed through intracranial pressure and near infrared spectroscopy measures. Using these derived measures, the relationship between hourly dose of medication and hourly index values could be evaluated. The individual medication dose change and their corresponding physiological response was compared. Given the high number of doses of propofol and norepinephrine, a latent profile analysis was used to identify any underlying demographic or variable relationships. Finally, using time-series methodologies of Granger causality and vector impulse response functions, the relationships between the cerebrovascular reactivity derived variables were compared.ResultsFrom this retrospective observational study of 103 TBI patients, the evaluation between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies was completed. The assessment of the physiology pre/post infusion agent change resulted in similar overall values (Wilcoxon signed-ranked p value > 0.05). Time series methodologies demonstrated that the basic physiological relationships were identical before and after an infusion agent was changed (Granger causality demonstrated the same directional impact in over 95% of the moments, with response function being graphically identical).ConclusionsThis study suggests that overall, there was a limited association between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies including that of cerebrovascular reactivity. Thus, current regimens of administered sedative and vasopressor agents appear to have little to no impact on cerebrovascular reactivity in TBI.}, keywords = {Cerebrovascular reactivity; AUTOREGULATION; vasopressors; Sedative drugs}, year = {2023}, eissn = {2197-425X}, orcid-numbers = {Froese, Logan/0000-0002-6076-0189; Gomez, Alwyn/0000-0002-3737-2065; Sainbhi, Amanjyot Singh/0000-0003-3231-5683; Vakitbilir, Nuray/0000-0003-2764-145X} } @article{MTMT:34288225, title = {The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/34288225}, author = {Froese, Logan and Hammarlund, Emma and Akerlund, Cecilia A. I. and Tjerkaski, Jonathan and Hong, Erik and Lindblad, Caroline and Nelson, David W. and Thelin, Eric P. and Zeiler, Frederick A.}, doi = {10.1186/s40635-023-00524-4}, journal-iso = {INTENSIVE CARE MED EXP}, journal = {INTENSIVE CARE MEDICINE EXPERIMENTAL}, volume = {11}, unique-id = {34288225}, abstract = {BackgroundThe aim of this study is to evaluate the impact of commonly administered sedatives (Propofol, Alfentanil, Fentanyl, and Midazolam) and vasopressor (Dobutamine, Ephedrine, Noradrenaline and Vasopressin) agents on cerebrovascular reactivity in moderate/severe TBI patients. Cerebrovascular reactivity, as a surrogate for cerebral autoregulation was assessed using the long pressure reactivity index (LPRx). We evaluated the data in two phases, first we assessed the minute-by-minute data relationships between different dosing amounts of continuous infusion agents and physiological variables using boxplots, multiple linear regression and ANOVA. Next, we assessed the relationship between continuous/bolus infusion agents and physiological variables, assessing pre-/post- dose of medication change in physiology using a Wilcoxon signed-ranked test. Finally, we evaluated sub-groups of data for each individual dose change per medication, focusing on key physiological thresholds and demographics.ResultsOf the 475 patients with an average stay of 10 days resulting in over 3000 days of recorded information 367 (77.3%) were male with a median Glasgow coma score of 7 (4-9). The results of this retrospective observational study confirmed that the infusion of most administered agents do not impact cerebrovascular reactivity, which is confirmed by the multiple linear regression components having p value > 0.05. Incremental dose changes or bolus doses in these medications in general do not lead to significant changes in cerebrovascular reactivity (confirm by Wilcoxon signed-ranked p value > 0.05 for nearly all assessed relationships). Within the sub-group analysis that separated the data based on LPRx pre-dose, a significance between pre-/post-drug change in LPRx was seen, however this may be more of a result from patient state than drug impact.ConclusionsOverall, this study indicates that commonly administered agents with incremental dosing changes have no clinically significant influence on cerebrovascular reactivity in TBI (nor do they impair cerebrovascular reactivity). Though further investigation in a larger and more diverse TBI patient population is required.}, keywords = {Cerebrovascular reactivity; AUTOREGULATION; vasopressors; Sedative drugs}, year = {2023}, eissn = {2197-425X}, orcid-numbers = {Froese, Logan/0000-0002-6076-0189} } @article{MTMT:33944160, title = {Avoiding brain hypoxia in severe traumatic brain injury in settings with limited resources-A pathophysiological guide}, url = {https://m2.mtmt.hu/api/publication/33944160}, author = {Godoy, Daniel Agustin and Rubiano, Andres M. and Paranhos, Jorge and Robba, Chiara and Lazaridis, Christos}, doi = {10.1016/j.jcrc.2023.154260}, journal-iso = {J CRIT CARE}, journal = {JOURNAL OF CRITICAL CARE}, volume = {75}, unique-id = {33944160}, issn = {0883-9441}, abstract = {Cerebral oxygenation represents the balance between oxygen delivery, consumption and utilization by the brain, and therefore reflects the adequacy of cerebral perfusion. Different factors can influence the amount of oxygen to the brain including arterial blood pressure, hemoglobin levels, systemic oxygenation, and transfer of oxygen from blood to the cerebral microcirculation. A mismatch between cerebral oxygen supply and demand results in cerebral hypoxia/ischemia, and is associated with secondary brain damage and worsened outcome after acute brain injury. Therefore, monitoring and prompt treatment of cerebral oxygenation compromise is warranted in both neuro and general intensive care unit populations. Several tools have been proposed for the assessment of cerebral oxygenation, including non-invasive/invasive or indirect/direct methods, including Jugular Venous Oxygen Saturation (SjO2), Partial Brain Tissue Oxygen Tension (PtiO2), Near infrared spectroscopy (NIRS), Transcranial Doppler, electroencephalography and Computed Tomography. In this manuscript, we aim to review the pathophysiology of cerebral oxygenation, describe monitoring technics, and generate recommendations for avoiding brain hypoxia in settings with low availability of resources for direct brain oxygen monitoring.}, keywords = {traumatic brain injury; Cerebral ischemia; brain hypoxia; brain oxygenation; Cerebral oxygenation monitoring; Limited resources setting}, year = {2023}, eissn = {1557-8615} } @article{MTMT:33944158, title = {The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management}, url = {https://m2.mtmt.hu/api/publication/33944158}, author = {Godoy, Daniel Agustin and Brasil, Sergio and Iaccarino, Corrado and Paiva, Wellingson and Rubiano, Andres M.}, doi = {10.1186/s13054-023-04427-4}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {33944158}, issn = {1364-8535}, abstract = {For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has suffered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospinal fluid) dynamics and recent development in monitoring techniques suggest that targeting intracranial compliance (ICC) could be a more reliable approach rather than guiding actions by predetermined intracranial pressure values. It is known that ICC impairment forecasts IH, as intracranial volume may rapidly increase inside the skull, a closed bony box with derisory expansibility. Therefore, an intracranial compartmental syndrome (ICCS) can occur with deleterious brain effects, precipitating a reduction in brain perfusion, thereby inducing brain ischemia. The present perspective review aims to discuss the ICCS concept and suggest an integrative model for the combination of modern invasive and noninvasive techniques for IH and ICC assessment. The theory and logic suggest that the combination of multiple ancillary methods may enhance ICC impairment prediction, pointing proactive actions and improving patient outcomes.}, keywords = {traumatic brain injury; Intracranial Hypertension; Acute brain injury; Intracranial compartmental syndrome; Cerebral compliance; Intracranial pressure waveform}, year = {2023}, eissn = {1466-609X} } @article{MTMT:33917231, title = {"THE MANTLE" bundle for minimizing cerebral hypoxia in severe traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33917231}, author = {Godoy, Daniel Agustin and Murillo-Cabezas, Francisco and Suarez, Jose Ignacio and Badenes, Rafael and Pelosi, Paolo and Robba, Chiara}, doi = {10.1186/s13054-022-04242-3}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {33917231}, issn = {1364-8535}, abstract = {To ensure neuronal survival after severe traumatic brain injury, oxygen supply is essential. Cerebral tissue oxygenation represents the balance between oxygen supply and consumption, largely reflecting the adequacy of cerebral perfusion. Multiple physiological parameters determine the oxygen delivered to the brain, including blood pressure, hemoglobin level, systemic oxygenation, microcirculation and many factors are involved in the delivery of oxygen to its final recipient, through the respiratory chain. Brain tissue hypoxia occurs when the supply of oxygen is not adequate or when for some reasons it cannot be used at the cellular level. The causes of hypoxia are variable and can be analyzed pathophysiologically following "the oxygen route. " The current trend is precision medicine, individualized and therapeutically directed to the pathophysiology of specific brain damage; however, this requires the availability of multimodal monitoring. For this purpose, we developed the acronym "THE MANTLE, " a bundle of therapeutical interventions, which covers and protects the brain, optimizing the components of the oxygen transport system from ambient air to the mitochondria.}, keywords = {traumatic brain injury; Cerebral ischemia; brain hypoxia; brain oxygenation; Cerebral oxygenation monitoring}, year = {2023}, eissn = {1466-609X} } @article{MTMT:34329822, title = {Statistical properties of cerebral near infrared and intracranial pressure-based cerebrovascular reactivity metrics in moderate and severe neural injury: a machine learning and time-series analysis}, url = {https://m2.mtmt.hu/api/publication/34329822}, author = {Gomez, Alwyn and Sainbhi, Amanjyot Singh and Stein, Kevin Y. and Vakitbilir, Nuray and Froese, Logan and Zeiler, Frederick A.}, doi = {10.1186/s40635-023-00541-3}, journal-iso = {INTENSIVE CARE MED EXP}, journal = {INTENSIVE CARE MEDICINE EXPERIMENTAL}, volume = {11}, unique-id = {34329822}, abstract = {BackgroundCerebrovascular reactivity has been identified as a key contributor to secondary injury following traumatic brain injury (TBI). Prevalent intracranial pressure (ICP) based indices of cerebrovascular reactivity are limited by their invasive nature and poor spatial resolution. Fortunately, interest has been building around near infrared spectroscopy (NIRS) based measures of cerebrovascular reactivity that utilize regional cerebral oxygen saturation (rSO2) as a surrogate for pulsatile cerebral blood volume (CBV). In this study, the relationship between ICP- and rSO2-based indices of cerebrovascular reactivity, in a cohort of critically ill TBI patients, is explored using classical machine learning clustering techniques and multivariate time-series analysis.MethodsHigh-resolution physiologic data were collected in a cohort of adult moderate to severe TBI patients at a single quaternary care site. From this data both ICP- and rSO2-based indices of cerebrovascular reactivity were derived. Utilizing agglomerative hierarchical clustering and principal component analysis, the relationship between these indices in higher dimensional physiologic space was examined. Additionally, using vector autoregressive modeling, the response of change in ICP and rSO2 (& UDelta;ICP and & UDelta;rSO2, respectively) to an impulse in change in arterial blood pressure (& UDelta;ABP) was also examined for similarities.ResultsA total of 83 patients with 428,775 min of unique and complete physiologic data were obtained. Through agglomerative hierarchical clustering and principal component analysis, there was higher order clustering between rSO2- and ICP-based indices, separate from other physiologic parameters. Additionally, modeled responses of & UDelta;ICP and & UDelta;rSO2 to impulses in & UDelta;ABP were similar, indicating that & UDelta;rSO2 may be a valid surrogate for pulsatile CBV.ConclusionsrSO2- and ICP-based indices of cerebrovascular reactivity relate to one another in higher dimensional physiologic space. & UDelta;ICP and & UDelta;rSO2 behave similar in modeled responses to impulses in & UDelta;ABP. This work strengthens the body of evidence supporting the similarities between ICP-based and rSO2-based indices of cerebrovascular reactivity and opens the door to cerebrovascular reactivity monitoring in settings where invasive ICP monitoring is not feasible.}, keywords = {Cerebrovascular reactivity; traumatic brain injury; near infrared spectroscopy; multi-modal monitoring}, year = {2023}, eissn = {2197-425X}, orcid-numbers = {Gomez, Alwyn/0000-0002-3737-2065} } @article{MTMT:34497609, title = {Temporal Statistical Relationship between Regional Cerebral Oxygen Saturation (rSO2) and Brain Tissue Oxygen Tension (PbtO2) in Moderate-to-Severe Traumatic Brain Injury: A Canadian High Resolution-TBI (CAHR-TBI) Cohort Study}, url = {https://m2.mtmt.hu/api/publication/34497609}, author = {Gomez, Alwyn and Griesdale, Donald and Froese, Logan and Yang, Eleen and Thelin, Eric P. and Raj, Rahul and Aries, Marcel and Gallagher, Clare and Bernard, Francis and Kramer, Andreas H. and Zeiler, Frederick A.}, doi = {10.3390/bioengineering10101124}, journal-iso = {BIOENGINEERING-BASEL}, journal = {BIOENGINEERING}, volume = {10}, unique-id = {34497609}, abstract = {Brain tissue oxygen tension (PbtO(2)) has emerged as a cerebral monitoring modality following traumatic brain injury (TBI). Near-infrared spectroscopy (NIRS)-based regional cerebral oxygen saturation (rSO(2)) can non-invasively examine cerebral oxygen content and has the potential for high spatial resolution. Past studies examining the relationship between PbtO(2) and NIRS-based parameters have had conflicting results with varying degrees of correlation. Understanding this relationship will help guide multimodal monitoring practices and impact patient care. The aim of this study is to examine the relationship between PbtO(2) and rSO(2) in a cohort of TBI patients by leveraging contemporary statistical methods. A multi-institutional retrospective cohort study of prospectively collected data was performed. Moderate-to-severe adult TBI patients were included with concurrent rSO(2) and PbtO(2) monitoring during their stay in the intensive care unit (ICU). The high-resolution data were analyzed utilizing time series techniques to examine signal stationarity as well as the cross-correlation relationship between the change in PbtO(2) and the change in rSO(2) signals. Finally, modeling of the change in PbtO(2) by the change in rSO(2) was attempted utilizing linear methods that account for the autocorrelative nature of the data signals. A total of 20 subjects were included in the study. Cross-correlative analysis found that changes in PbtO(2) were most significantly correlated with changes in rSO(2) one minute earlier. Through mixed-effects and time series modeling of parameters, changes in rSO(2) were found to often have a statistically significant linear relationship with changes in PbtO(2) that occurred a minute later. However, changes in rSO(2) were inadequate to predict changes in PbtO(2). In this study, changes in PbtO(2) were found to correlate most with changes in rSO(2) approximately one minute earlier. While changes in rSO(2) were found to contain information about future changes in PbtO(2), they were not found to adequately model them. This strengthens the body of literature indicating that NIRS-based rSO(2) is not an adequate substitute for PbtO(2) in the management of TBI.}, keywords = {traumatic brain injury; near-infrared spectroscopy; Biotechnology & Applied Microbiology; Regional cerebral oxygen saturation; Brain tissue oxygen tension}, year = {2023}, eissn = {2306-5354}, orcid-numbers = {Gomez, Alwyn/0000-0002-3737-2065; Froese, Logan/0000-0002-6076-0189; Thelin, Eric P./0000-0002-2338-4364; Raj, Rahul/0000-0003-4243-9591} } @article{MTMT:34307964, title = {Epidemiological characteristics for patients with traumatic brain injury and the nomogram model for poor prognosis: an 18-year hospital-based study}, url = {https://m2.mtmt.hu/api/publication/34307964}, author = {Guo, Shaochun and Han, Ruili and Chen, Fan and Ji, Peigang and Liu, Jinghui and Zhai, Yulong and Chao, Min and Zhao, Wenjian and Jiao, Yang and Fan, Chao and Huang, Tao and Wang, Na and Ge, Shunnan and Qu, Yan and Wang, Yuan and Wang, Liang}, doi = {10.3389/fneur.2023.1138217}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {14}, unique-id = {34307964}, issn = {1664-2295}, abstract = {ObjectiveTraumatic brain injury (TBI) is a global social, economic, and health challenge that is associated with premature death and long-term disability. In the context of rapid development of urbanization, the analysis of TBI rate and mortality trend could provide abundant diagnosis and treatment suggestions, which helps to form future reference on public health strategies. MethodsIn this study, as one of major neurosurgical centers in China, we focused on the regime shift of TBI based on 18-year consecutive clinical data and evaluated the epidemiological features. In our current study, a total of 11,068 TBI patients were reviewed. ResultsThe major cause of TBI was road traffic injuries (44.%), while the main type of injury was cerebral contusion (n = 4,974 [44.94%]). Regarding to temporal changes, a decreasing trend in TBI incidence for patients under 44 years old was observed, while an increasing trend for those aged over 45 years was indicated. Incidences of RTI and assaults decreased, while ground level fall presented increasing incidences. The total number of deaths was 933 (8.43%), with a decreasing trend in overall mortality since 2011. Age, cause of injury, GCS at admission, Injury Severity Score, shock state at admission, trauma-related diagnoses and treatments were significantly associated with mortality. A predictive nomogram model for poor prognosis was developed based on patient's GOS scores at discharge. ConclusionsThe trends and characteristics of TBI patients changed with rapid development of urbanization in the past 18 years. Further larger studies are warranted to verify its clinical suggestions.}, keywords = {MORTALITY; EPIDEMIOLOGY; traumatic brain injury; clinical characteristics; prognostic nomogram}, year = {2023}, eissn = {1664-2295} } @article{MTMT:34330034, title = {Early Signs of Elevated Intracranial Pressure on Computed Tomography Correlate With Measured Intracranial Pressure in the Intensive Care Unit and Six-Month Outcome After Moderate to Severe Traumatic Brain Injury}, url = {https://m2.mtmt.hu/api/publication/34330034}, author = {Harder, Tyler J. and Leary, Owen P. and Yang, Zhihui and Lucke-Wold, Brandon and Liu, David D. and Still, Megan E. H. and Zhang, Miao and Yeatts, Sharon D. and Allen, Jason W. and Wright, David W. and Merck, Derek and Merck, Lisa H.}, doi = {10.1089/neu.2022.0433}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, unique-id = {34330034}, issn = {0897-7151}, abstract = {Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Early triage and treatment after TBI have been shown to improve outcome. Identifying patients at risk for increased intracranial pressure (ICP) via baseline computed tomography (CT) , however, has not been validated previously in a prospective dataset. We hypothesized that acute CT findings of elevated ICP, combined with direct ICP measurement, hold prognostic value in terms of six-month patient outcome after TBI. Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multi-center clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, third ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (six-month functional outcome and death) were assessed. Secondary analyses of 354 patients with recorded ICP monitoring data available explored the relationships between hemorrhage phenotype/anatomic location, sustained ICP >= 20 mm Hg, and surgical intervention(s). Univariate and multi-variate logistic/linear regressions were performed; p < 0.05 is defined as statistically significant. Imaging characteristics associated with ICP in this cohort include sulcal obliteration (p = 0.029) and third ventricular compression (p = 0.039). Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with death, poor functional outcome, and time to death. There was also an increased likelihood of death if patients required craniotomy (odds ratio [OR] = 4.318, 95% confidence interval [1.330-16.030]) or hemicraniectomy (OR = 2.993 [1.109-8.482]). On multi-variate regression analyses, hemorrhage location was associated with death (posterior fossa, OR = 3.208 [1.120-9.188] and basal ganglia, OR = 3.079 [1.178-8.077]). Volume of hemorrhage >30 cc was also associated with increased death, OR = 3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP >= 20 mm Hg, and maximum ICP >= 20 mm Hg were also directly correlated with increased death (OR = 6 4.99 [7.731-635.51]; and OR = 1.025 [1.004-1.047]), but not with functional outcome. Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR = 4.44 [1.514-14.183]) and presence of frontal lobe (OR = 2.951 [1.265-7.067]), subarachnoid (OR = 2.231 [1.067-4.717]), or intraventricular (OR = 2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP >= 20 mm Hg (effect size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization. Sulcal obliteration and third ventricular compression, radiographic signs of elevated ICP, were significantly associated with measurements of ICP >= 20 mm Hg. These radiographic biomarkers were significantly associated with patient outcome. There is potential utility of ICP-related imaging variables in triage and prognostication for patients after moderate-severe TBI.}, keywords = {MORTALITY; traumatic brain injury; Functional outcome; Intracranial Pressure; Predictive modeling; Goal directed therapy}, year = {2023}, eissn = {1557-9042} } @article{MTMT:34548394, title = {Improving Neurotrauma by Depolarization Inhibition With Combination Therapy: A Phase 2 Randomized Feasibility Trial}, url = {https://m2.mtmt.hu/api/publication/34548394}, author = {Hartings, Jed A. and Dreier, Jens P. and Ngwenya, Laura B. and Balu, Ramani and Carlson, Andrew P. and Foreman, Brandon}, doi = {10.1227/neu.0000000000002509}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {93}, unique-id = {34548394}, issn = {0148-396X}, abstract = {BACKGROUND AND OBJECTIVES: Spreading depolarizations (SDs) are a pathological mechanism that mediates lesion development in cerebral gray matter. They occur in similar to 60% of patients with severe traumatic brain injury (TBI), often in recurring and progressive patterns from days 0 to 10 after injury, and are associated with worse outcomes. However, there are no protocols or trials suggesting how SD monitoring might be incorporated into clinical management. The objective of this protocol is to determine the feasibility and efficacy of implementing a treatment protocol for intensive care of patients with severe TBI that is guided by electrocorticographic monitoring of SDs. METHODS: Patients who undergo surgery for severe TBI with placement of a subdural electrode strip will be eligible for enrollment. Those who exhibit SDs on electrocorticography during intensive care will be randomized 1:1 to either (1) standard care that is blinded to the further course of SDs or (2) a tiered intervention protocol based on efficacy to suppress further SDs. Interventions aim to block the triggering and propagation of SDs and include adjusted targets for management of blood pressure, CO2, temperature, and glucose, as well as ketamine pharmacotherapy up to 4 mg/kg/ hour. Interventions will be escalated and de-escalated depending on the course of SD pathology. EXPECTED OUTCOMES: We expect to demonstrate that electrocorticographic monitoring of SDs can be used as a real-time diagnostic in intensive care that leads to meaningful changes in patient management and a reduction in secondary injury, as compared with standard care, without increasing medical complications or adverse events. DISCUSSION: This trial holds potential for personalization of intensive care management by tailoring therapies based on monitoring and confirmation of the targeted neuronal mechanism of SD. Results are expected to validate the concept of this approach, inform refinement of the treatment protocol, and lead to larger-scale trials.}, keywords = {electrocorticography; MANAGEMENT; intensive care; KETAMINE; KETAMINE; SUBARACHNOID HEMORRHAGE; GUIDELINES; SPREADING DEPRESSION; Cortical spreading depression; TRANSIENTS; TRAUMATIC BRAIN-INJURY; Decompressive craniectomy; Spreading depolarization; Clinical Neurology; adult patients; PERIINFARCT DEPOLARIZATIONS}, year = {2023}, eissn = {1524-4040}, pages = {924-931} } @article{MTMT:34559960, title = {Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary}, url = {https://m2.mtmt.hu/api/publication/34559960}, author = {Hawryluk, G.W.J. and Lulla, A. and Bell, R. and Jagoda, A. and Mangat, H.S. and Bobrow, B.J. and Ghajar, J.}, doi = {10.1227/neu.0000000000002672}, journal-iso = {NEUROSURGERY}, journal = {NEUROSURGERY}, volume = {93}, unique-id = {34559960}, issn = {0148-396X}, year = {2023}, eissn = {1524-4040}, pages = {E159-E169} } @article{MTMT:34559905, title = {The management of severe traumatic brain injury in the initial postinjury hours - Current evidence and controversies}, url = {https://m2.mtmt.hu/api/publication/34559905}, author = {Hossain, I. and Rostami, E. and Marklund, N.}, doi = {10.1097/MCC.0000000000001094}, journal-iso = {CURR OPIN CRIT CARE}, journal = {CURRENT OPINION IN CRITICAL CARE}, volume = {29}, unique-id = {34559905}, issn = {1070-5295}, year = {2023}, eissn = {1531-7072}, pages = {650-658} } @article{MTMT:34243470, title = {Acute kidney injury in neurocritical care}, url = {https://m2.mtmt.hu/api/publication/34243470}, author = {Husain-Syed, Faeq and Takeuchi, Tomonori and Neyra, Javier A. and Ramirez-Guerrero, Gonzalo and Rosner, Mitchell H. and Ronco, Claudio and Tolwani, Ashita J.}, doi = {10.1186/s13054-023-04632-1}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {34243470}, issn = {1364-8535}, abstract = {Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI in critically ill adults with neurological conditions, outlines potential mechanisms connecting AKI and ABI progression, and highlights AKI management principles. Tailored approaches include optimizing blood pressure, managing intracranial pressure, adjusting medication dosages, and assessing the type of administered fluids. Preventive measures include avoiding nephrotoxic drugs, improving hemodynamic and fluid balance, and addressing coexisting AKI syndromes. ABI patients undergoing renal replacement therapy (RRT) are more susceptible to neurological complications. RRT can negatively impact cerebral blood flow, intracranial pressure, and brain tissue oxygenation, with effects tied to specific RRT methods. Continuous RRT is favored for better hemodynamic stability and lower risk of dialysis disequilibrium syndrome. Potential RRT modifications for ABI patients include adjusted dialysate and blood flow rates, osmotherapy, and alternate anticoagulation methods. Future research should explore whether these strategies enhance outcomes and if using novel AKI biomarkers can mitigate AKI-related complications in ABI patients.}, keywords = {renal replacement therapy; traumatic brain injury; SUBARACHNOID HEMORRHAGE; stroke; Uremia; Intracerebral hemorrhage; Dialysis disequilibrium syndrome}, year = {2023}, eissn = {1466-609X} } @article{MTMT:34555688, title = {Evaluation of Miethke M.scio Device Implantation for Intracranial Pressure Monitoring in Patients with Cerebrospinal Fluid Disorders}, url = {https://m2.mtmt.hu/api/publication/34555688}, author = {Jirlow, Unni and Arvidsson, Lisa and Magneli, Sara and Cesarini, Kristina and Rostami, Elham}, doi = {10.1016/j.wneu.2023.07.102}, journal-iso = {WORLD NEUROSURG}, journal = {WORLD NEUROSURGERY}, volume = {179}, unique-id = {34555688}, issn = {1878-8750}, abstract = {-BACKGROUND: Patients with complex shunt-related problems and varying diagnoses of cerebrospinal fluid (CSF) disturbance can present with headache and clinical symptoms that may be difficult to relate to underdrainage or overdrainage. Telemetric intracranial pressure (ICP) monitoring may assist in evaluating individual patients and assessing shunt function and adjustment. We report a case series of patients receiving a Miethke M.scio sensor.-METHODS: Between June 2016 and August 2021, 14 patients older than 18 years with different diagnoses underwent ventriculoperitoneal shunt surgery and received a Miethke M.scio sensor.-RESULTS: Patients had idiopathic intracranial hyper-tension (n = 3), obstructive hydrocephalus caused by tumors (n = 4), and malformations (n = 5). Headaches (71%) and visual impairment (50%) were the most common symptoms before surgery and 65% of the symptoms were improved after surgery. In total, 25 measurements were made and 11 of these led to changes in the shunt settings. Postoperative measurements were taken in 8 patients and the most common indication of ICP measurement was headache and/or control of the shunt settings.-CONCLUSIONS: The Miethke M.scio is a safe and valuable device to use in shunt-treated patients, in particular those expected to need assessment of ICP monitoring postoperatively. Repeated ICP measurements can also assist in personalized adjustment of the shunt setting to optimize CSF flow in this diverse patient group. Future studies should include a standardized protocol with ICP measurements correlated to the symptoms and cause of CSF disturbances to provide better understanding of the dynamics of the ICP in each patient.}, keywords = {COMPLICATIONS; Intracranial Pressure; TRAUMATIC BRAIN-INJURY; Clinical Neurology; Miethke M.scio; VALVE ADJUSTMENTS}, year = {2023}, eissn = {1878-8769}, pages = {E63-E74}, orcid-numbers = {Jirlow, Unni/0000-0002-3418-9951; Arvidsson, Lisa/0000-0003-2129-5357} } @article{MTMT:34280473, title = {Critical Assessment of the Guidelines-Based Management of Severe Traumatic Brain with the of Guidelines for Research and Evaluation II}, url = {https://m2.mtmt.hu/api/publication/34280473}, author = {Karagianni, Maria D. and Tasiou, Anastasia and Brotis, Alexandros G. and Tzerefos, Christos and Lambrianou, Xanthoula and Alkiviadis, Tzannis and Kalogeras, Adamantios and Spiliotopoulos, Theodosis and Arvaniti, Christina and Papageorgakopoulou, Manthia and Gatos, Charalambos and Fountas, Konstantinos N.}, doi = {10.1016/j.WNEU.2023.01.054}, journal-iso = {WORLD NEUROSURG}, journal = {WORLD NEUROSURGERY}, volume = {176}, unique-id = {34280473}, issn = {1878-8750}, abstract = {BACKGROUND: Severe traumatic brain injury constitutes a clinical entity with complex underlying pathophysiology. Management of patients with severe traumatic brain injury is guided by Clinical Practice Guidelines and Consensus Statements (CPG and CS). The published CPG and CS vary in quality, compre-hensiveness, and clinical applicability. The value of critically assessing CPG and CS cannot be overemphasized. The aim of our study was to assess the quality of the published CPG and CS, based on the Appraisal of Guidelines for Research and Evaluation II instrument.METHODS: A systematic search was performed in PubMed, Scopus, Embase, and Web of Science focusing on guidelines and consensi about severe traumatic brain injury . The search terms used were "traumatic brain injury," "TBI," "brain injury," "cerebral trauma," "head trauma," "closed head injury," "head injury," "guidelines," "recommendations," "consensus" in any possible combination. The search period extended from 1964 to 2021 and was limited to literature published in English. The eligible studies were scored by 4 raters, using the Appraisal of Guidelines for Research and Evaluation II instrument. The inter -rater agreement was assessed using the Cronbach's alpha.RESULTS: Twelve CPG and CS were assessed. Overall, the study by Carney et al. was the most Appraisal of Guidelines for Research and Evaluation II compliant study. In general, the domains of clarity of presentation, and scope and purpose, achieved the highest scores. The lowest inter-rater agreement in our analysis was "fair."CONCLUSIONS: The purpose of our study for assessing the quality of CPG and CS was served. We present the strong and weak points of CPG and CS. Our findings support the idea of periodically updating guidelines and improving their rigor of development.}, keywords = {MANAGEMENT; GUIDELINES; Critical appraisal; Severe traumatic brain injury; AGREE-II; Consensi}, year = {2023}, eissn = {1878-8769}, pages = {179-188} } @article{MTMT:34329874, title = {HDAC inhibitor attenuates rat traumatic brain injury induced neurological impairments}, url = {https://m2.mtmt.hu/api/publication/34329874}, author = {Lu, Yiming and Chen, Yiming and Xu, Siyi and Wei, Liang and Zhang, Yanfei and Chen, Wei and Liu, Min and Zhong, Chunlong}, doi = {10.1016/j.heliyon.2023.e18485}, journal-iso = {HELIYON}, journal = {HELIYON}, volume = {9}, unique-id = {34329874}, abstract = {Oxidative stress plays an important role in the secondary neuronal damage after traumatic brain injury (TBI). Inhibition of histone deacetylases (HDACs) has been shown to reduce reactive oxygen species (ROS) production and NADPH oxidases (Nox) transcription. Vorinostat is an HDAC inhibitor. This study investigated the influence of vorinostat on neurological impairments in a rat model of TBI induced by lateral fluid percussion injury (LFPI). Different concentrations of vorinostat (5, 25, and 50 mg/kg) were administered via intraperitoneal injection. Neurological deficits were evaluated by modified neurological severity scoring (mNSS). Evans blue extravasation was performed to assess blood-brain barrier (BBB) permeability. Morris water maze assay was performed to evaluate cognitive impairments. Protein levels were evaluated through ELISA and Western blot. Vorinostat was found to attenuate TBI induced brain edema and BBB permeability in rats. Vorinostat also alleviated TBI-induced neurological impairments and anxiety-like behavior in rats. Vorinostat attenuated TBI induced apoptosis and oxidative stresses in ipsilateral injury cortical tissue. Vorinostat inhibited HDAC1, HDAC3, and Nox4 while activated AMPK signaling in ipsilateral injury cortical tissue. In conclusion, administration of vorinostat alleviates the secondary damage of TBI in rat model. The oxidative stress in the ipsilateral injury cortical tissues is decreased by the inhibition of Nox4 expression and the activation of AMPK.}, keywords = {traumatic brain injury; vorinostat; AMPK; HDAC; NOX}, year = {2023}, eissn = {2405-8440}, orcid-numbers = {Chen, Yiming/0000-0002-1408-5194; Zhong, Chunlong/0000-0002-0605-7273} } @article{MTMT:34782675, title = {External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful?}, url = {https://m2.mtmt.hu/api/publication/34782675}, author = {Moyer, J.-D. and Elouahmani, S. and Codorniu, A. and Abback, P.-S. and Jeantrelle, C. and Goutagny, S. and Gauss, T. and Sigaut, S.}, doi = {10.1007/s00068-022-01903-4}, journal-iso = {EUR J TRAUMA EMERG S}, journal = {EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY}, volume = {49}, unique-id = {34782675}, issn = {1863-9933}, year = {2023}, eissn = {1863-9941}, pages = {1227-1234} } @article{MTMT:34333922, title = {Impact of early external ventricular drainage on functional outcome after traumatic brain injury: a bicentric retrospective cohort analysis}, url = {https://m2.mtmt.hu/api/publication/34333922}, author = {Moyer, Jean-Denis and Leger, Maxime and Trolonge, Baptiste and Codorniu, Anais and Lhermitte, Amaury and Gaberel, Thomas and Jeantrelle, Caroline and Gakuba, Clement}, doi = {10.1016/j.neuchi.2023.101487}, journal-iso = {NEUROCHIRURGIE}, journal = {NEUROCHIRURGIE}, volume = {69}, unique-id = {34333922}, issn = {0028-3770}, abstract = {Purpose: Several studies have confirmed that external ventricular drain decreases intracranial pressure (ICP) after traumatic brain injury (TBI). Considering its impact on ICP control and cerebral waste metabolites clearance, timing of external ventricular drain (EVD) insertion could improve CSF drainage efficiency. The aim of the study was to evaluate the impact of early EVD versus a later one on the 3-month outcome. Methods: For this retrospective cohort study conducted in two regional trauma-center (Caen CHU Cote de Nacre and Beaujon Hospital) between May 2011 and March 2019, all patients with intracranial hypertension following TBI and treated with EVD were included. We defined the early EVD by drainage within the 24 h of the hospital admission and the late EVD insertion by drainage beyond 24 h. A poor outcome was defined as a Glasgow Outcome Scale of one or two at 3 months. Results: Among the cohort of 671 patients, we analyzed 127 patients. Sixty-one (48.0%) patients had an early insertion of EVD. In the early EVD group, the mean time to insertion was 10 h versus 55 h in the late EVD group. Among the analyzed patients, 69 (54.3%) had a poor outcome including 39 (63.9%) in the early group and 30 (45.5%) in the later one. After adjustment on prognostic factors, early EVD insertion was not associated with a decrease in a poor outcome at 3-months (OR = 1.80 [0.73-4.53]). Conclusion: Early insertion of EVD (<24 h) for intracranial hypertension after TBI was not associated with improved outcome at 3 months.}, keywords = {traumatic brain injury; Intracranial Hypertension; External ventricular drain; Cerebro-spinal fluid drainage}, year = {2023}, eissn = {1773-0619} } @article{MTMT:33941495, title = {Prehospital ventilation targets in severe traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33941495}, author = {Olasveengen, Theresa Mariero and Stocchetti, Nino}, doi = {10.1007/s00134-023-07044-5}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, volume = {49}, unique-id = {33941495}, issn = {0342-4642}, year = {2023}, eissn = {1432-1238}, pages = {554-555} } @article{MTMT:34559962, title = {Intracranial pressure monitoring with and without brain tissue oxygen pressure monitoring for severe traumatic brain injury in France (OXY-TC): an open-label, randomised controlled superiority trial}, url = {https://m2.mtmt.hu/api/publication/34559962}, author = {Payen, J.-F. and Launey, Y. and Chabanne, R. and Gay, S. and Francony, G. and Gergele, L. and Vega, E. and Montcriol, A. and Couret, D. and Cottenceau, V. and Pili-Floury, S. and Gakuba, C. and Hammad, E. and Audibert, G. and Pottecher, J. and Dahyot-Fizelier, C. and Abdennour, L. and Gauss, T. and Richard, M. and Vilotitch, A. and Bosson, J.-L. and Bouzat, P. and Fevre, M.-C. and SCHILTE, C. and Vincent, O. and Hérault, M.-C. and Mistral, T. and Trouve-Buisson, T. and Picard, J. and Falcon, D. and Bersinger, S. and Mourey, C. and Adolle, A. and Salah, S. and Manhes, P. and Pollet, A. and GRECO, F. and CHALARD, K. and Andréa, B. and Velly, L. and Bruder, N. and Inal, I. and Magand, C. and Burnol, L. and Morel, J. and PREGNY, A. and FERRE, J.-C. and Bannier, E. and Lebouvier, T. and Caradec, S. and Drevet, C.-M. and Nadji, A. and Lewandowski, R. and DAILLER, F. and CARRILLON, R. and GOBERT, F. and RITZENTHALER, T. and LECLERCQ, M. and Dumont, N. and Charpentier, C. and Alb, I. and De, Sa N. and Declerck, N. and Boussemart, P. and Bellet, J. and MEAUDRE-DESGOUTTES, E. and D'ARANDA, E. and ESNAULT, P. and CHARRUAU, C. and BELLIER, R. and BENARD, T. and Carise, E. and SEGUIN, S. and Lefrant, J.Y. and Daurat, A. and Ambert, A. and Lebouc, M. and Hautefeuille, S. and Escudier, E. and Bing, F. and Cosserant, B. and Grobost, R. and Boissy, C. and Begard, M. and Guyot, A. and Lagarde, K. and Caumon, E. and Geeraerts, T. and POMMIER, M. and NABOULSI, E. and BEILVERT, M. and PARRY, E. and Leone, M. and Zieleskiewicz, L. and Duclos, G. and Arbelot, C. and Carole, I. and Hervé, Q. and Aminata, D. and Puybasset, L. and Torkomian, G. and Szczot, M. and Kremer, S. and Becker, G. and Hecketsweiler, S. and ILIC, D. and VETTORETTI, L. and Grisotto, C. and Asmolov, R. and Ehinger, V. and Laquay, N. and Chevallier, V. and Mahlal, Z. and LASOCKI, S. and SCHOLASTIQUE, A.-S. and GAILLARD, T. and GERGAUD, S. and BARBIER, E. and TAHON, F. and KRAINIK, A. and DOJAT, M. and TROPRES, I. and VIGUE, B. and LEO, L. and Piriou, V. and Coquerel, A. and Cracowski, J.-L. and Proust, F. and Mallaret, M. and OXY-TC, trial collaborators}, doi = {10.1016/S1474-4422(23)00290-9}, journal-iso = {LANCET NEUROL}, journal = {LANCET NEUROLOGY}, volume = {22}, unique-id = {34559962}, issn = {1474-4422}, year = {2023}, eissn = {1474-4465}, pages = {1005-1014} } @article{MTMT:34280471, title = {Prediction of intracranial pressure crises after severe traumatic brain injury using machine learning algorithms}, url = {https://m2.mtmt.hu/api/publication/34280471}, author = {Petrov, Dmitriy and Miranda, Stephen P. and Balu, Ramani and Wathen, Connor and Vaz, Alex and Mohan, Vinodh and Colon, Christian and Diaz-Arrastia, Ramon}, doi = {10.3171/2022.12.JNS221860}, journal-iso = {J NEUROSURG}, journal = {JOURNAL OF NEUROSURGERY}, volume = {139}, unique-id = {34280471}, issn = {0022-3085}, abstract = {OBJECTIVE Avoiding intracranial hypertension after traumatic brain injury (TBI) is a foundation of neurocritical care, to minimize secondary brain injury related to elevated intracranial pressure (ICP). However, this approach at best is reactive to episodes of intracranial hypertension, allowing for periods of elevated ICP before therapies can be initiated. Accurate prediction of ICP crises before they occur would permit clinicians to implement preventive strategies, minimize total time with ICP above threshold, and potentially avoid secondary injury. The objective of this study was to develop an algorithm capable of predicting the onset of ICP crises with sufficient lead time to enable application of preventative therapies.METHODS Thirty-six patients admitted to a level I trauma center with severe TBI (Glasgow Coma Scale score < 8) between April 2015 and January 2019 who underwent continuous intraparenchymal ICP monitor placement were retro-spectively identified. Continuous ICP data were extracted from each monitoring period (range 4-96 hours of monitoring). An ICP crisis was treated as a binary outcome, defined as ICP > 22 mm Hg for at least 75% of the data within a 5-minute interval. ICP data preceding each ICP crisis were grouped into four total data sets of 1-and 2-hour epochs, each with 10-to 20-minute lead-time intervals before an ICP crisis. Crisis and noncrisis events were identified from continuous time-series data and randomly split into 70% for training and 30% for testing, from a subset of 30 patients. Machine learning algorithms were trained to predict ICP crises, including light gradient boosting, extreme gradient boosting, and random forest. Accuracy and area under the receiver operating characteristic curve (AUC) were measured to compare performance. The most predictive algorithm was optimized using feature selection and hyperparameter tuning to avoid overfitting, and then tested on a validation subset of 5 patients. Precision, recall, F1 score, and accuracy were measured.RESULTS The random forest model demonstrated the highest accuracy (range 0.82-0.88) and AUC (range 0.86-0.88) across all four data sets. Further validation testing revealed high precision (0.76), relatively low recall (0.46), and overall strong predictive performance (F1 score 0.57, accuracy 0.86) for ICP crises. Decision curve analysis showed that the model provided net benefit at probability thresholds above 0.1 and below 0.9.CONCLUSIONS The presented model can provide accurate and timely forecasts of ICP crises in patients with severe TBI 10-20 minutes prior to their occurrence. If validated and implemented in clinical workflows, this algorithm can en- able earlier intervention for ICP crises, more effective treatment of intracranial hypertension, and potentially improved outcomes following severe TBI.}, keywords = {machine learning; traumatic brain injury; Intracranial Pressure}, year = {2023}, eissn = {1933-0693}, pages = {528-535} } @article{MTMT:34559968, title = {Traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/34559968}, author = {Pinggera, D. and Geiger, P. and Thomé, C.}, doi = {10.1007/s00115-023-01546-9}, journal-iso = {NERVENARZT}, journal = {NERVENARZT}, volume = {94}, unique-id = {34559968}, issn = {0028-2804}, year = {2023}, eissn = {1433-0407}, pages = {960-972} } @article{MTMT:34555685, title = {Impact of Therapeutic Interventions on Cerebral Autoregulatory Function Following Severe Traumatic Brain Injury: A Secondary Analysis of the BOOST-II Study}, url = {https://m2.mtmt.hu/api/publication/34555685}, author = {Prasad, Ayush and Gilmore, Emily J. and Kim, Jennifer A. and Begunova, Liza and Olexa, Madelynne and Beekman, Rachel and Falcone, Guido J. and Matouk, Charles and Ortega-Gutierrez, Santiago and Temkin, Nancy R. and Barber, Jason and Diaz-Arrastia, Ramon and de, Havenon Adam and Petersen, Nils H.}, doi = {10.1007/s12028-023-01896-x}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, unique-id = {34555685}, issn = {1541-6933}, abstract = {Background : The Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II randomized controlled trial used a tier-based management protocol based on brain tissue oxygen (PbtO2) and intracranial pressure (ICP) monitoring to reduce brain tissue hypoxia after severe traumatic brain injury. We performed a secondary analysis to explore the relationship between brain tissue hypoxia, blood pressure (BP), and interventions to improve cerebral perfusion pressure (CPP). We hypothesized that BP management below the lower limit of autoregulation would lead to cerebral hypoperfusion and brain tissue hypoxia that could be improved with hemodynamic augmentation.Methods: Of the 119 patients enrolled in the Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II trial, 55 patients had simultaneous recordings of arterial BP, ICP, and PbtO2. Autoregulatory function was measured by interrogating changes in ICP and PbtO2 in response to fluctuations in CPP using time-correlation analysis. The resulting autoregulatory indices (pressure reactivity index and oxygen reactivity index) were used to identify the "optimal" CPP and limits of autoregulation for each patient. Autoregulatory function and percent time with CPP outside personalized limits of autoregulation were calculated before, during, and after all interventions directed to optimize CPP.Results: Individualized limits of autoregulation were computed in 55 patients (mean age 38 years, mean monitoring time 92 h). We identified 35 episodes of brain tissue hypoxia (PbtO(2) < 20 mm Hg) treated with CPP augmentation. Following each intervention, mean CPP increased from 73 +/- 14 mm Hg to 79 +/- 17 mm Hg (p = 0.15), and mean PbtO(2) improved from 18.4 +/- 5.6 mm Hg to 21.9 +/- 5.6 mm Hg (p = 0.01), whereas autoregulatory function trended toward improvement (oxygen reactivity index 0.42 vs. 0.37, p = 0.14; pressure reactivity index 0.25 vs. 0.21, p = 0.2). Although optimal CPP and limits remained relatively unchanged, there was a significant decrease in the percent time with CPP below the lower limit of autoregulation in the 60 min after compared with before an intervention (11% vs. 23%, p = 0.05).Conclusions: Our analysis suggests that brain tissue hypoxia is associated with cerebral hypoperfusion characterized by increased time with CPP below the lower limit of autoregulation. Interventions to increase CPP appear to improve autoregulation. Further studies are needed to validate the importance of autoregulation as a modifiable variable with the potential to improve outcomes.}, keywords = {OXYGEN; traumatic brain injury; PERFUSION-PRESSURE; THRESHOLDS; cerebral perfusion pressure; Tissue hypoxia; CONSENSUS CONFERENCE; Critical Care Medicine; Cerebral autoregulation; Brain tissue oxygen}, year = {2023}, eissn = {1556-0961} } @article{MTMT:33944159, title = {Acute respiratory distress syndrome complicating traumatic brain injury. Can opposite strategies converge?}, url = {https://m2.mtmt.hu/api/publication/33944159}, author = {Robba, Chiara and Camporota, Luigi and Citerio, Giuseppe}, doi = {10.1007/s00134-023-07043-6}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, volume = {49}, unique-id = {33944159}, issn = {0342-4642}, year = {2023}, eissn = {1432-1238}, pages = {583-586}, orcid-numbers = {Camporota, Luigi/0000-0001-5600-1676; Citerio, Giuseppe/0000-0002-5374-3161} } @article{MTMT:34320830, title = {Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study}, url = {https://m2.mtmt.hu/api/publication/34320830}, author = {Robba, Chiara and Battaglini, Denise and Cinotti, Raphael and Asehnoune, Karim and Stevens, Robert and Taccone, Fabio Silvio and Badenes, Rafael and Pelosi, Paolo}, doi = {10.1007/s12028-023-01761-x}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, unique-id = {34320830}, issn = {1541-6933}, abstract = {BackgroundIn acute brain injury (ABI), the effects of hypoxemia as a potential cause of secondary brain damage and poor outcome are well documented, whereas the impact of hyperoxemia is unclear. The primary aim of this study was to assess the episodes of hypoxemia and hyperoxemia in patients with ABI during the intensive care unit (ICU) stay and to determine their association with in-hospital mortality. The secondary aim was to identify the optimal thresholds of arterial partial pressure of oxygen (PaO2) predicting in-hospital mortality.MethodsWe conducted a secondary analysis of a prospective multicenter observational cohort study. Adult patients with ABI (traumatic brain injury, subarachnoid aneurysmal hemorrhage, intracranial hemorrhage, ischemic stroke) with available data on PaO2 during the ICU stay were included. Hypoxemia was defined as PaO2 < 80 mm Hg, normoxemia was defined as PaO2 between 80 and 120 mm Hg, mild/moderate hyperoxemia was defined as PaO2 between 121 and 299 mm Hg, and severe hyperoxemia was defined as PaO2 levels >= 300 mm Hg.ResultsA total of 1,407 patients were included in this study. The mean age was 52 (+/- 18) years, and 929 (66%) were male. Over the ICU stay, the fractions of patients in the study cohort who had at least one episode of hypoxemia, mild/moderate hyperoxemia, and severe hyperoxemia were 31.3%, 53.0%, and 1.7%, respectively. PaO2 values below 92 mm Hg and above 156 mm Hg were associated with an increased probability of in-hospital mortality. Differences were observed among subgroups of patients with ABI, with consistent effects only seen in patients without traumatic brain injury.ConclusionsIn patients with ABI, hypoxemia and mild/moderate hyperoxemia were relatively frequent. Hypoxemia and hyperoxemia during ICU stay may influence in-hospital mortality. However, the small number of oxygen values collected represents a major limitation of the study.}, keywords = {OXYGEN; HYPEROXIA; outcome; brain injury; critically ill; hyperoxemia}, year = {2023}, eissn = {1556-0961}, orcid-numbers = {Battaglini, Denise/0000-0002-6895-6442} } @article{MTMT:33622909, title = {Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study}, url = {https://m2.mtmt.hu/api/publication/33622909}, author = {Robba, Chiara and Graziano, Francesca and Guglielmi, Angelo and Rebora, Paola and Galimberti, Stefania and Taccone, Fabio and Citerio, Giuseppe and SYNAPSE-ICU, Investigators}, doi = {10.1007/s00134-022-06937-1}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, volume = {49}, unique-id = {33622909}, issn = {0342-4642}, abstract = {Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles=39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles=35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR=1.612, 95% Confidence Interval, CI=1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR=1.017, 95% CI=0.823-1.257, p=0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.}, keywords = {PRESSURE; Reliability; MANAGEMENT; traumatic brain injury; VALIDITY; Intracranial Pressure; Decompressive craniectomy; hyperventilation; MODERATE; intracranial haemorrhage; Therapy intensity level; INTENSITY LEVEL}, year = {2023}, eissn = {1432-1238}, pages = {50-61} } @article{MTMT:33944161, title = {Brain Tissue Oxygen Levels as a Perspective Therapeutic Target in Traumatic Brain Injury. Retrospective Cohort Study}, url = {https://m2.mtmt.hu/api/publication/33944161}, author = {Roman, Gal and Hrdy, Ondrej and Vrbica, Kamil and Hudec, Jan and Mrlian, Andrej and Smrcka, Martin}, doi = {10.2478/jccm-2023-0001}, journal-iso = {J CRIT CARE MED}, journal = {THE JOURNAL OF CRITICAL CARE MEDICINE}, volume = {9}, unique-id = {33944161}, issn = {2393-1809}, abstract = {Introduction: Management of traumatic brain injury (TBI) requires a multidisciplinary approach and represents a significant challenge for both neurosurgeons and intensivists. The role of brain tissue oxygenation (PbtO2) monitoring and its impact on posttraumatic outcomes remains a controversial topic. Aim of the study: Our study aimed to evaluate the impact of PbtO2 monitoring on mortality, 30 days and 6 months neurological outcomes in patients with severe TBI compared with those resulting from standard intracranial pressure (ICP) monitoring. Material and methods: In this retrospective cohort study, we analysed the outcomes of 77 patients with severe TBI who met the inclusion criteria. These patients were divided into two groups, including 37 patients who were managed with ICP and PbtO2 monitoring protocols and 40 patients who were managed using ICP protocols alone. Results: There were no significant differences in demographic data between the two groups. We found no statistically significant differences in mortality or Glasgow Outcome Scale (GOS) scores one month after TBI. However, our results revealed that GOS scores at 6 months had improved significantly among patients managed with PbtO2; this finding was particularly notable for Glasgow Outcome Scale (GOS) scores of 4-5. Close monitoring and management of reductions in PbtO2, particularly by increasing the fraction of inspired oxygen, was associated with higher partial pressures of oxygen in this group. Conclusions: Monitoring of PbtO2 may facilitate the appropriate evaluation and treatment of low PbtO2 and represents a promising tool for the management of patients with severe TBI. Additional studies will be needed to confirm these findings.}, keywords = {traumatic brain injury; Glasgow Outcome Scale; Critical care; Brain tissue oxygen}, year = {2023}, eissn = {2393-1817}, pages = {12-19} } @article{MTMT:33944162, title = {Respiratory Monitoring During Mechanical Ventilation: The Present and the Future}, url = {https://m2.mtmt.hu/api/publication/33944162}, author = {Roshdy, Ashraf}, doi = {10.1177/08850666231153371}, journal-iso = {J INTENSIVE CARE MED}, journal = {JOURNAL OF INTENSIVE CARE MEDICINE}, volume = {38}, unique-id = {33944162}, issn = {0885-0666}, abstract = {The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.}, keywords = {MONITORING; intensive care; LUNG INJURY; Mechanical ventilation; Lung mechanics; Noninvasive ventilation; critical care ultrasound; esophageal pressure}, year = {2023}, eissn = {1525-1489}, pages = {407-417}, orcid-numbers = {Roshdy, Ashraf/0000-0002-8656-9606} } @article{MTMT:33941494, title = {Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group}, url = {https://m2.mtmt.hu/api/publication/33941494}, author = {Sarigul, Buse and Bell, Randy S. and Chesnut, Randall and Aguilera, Sergio and Buki, Andras and Citerio, Giuseppe and Cooper, D. Jamie and Diaz-Arrastia, Ramon and Diringer, Michael and Figaji, Anthony and Gao, Guoyi and Geocadin, Romergryko G. and Ghajar, Jamshid and Harris, Odette and Hoffer, Alan and Hutchinson, Peter and Joseph, Mathew and Kitagawa, Ryan and Manley, Geoffrey and Mayer, Stephan A. and Menon, David K. and Meyfroidt, Geert and Michael, Daniel B. and Oddo, Mauro and Okonkwo, David O. and Patel, Mayur B. and Robertson, Claudia and Rosenfeld, Jeffrey V. and Rubiano, Andres M. and Sahuquillo, Juan and Servadei, Franco and Shutter, Lori and Stein, Deborah D. and Stocchetti, Nino and Taccone, Fabio Silvio and Timmons, Shelly D. and Tsai, Eve and Ullman, Jamie S. and Vespa, Paul and Videtta, Walter and Wright, David W. and Zammit, Christopher and Hawryluk, Gregory W. J.}, doi = {10.1089/neu.2022.0414}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, volume = {40}, unique-id = {33941494}, issn = {0897-7151}, abstract = {Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a "nihilism guard." More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment to standardizing the approach to care-limiting decisions.}, keywords = {Prognosis; Survey; brain injury; SIBICC; NIHILISM; withdrawal of care}, year = {2023}, eissn = {1557-9042}, pages = {1707-1717} } @article{MTMT:33941491, title = {Are We Ready for Clinical Therapy based on Cerebral Autoregulation? A Pro-con Debate}, url = {https://m2.mtmt.hu/api/publication/33941491}, author = {Sarwal, Aarti and Robba, Chiara and Venegas, Carla and Ziai, Wendy and Czosnyka, Marek and Sharma, Deepak}, doi = {10.1007/s12028-023-01741-1}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, unique-id = {33941491}, issn = {1541-6933}, abstract = {Cerebral autoregulation (CA) is a physiological mechanism that maintains constant cerebral blood flow regardless of changes in cerebral perfusion pressure and prevents brain damage caused by hypoperfusion or hyperperfusion. In recent decades, researchers have investigated the range of systemic blood pressures and clinical management strategies over which cerebral vasculature modifies intracranial hemodynamics to maintain cerebral perfusion. However, proposed clinical interventions to optimize autoregulation status have not demonstrated clear clinical benefit. As future trials are designed, it is crucial to comprehend the underlying cause of our inability to produce robust clinical evidence supporting the concept of CA-targeted management. This article examines the technological advances in monitoring techniques and the accuracy of continuous assessment of autoregulation techniques used in intraoperative and intensive care settings today. It also examines how increasing knowledge of CA from recent clinical trials contributes to a greater understanding of secondary brain injury in many disease processes, despite the fact that the lack of robust evidence influencing outcomes has prevented the translation of CA-guided algorithms into clinical practice.}, keywords = {PHARMACOLOGY; Carbon Dioxide; outcome; cerebral perfusion pressure; VASOMOTOR REACTIVITY; Cerebral autoregulation; Multimodality monitoring}, year = {2023}, eissn = {1556-0961} } @article{MTMT:34555687, title = {Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants}, url = {https://m2.mtmt.hu/api/publication/34555687}, author = {Sparling, Jamie L. and Martyn, J. A. Jeevendra}, doi = {10.1007/s40140-023-00584-y}, journal-iso = {CURR ANESTHESIOL REP}, journal = {CURRENT ANESTHESIOLOGY REPORTS}, unique-id = {34555687}, issn = {1523-3855}, abstract = {Purpose of ReviewThe purpose of this clinical review is to summarize the physiology of the neuromuscular junction (NMJ) in the normal and denervated state, discuss the pharmacology of the neuromuscular relaxants (NMRs) within and outside the NMJ, and review recent advances in the development of new NMRs and their reversal agents.Recent FindingsRecent studies have delineated the mechanisms of the non-NMJ, anti-inflammatory effects of non-depolarizing NMRs, mediated by the alpha 7 acetylcholine receptors expressed in innate immune cells (e.g., macrophages). Several chlorofumarate molecules (including gantacurium) have been developed as experimental NMRs, with specific reversal by l-cysteine. Additionally, reversal of existing NMRs (both aminosteroids and benzylisoquinolones) by calabadion 1 and 2 is under investigation.SummaryNew NMRs and reversal agents hold promise for the use in anesthesiology and critical care, with improved pharmacokinetic parameters and more favorable side-effect profiles compared with existing agents. Further research is warranted to exploit the systemic anti-inflammatory properties exhibited by NMRs for other disease processes aside from acute respiratory distress syndrome (ARDS).}, keywords = {BLOCKADE; anesthesia; MUSCLE RELAXANTS; CLINICAL-PRACTICE GUIDELINES; Abdominal compartment syndrome; neuromuscular relaxants; cisatracurium; MYASTHENIC SYNDROME; BLOCKING-AGENTS; REVERSE; Neuromuscular blockers; Paralytics; ALPHA-7 ACETYLCHOLINE-RECEPTORS}, year = {2023}, eissn = {2167-6275} } @article{MTMT:33940146, title = {Multimodal and autoregulation monitoring in the neurointensive care unit}, url = {https://m2.mtmt.hu/api/publication/33940146}, author = {Vitt, Jeffrey R. and Loper, Nicholas E. and Mainali, Shraddha}, doi = {10.3389/fneur.2023.1155986}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {14}, unique-id = {33940146}, issn = {1664-2295}, abstract = {Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed "multimodal monitoring," is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.}, keywords = {TRANSCRANIAL DOPPLER; near infrared spectroscopy; Neurovascular coupling; neuromonitoring; Cerebral autoregulation; Pressure reactivity index; Multimodal monitoring; PbtO(2) = brain tissue oxygen tension}, year = {2023}, eissn = {1664-2295} } @{MTMT:34559989, title = {Traumatic brain injury: Imaging, operative and nonoperative care, and complications}, url = {https://m2.mtmt.hu/api/publication/34559989}, author = {Wilson, J.L. and Hoth, J.J. and Couture, D.E.}, booktitle = {Current Therapy of Trauma and Surgical Critical Care}, doi = {10.1016/B978-0-323-69787-3.00040-X}, unique-id = {34559989}, year = {2023}, pages = {161-168.e1} } @article{MTMT:33993231, title = {Traumatic Brain Injury: Contemporary Challenges and the Path to Progress}, url = {https://m2.mtmt.hu/api/publication/33993231}, author = {Yue, John K. and Deng, Hansen}, doi = {10.3390/jcm12093283}, journal-iso = {J CLIN MED}, journal = {JOURNAL OF CLINICAL MEDICINE}, volume = {12}, unique-id = {33993231}, year = {2023}, eissn = {2077-0383} } @article{MTMT:34559966, title = {Research progress of treatment position in patients with severe craniocerebral injury}, url = {https://m2.mtmt.hu/api/publication/34559966}, author = {Yunlong, J. and Bingbing, G. and Jianhua, W. and Fangfang, H.}, doi = {10.3760/cma.j.cn211501-20220523-01591}, journal-iso = {CHINESE JOURNAL OF PRACTICAL NURSING}, journal = {CHINESE JOURNAL OF PRACTICAL NURSING}, volume = {39}, unique-id = {34559966}, issn = {1672-7088}, year = {2023}, pages = {2389-2393} } @article{MTMT:34559976, title = {Application of percutaneous dilated tracheotomy under direct vision in severe neurosurgical patients}, url = {https://m2.mtmt.hu/api/publication/34559976}, author = {Zhang, T. and Ding, Y. and Yuan, L.-Q.}, doi = {10.3969/j.issn.1672-6731.2023.06.006}, journal-iso = {CHIN J CONTEMP NEUROLNEUROSURG}, journal = {ZHONGGUO XIANDAI SHENJING JIBING ZAZHI / CHINESE JOURNAL OF CONTEMPORARY NEUROLOGY AND NEUROSURGERY}, volume = {23}, unique-id = {34559976}, issn = {1672-6731}, year = {2023}, pages = {503-508} } @article{MTMT:34333929, title = {The alteration of serum bile acid profile among traumatic brain injury patients: a small-scale prospective study}, url = {https://m2.mtmt.hu/api/publication/34333929}, author = {Zhu, Yuanrun and Zheng, Peidong and Lin, Yajun and Wang, Juehan and You, Wendong and Wang, Yadong and Zheng, Huiqing and Wen, Liang and Yang, Xiaofeng}, doi = {10.3164/jcbn.23-10}, journal-iso = {J CLIN BIOCHEM NUTR}, journal = {JOURNAL OF CLINICAL BIOCHEMISTRY AND NUTRITION}, volume = {73}, unique-id = {34333929}, issn = {0912-0009}, abstract = {Traumatic brain injury is one of the major causes of morbidity and mortality worldwide. With the development of bile acids as a potential treatment, to identify the influence of traumatic brain injury on bile acid metabolism shows growing importance. This present study did a preliminary exploration of the bile acid profile alteration among traumatic brain injury patients. In total, 14 patients and 7 healthy volunteers were enrolled. The bile acid profile of the blood samples were detected by an Ultra-performance Liquid Chromatography Mass Spectrometer/ Mass Spectrometer system. It was found that 6 bile acids were statistically decreased in traumatic brain injury patients comparing with healthy volunteers: glycocholic acid (median level 44.4 ng/ml vs 98.7 ng/ml, p = 0.003), taurocholic acid (median level 10.9 ng/ml vs 19.5 ng/ml, p = 0.006), glycoursodeoxycholic acid (median level 17.4 ng/ml vs 71.4 ng/ml, p = 0.001), ursodeoxycholic acid (median level <1 ng/ml vs 32.4 ng/ml, p = 0.002), taurochenodeoxycholic acid (median level <1 ng/ml vs 53.6 ng/ml, p = 0.003) and glycochenodeoxycholic acid (GCDCA, median level 160 ng/ml vs 364 ng/ml, p<0.001). In conclusion, traumatic brain injury events are able to induce bile acid metabolism alteration in plasma and might cause reduction in glycocholic, taurocholic, glycoursodeoxycholic, ursodeoxycholic, taurochenodeoxycholic and glycochenodeoxycholic acid levels.}, keywords = {prospective study; traumatic brain injury; bile acid; Brain-gut axis; nutrition for neurological disease}, year = {2023}, eissn = {1880-5086}, pages = {97-102}, orcid-numbers = {Yang, Xiaofeng/0000-0002-2758-4451} } @article{MTMT:34559975, title = {Progress in the treatment of refractory intracranial hypertension after craniocerebral trauma}, url = {https://m2.mtmt.hu/api/publication/34559975}, doi = {10.3760/cma.j.cn112050-20211211-00580}, journal-iso = {CHINESE J NEUROSUR}, journal = {CHINESE JOURNAL OF NEUROSURGERY}, volume = {39}, unique-id = {34559975}, issn = {1001-2346}, year = {2023}, pages = {641-644} } @article{MTMT:34783507, title = {Excavating FAIR Data: the Case of the Multicenter Animal Spinal Cord Injury Study (MASCIS), Blood Pressure, and Neuro-Recovery}, url = {https://m2.mtmt.hu/api/publication/34783507}, author = {Almeida, C.A. and Torres-Espin, A. and Huie, J.R. and Sun, D. and Noble-Haeusslein, L.J. and Young, W. and Beattie, M.S. and Bresnahan, J.C. and Nielson, J.L. and Ferguson, A.R.}, doi = {10.1007/s12021-021-09512-z}, journal-iso = {NEUROINFORMATICS}, journal = {NEUROINFORMATICS}, volume = {20}, unique-id = {34783507}, issn = {1539-2791}, year = {2022}, eissn = {1559-0089}, pages = {39-52} } @article{MTMT:33450354, title = {High oxygen level in traumatic brain injury patients. Never ending story?}, url = {https://m2.mtmt.hu/api/publication/33450354}, author = {Asehnoune, Karim and Taccone, Fabio S. and Singer, Mervyn}, doi = {10.1007/s00134-022-06903-x}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, volume = {48}, unique-id = {33450354}, issn = {0342-4642}, year = {2022}, eissn = {1432-1238}, pages = {1772-1774} } @article{MTMT:33435318, title = {Brain Tissue Oxygenation-Guided Therapy and Outcome in Traumatic Brain Injury: A Single-Center Matched Cohort Study}, url = {https://m2.mtmt.hu/api/publication/33435318}, author = {Barrit, Sami and Al Barajraji, Mejdeddine and El Hadweh, Salim and Dewitte, Olivier and Torcida, Nathan and Andre, Joachim and Taccone, Fabio Silvio and Schuind, Sophie and Bogossian, Elisa Gouvea}, doi = {10.3390/brainsci12070887}, journal-iso = {BRAIN SCI}, journal = {BRAIN SCIENCES}, volume = {12}, unique-id = {33435318}, abstract = {Brain tissue oxygenation (PbtO(2))-guided therapy can improve the neurological outcome of traumatic brain injury (TBI) patients. With several Phase-III ongoing studies, most of the existing evidence is based on before-after cohort studies and a phase-II randomized trial. The aim of this study was to assess the effectiveness of PbtO(2)-guided therapy in a single-center cohort. We performed a retrospective analysis of consecutive severe TBI patients admitted to our center who received either intracranial pressure (ICP) guided therapy (from January 2012 to February 2016) or ICP/PbtO(2) guided therapy (February 2017 to December 2019). A genetic matching was performed based on covariates including demographics, comorbidities, and severity scores on admission. Intracranial hypertension (IH) was defined as ICP > 20 mmHg for at least 5 min. Brain hypoxia (BH) was defined as PbtO(2) < 20 mmHg for at least 10 min. IH and BH were targeted by specific interventions. Mann-Whitney U and Fisher's exact tests were used to assess differences between groups. A total of 35 patients were matched in both groups: significant differences in the occurrence of IH (ICP 85.7% vs. ICP/PbtO(2) 45.7%, p < 0.01), ICU length of stay [6 (3-13) vs. 16 (9-25) days, p < 0.01] and Glasgow Coma Scale at ICU discharge [10 (5-14) vs. 13 (11-15), p = 0.036] were found. No significant differences in ICU mortality and Glasgow Outcome Scales at 3 months were observed. This study suggests that the role of ICP/PbtO(2)-guided therapy should await further confirmation in well-conducted large phase III studies.}, keywords = {head injury; TRAUMA; outcome; brain oxygenation; protocolized care}, year = {2022}, eissn = {2076-3425}, orcid-numbers = {Barrit, Sami/0000-0002-9073-4504} } @{MTMT:34559673, title = {Traumatic brain injury and translational research: pharmacological and nonpharmacological perspectives}, url = {https://m2.mtmt.hu/api/publication/34559673}, author = {Battaglini, D. and Robba, C. and Pelosi, P.}, booktitle = {Perioperative Neuroscience: Translational Research}, doi = {10.1016/B978-0-323-91003-3.00014-3}, unique-id = {34559673}, year = {2022}, pages = {139-154} } @article{MTMT:33413069, title = {Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis}, url = {https://m2.mtmt.hu/api/publication/33413069}, author = {Battaglini, Denise and Premraj, Lavienraj and Huth, Samuel and Fanning, Jonathon and Whitman, Glenn and Arora, Rakesh C. and Bellapart, Judith and Porto, Diego Bastos and Taccone, Fabio Silvio and Suen, Jacky Y. and Li Bassi, Gianluigi and Fraser, John F. and Badenes, Rafael and Cho, Sung-Min and Robba, Chiara}, doi = {10.3389/fneur.2022.814405}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {13}, unique-id = {33413069}, issn = {1664-2295}, abstract = {Introduction: Neurological complications are frequent in patients with coronavirus disease-2019 (COVID-19). The use of non-invasive neuromonitoring in subjects without primary brain injury but with potential neurological derangement is gaining attention outside the intensive care unit (ICU). This systematic review and meta-analysis investigates the use of non-invasive multimodal neuromonitoring of the brain in non-critically ill patients with COVID-19 outside the ICU and quantifies the prevalence of abnormal neuromonitoring findings in this population. Methods: A structured literature search was performed in MEDLINE/PubMed, Scopus, Cochrane, and EMBASE to investigate the use of non-invasive neuromonitoring tools, including transcranial doppler (TCD); optic nerve sheath diameter (ONSD); near-infrared spectroscopy (NIRS); pupillometry; and electroencephalography (EEG) inpatients with COVID-19 outside the ICU. The proportion of non-ICU patients with CVOID-19 and a particular neurological feature at neuromonitoring at the study time was defined as prevalence. Results: A total of 6,593 records were identified through literature searching. Twenty-one studies were finally selected, comprising 368 non-ICU patients, of whom 97 were considered for the prevalence of meta-analysis. The pooled prevalence of electroencephalographic seizures, periodic and rhythmic patterns, slow background abnormalities, and abnormal background on EEG was.17 (95% CI 0.04-0.29), 0.42 (95% CI 0.01-0.82), 0.92 (95% CI 0.83-1.01), and.95 (95% CI 0.088-1.09), respectively. No studies investigating NIRS and ONSD outside the ICU were found. The pooled prevalence for abnormal neuromonitoring findings detected using the TCD and pupillometry were incomputable due to insufficient data. Conclusions: Neuromonitoring tools are non-invasive, less expensive, safe, and bedside available tools with a great potential for both diagnosis and monitoring of patients with COVID-19 at risk of brain derangements. However, extensive literature searching reveals that they are rarely used outside critical care settings.}, keywords = {Electroencephalogram; hospital; neuromonitoring; COVID-19; coronavirus disease}, year = {2022}, eissn = {1664-2295}, orcid-numbers = {Battaglini, Denise/0000-0002-6895-6442; Premraj, Lavienraj/0000-0003-3682-3722; Badenes, Rafael/0000-0001-7017-0150} } @article{MTMT:33450372, title = {Patients With Suspected Severe Adverse Reactions to COVID-19 Vaccination Admitted to Intensive Care Unit: A Case Report}, url = {https://m2.mtmt.hu/api/publication/33450372}, author = {Battaglini, Denise and Ball, Lorenzo and Robba, Chiara and Maiani, Simona and Brunetti, Iole and Benedetti, Luana and Castellan, Lucio and Zona, Gianluigi and Pesce, Giampaola and Rocco, Patricia R. M. and Pelosi, Paolo}, doi = {10.3389/fmed.2022.823837}, journal-iso = {FRONT MED}, journal = {FRONTIERS IN MEDICINE}, volume = {9}, unique-id = {33450372}, abstract = {BackgroundSeveral cases of adverse reactions following vaccination for coronavirus disease 2019 (COVID-19) with adenoviral vector vaccines or mRNA-based vaccines have been reported to date. The underlying syndrome has been named "vaccine-induced immune thrombotic thrombocytopenia" (VITT) or "thrombosis with thrombocytopenia syndrome (TTS)" with different clinical manifestations. MethodsWe report the clinical course of five patients who had severe adverse reactions to COVID-19 vaccines, either with VITT/TTS, abdominal or pulmonary thrombosis after adenoviral vaccines, or Stevens' Johnson syndrome because of mRNA vaccination, all of whom required admission to the intensive care unit (ICU). ConclusionsAll patients with severe or life-threatening suspected reaction to different types of COVID-19 vaccination required ICU admission. A prompt evaluation of early symptoms and individualized clinical management is needed to improve outcomes.}, keywords = {VACCINES; COVID-19; coronavirus disease 2019; vaccine-induced immune thrombotic thrombocytopenia; thrombosis with thrombocytopenia syndrome}, year = {2022}, eissn = {2296-858X}, orcid-numbers = {Battaglini, Denise/0000-0002-6895-6442; Ball, Lorenzo/0000-0002-3876-4730; Castellan, Lucio/0000-0002-5463-8785} } @article{MTMT:33047537, title = {Brain Oxygen Optimization in Severe Traumatic Brain Injury (BOOST-3): a multicentre, randomised, blinded-endpoint, comparative effectiveness study of brain tissue oxygen and intracranial pressure monitoring versus intracranial pressure alone}, url = {https://m2.mtmt.hu/api/publication/33047537}, author = {Bernard, Francis and Barsan, William and Diaz-Arrastia, Ramon and Merck, Lisa H. and Yeatts, Sharon and Shutter, Lori A.}, doi = {10.1136/bmjopen-2021-060188}, journal-iso = {BMJ OPEN}, journal = {BMJ OPEN}, volume = {12}, unique-id = {33047537}, issn = {2044-6055}, abstract = {Introduction Management of traumatic brain injury (TBI) includes invasive monitoring to prevent secondary brain injuries. Intracranial pressure (ICP) monitor is the main measurement used to that intent but cerebral hypoxia can occur despite normal ICP. This study will assess whether the addition of a brain tissue oxygenation (PbtO(2)) monitor prevents more secondary injuries that will translate into improved functional outcome. Methods and analysis Multicentre, randomised, blinde-dendpoint comparative effectiveness study enrolling 1094 patients with severe TBI monitored with both ICP and PbtO(2). Patients will be randomised to medical management guided by ICP alone (treating team blinded to PbtO(2) values) or both ICP and PbtO(2). Management is protocolised according to international guidelines in a tiered approach fashion to maintain ICP <22 mm Hg and PbtO(2) >20 mm Hg. ICP and PbtO(2) will be continuously recorded for a minimum of 5 days. The primary outcome measure is the Glasgow Outcome Scale-Extended performed at 180 (+/- 30) days by a blinded central examiner. Favourable outcome is defined according to a sliding dichotomy where the definition of favourable outcome varies according to baseline severity. Severity will be defined according to the probability of poor outcome predicted by the IMPACT core model. A large battery of secondary outcomes including granular neuropsychological and quality of life measures will be performed. Ethics and dissemination This has been approved by Advarra Ethics Committee (Pro00030585). Results will be presented at scientific meetings and published in peer-reviewed publications.}, keywords = {ASSOCIATION; HYPEROXIA; MANAGEMENT; TENSION; CARDIAC-ARREST; Patient outcomes; CEREBRAL PERFUSION-PRESSURE; CEREBROVASCULAR AUTOREGULATION; ROBIN-HOOD SYNDROME}, year = {2022}, eissn = {2044-6055} } @article{MTMT:34783395, title = {Delayed awakening in neurocritical care}, url = {https://m2.mtmt.hu/api/publication/34783395}, author = {Bouchereau, E. and Sharshar, T. and Legouy, C.}, doi = {10.1016/j.neurol.2021.06.001}, journal-iso = {REV NEUROL-FRANCE}, journal = {REVUE NEUROLOGIQUE}, volume = {178}, unique-id = {34783395}, issn = {0035-3787}, year = {2022}, eissn = {2213-0004}, pages = {21-33} } @article{MTMT:33619088, title = {Multimodal brain monitoring following traumatic brain injury: A primer for intensive care practitioners}, url = {https://m2.mtmt.hu/api/publication/33619088}, author = {Casault, Colin and Couillard, Philippe and Kromm, Julie and Rosenthal, Eric and Kramer, Andreas and Brindley, Peter}, doi = {10.1177/1751143720980273}, journal-iso = {J INTENSIVE CARE SOC}, journal = {JOURNAL OF THE INTENSIVE CARE SOCIETY}, volume = {23}, unique-id = {33619088}, issn = {1751-1437}, abstract = {Traumatic brain injury (TBI) is common and potentially devastating. Traditional examination-based patient monitoring following TBI may be inadequate for frontline clinicians to reduce secondary brain injury through individualized therapy. Multimodal neurologic monitoring (MMM) offers great potential for detecting early injury and improving outcomes. By assessing cerebral oxygenation, autoregulation and metabolism, clinicians may be able to understand neurophysiology during acute brain injury, and offer therapies better suited to each patient and each stage of injury. Hence, we offer this primer on brain tissue oxygen monitoring, pressure reactivity index monitoring and cerebral microdialysis. This narrative review serves as an introductory guide to the latest clinically-relevant evidence regarding key neuromonitoring techniques.}, keywords = {traumatic brain injury; HEAD-INJURY; MICRODIALYSIS; Cerebral microdialysis; INTRACRANIAL-PRESSURE; Multimodality monitoring; CEREBRAL PERFUSION-PRESSURE; Pressure reactivity index; induced normothermia; brain tissue oxygen monitoring; TISSUE OXYGEN-TENSION; METABOLIC DISTRESS; EXTRACELLULAR LACTATE; SUBSTRATE DELIVERY}, year = {2022}, eissn = {2057-360X}, pages = {191-202} } @article{MTMT:32689218, title = {Big Data and Artificial Intelligence for Precision Medicine in the Neuro-ICU: Bla, Bla, Bla}, url = {https://m2.mtmt.hu/api/publication/32689218}, author = {Citerio, Giuseppe}, doi = {10.1007/s12028-021-01427-6}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {37}, unique-id = {32689218}, issn = {1541-6933}, keywords = {Brain; PRESSURE; Artificial intelligence; MANAGEMENT; big data; Critical Care Medicine}, year = {2022}, eissn = {1556-0961}, pages = {163-165} } @article{MTMT:33450359, title = {Effect of inotropic agents on oxygenation and cerebral perfusion in acute brain injury}, url = {https://m2.mtmt.hu/api/publication/33450359}, author = {Coppalini, Giacomo and Duvigneaud, Elie and Diosdado, Alberto and Migliorino, Ernesto and Schuind, Sophie and Creteur, Jacques and Taccone, Fabio Silvio and Bogossian, Elisa Gouvea}, doi = {10.3389/fneur.2022.963562}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {13}, unique-id = {33450359}, issn = {1664-2295}, abstract = {IntroductionTissue hypoxia and insufficient energy delivery is one of the mechanisms behind the occurrence of several complications in acute brain injured patients. Several interventions can improve cerebral oxygenation; however, the effects of inotropic agents remain poorly characterized. MethodsRetrospective analysis including patients suffering from acute brain injury and monitored with brain oxygen pressure (PbtO(2)) catheter, in whom inotropic agents were administered according to the decision of the treating physician's decision; PbtO(2) values were collected before, 1 and 2 h after the initiation of therapy from the patient data monitoring system. PbtO(2) "responders" were patients with a relative increase in PbtO(2) from baseline values of at least 20%. ResultsA total of 35 patients were included in this study. Most of them (31/35, 89%) suffered from non-traumatic subarachnoid hemorrhage (SAH). Compared with baseline values [20 (14-24) mmHg], PbtO(2) did not significantly increase over time [19 (15-25) mmHg at 1 h and 19 (17-25) mmHg at 2 h, respectively; p = 0.052]. A total of 12/35 (34%) patients were PbtO(2) "responders," in particular if low PbtO(2) was observed at baseline. A PbtO(2) of 17 mmHg at baseline had a sensibility of 84% and a specificity of 91% to predict a PbtO(2) responder. A significant direct correlation between changes in PbtO(2) and cardiac output [r = 0.496 (95% CI 0.122 to 0.746), p = 0.01; n = 25] and a significant negative correlation between changes in PbtO(2) and cerebral perfusion pressure [r = -0.389 (95% CI -0.681 to -0.010), p = 0.05] were observed. ConclusionsIn this study, inotropic administration significantly increased brain oxygenation in one third of brain injured patients, especially when tissue hypoxia was present at baseline. Future studies should highlight the role of inotropic agents in the management of tissue hypoxia in this setting.}, keywords = {Hemodynamics; cerebral blood flow; Inotropic agents; Acute brain injury; brain oxygenation}, year = {2022}, eissn = {1664-2295}, orcid-numbers = {Migliorino, Ernesto/0000-0002-3344-9678} } @article{MTMT:33016767, title = {A Precision Medicine Agenda in Traumatic Brain Injury}, url = {https://m2.mtmt.hu/api/publication/33016767}, author = {Cruz Navarro, Jovany and Ponce Mejia, Lucido L. and Robertson, Claudia}, doi = {10.3389/fphar.2022.713100}, journal-iso = {FRONT PHARMACOL}, journal = {FRONTIERS IN PHARMACOLOGY}, volume = {13}, unique-id = {33016767}, abstract = {Traumatic brain injury remains a leading cause of death and disability across the globe. Substantial uncertainty in outcome prediction continues to be the rule notwithstanding the existing prediction models. Additionally, despite very promising preclinical data, randomized clinical trials (RCTs) of neuroprotective strategies in moderate and severe TBI have failed to demonstrate significant treatment effects. Better predictive models are needed, as the existing validated ones are more useful in prognosticating poor outcome and do not include biomarkers, genomics, proteonomics, metabolomics, etc. Invasive neuromonitoring long believed to be a "game changer" in the care of TBI patients have shown mixed results, and the level of evidence to support its widespread use remains insufficient. This is due in part to the extremely heterogenous nature of the disease regarding its etiology, pathology and severity. Currently, the diagnosis of traumatic brain injury (TBI) in the acute setting is centered on neurological examination and neuroimaging tools such as CT scanning and MRI, and its treatment has been largely confronted using a "one-size-fits-all" approach, that has left us with many unanswered questions. Precision medicine is an innovative approach for TBI treatment that considers individual variability in genes, environment, and lifestyle and has expanded across the medical fields. In this article, we briefly explore the field of precision medicine in TBI including biomarkers for therapeutic decision-making, multimodal neuromonitoring, and genomics.}, keywords = {Biomarkers; traumatic brain injury; Precision Medicine; neuromonitoring; genomics and epigenomics}, year = {2022}, eissn = {1663-9812} } @book{MTMT:34152835, title = {The Final FFICM Structured Oral Examination Study Guide}, url = {https://m2.mtmt.hu/api/publication/34152835}, isbn = {9781000803426}, author = {Davies, E.}, doi = {10.1201/9781003243694}, publisher = {CRC Press}, unique-id = {34152835}, abstract = {This book is the definitive guide to the Final Fellowship of the Faculty of Intensive Care Medicine (FFICM) Structured Oral Examination. With a broad coverage of the clinical curriculum, it equips candidates to tackle this challenging examination. Each chapter contains sample questions with concise answers, focusing on key concepts to facilitate deeper understanding. The content is organised by subject, enabling more structured revision in an easy-to-use format. This text provides references to guidance that will remain relevant in the ever-changing landscape of intensive care medicine. Not only is this book an essential resource for studying intensivists but it also forms a useful reference for any professional encountering the world of critical care in their practice. © 2023 Taylor & Francis Group, LLC.}, year = {2022}, pages = {1-544} } @article{MTMT:33450358, title = {Cerebral metabolic derangements following traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/33450358}, author = {Demers-Marcil, Simon and Coles, Jonathan P.}, doi = {10.1097/ACO.0000000000001183}, journal-iso = {CURR OPIN ANESTHESIO}, journal = {CURRENT OPINION IN ANAESTHESIOLOGY}, volume = {35}, unique-id = {33450358}, issn = {0952-7907}, abstract = {Purpose of review Outcome following traumatic brain injury (TBI) remains variable, and derangements in cerebral metabolism are a common finding in patients with poor outcome. This review compares our understanding of cerebral metabolism in health with derangements seen following TBI. Recent findings Ischemia is common within the first 24 h of injury and inconsistently detected by bedside monitoring. Metabolic derangements can also result from tissue hypoxia in the absence of ischemic reductions in blood flow due to microvascular ischemia and mitochondrial dysfunction. Glucose delivery across the injured brain is dependent on blood glucose and regional cerebral blood flow, and is an important contributor to derangements in glucose metabolism. Alternative energy substrates such as lactate, ketone bodies and succinate that may support mitochondrial function, and can be utilized when glucose availability is low, have been studied following TBI but require further investigation. Mitochondrial dysfunction and the use of alternative energy substrates are potential therapeutic targets, but improved understanding of the causes, impact and significance of metabolic derangements in clinical TBI are needed. Maintaining adequate oxygen and glucose delivery across the injured brain may accelerate the recovery of mitochondrial function and cerebral energy metabolism and remain important management targets.}, keywords = {PET; ISCHEMIA; mitochondrial dysfunction; MICRODIALYSIS; cerebral metabolism; microvascular ischemia}, year = {2022}, eissn = {1473-6500}, pages = {562-569} } @{MTMT:34560003, title = {Mechanical Ventilation in Neurocritical Care Patient}, url = {https://m2.mtmt.hu/api/publication/34560003}, author = {Dibu, J.R.}, booktitle = {Personalized Mechanical Ventilation: Improving Quality of Care}, doi = {10.1007/978-3-031-14138-6_25}, unique-id = {34560003}, year = {2022}, pages = {329-349} } @article{MTMT:33435330, title = {Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint}, url = {https://m2.mtmt.hu/api/publication/33435330}, author = {Di Filippo, Simone and Godoy, Daniel Agustin and Manca, Marina and Paolessi, Camilla and Bilotta, Federico and Meseguer, Ainhoa and Severgnini, Paolo and Pelosi, Paolo and Badenes, Rafael and Robba, Chiara}, doi = {10.3389/fneur.2022.911460}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {13}, unique-id = {33435330}, issn = {1664-2295}, abstract = {Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.}, keywords = {pregnancy; traumatic brain injury; intensive care unit; outcome; neurosurgery; Intracranial Hypertension}, year = {2022}, eissn = {1664-2295}, orcid-numbers = {Badenes, Rafael/0000-0001-7017-0150} } @article{MTMT:33450362, title = {Intracranial Pulsating Balloon-Based Cardiac-Gated ICP Modulation Impact on Brain Oxygenation: A Proof-of-Concept Study in a Swine Model}, url = {https://m2.mtmt.hu/api/publication/33450362}, author = {Doron, Omer and Zadka, Yuliya and Rosenthal, Guy and Barnea, Ofer}, doi = {10.1007/s12028-022-01541-z}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {37}, unique-id = {33450362}, issn = {1541-6933}, abstract = {Background Brain oxygenation improvement is a sought-after goal in neurocritical care patients. Previously, we have shown that cerebral blood flow improvement by cardiac-gated intracranial pressure (ICP) modulation using an intracranial pulsating balloon is feasible in a swine model. We sought to explore specific ICP modulation protocols to assess the feasibility of influencing brain oxygenation. Methods A previously presented electrocardiogram (ECG)-gated intracranial balloon pump in which volume, timing, and duty cycle of balloon inflation could be altered was used. Different protocols were tested in a swine model of normal and elevated ICP attained by intracranial fluid infusion with continuous monitoring of physiological parameters, and brain tissue oxygen tension (PbtO(2)) was measured at baseline and after device activation. Results We studied five swine, subjected to two main protocols differing in their phase relative to the cardiac cycle. In reduced brain perfusion status (ICP > 20 mm Hg, PbtO(2) < 15 mm Hg), the late-diastolic-early-systolic (Inflation/deflation) protocol showed consistent elevation in PbtO(2) (+ 9%, p < 0.01), coupled with ICP reduction (- 12%, p < 0.01), whereas the early-systolic-late-diastolic (inflation/deflation) protocol resulted in PbtO(2) reduction (- 4%, p < 0.01), coupled with ICP increase (+ 5% above baseline, p < 0.01). No significant changes in brain oxygenation or ICP were observed at normal perfusion status (ICP < 20 mm Hg, PbtO(2) > 15 mm Hg). Conclusions Intracranial cardiac-gated balloon pump activation can influence cerebral oxygenation and raise PbtO(2) above threshold values. This study supports the concept of late-diastolic pressure rise, coupled with early-systolic pressure drop, as a potential effector of flow augmentation leading to improve brain tissue oxygenation. Further studies are warranted to assess the translational potential of using an intracranial cardiac-gated balloon pump device to improve brain tissue oxygenation.}, keywords = {cerebral blood flow; PbtO(2); Intracranial balloon pump; Cardiac gated; Intracranial pressure modulation}, year = {2022}, eissn = {1556-0961}, pages = {689-696} } @article{MTMT:33026093, title = {Temperature Management in the ICU}, url = {https://m2.mtmt.hu/api/publication/33026093}, author = {Drewry, Anne and Mohr, Nicholas M.}, doi = {10.1097/CCM.0000000000005556}, journal-iso = {CRIT CARE MED}, journal = {CRITICAL CARE MEDICINE}, volume = {50}, unique-id = {33026093}, issn = {0090-3493}, abstract = {OBJECTIVE: Temperature abnormalities are recognized as a marker of human disease, and the therapeutic value of temperature is an attractive treatment target. The objective of this synthetic review is to summarize and critically appraise evidence for active temperature management in critically ill patients. DATA SOURCES: We searched MEDLINE for publications relevant to body temperature management (including targeted temperature management and antipyretic therapy) in cardiac arrest, acute ischemic and hemorrhagic stroke, traumatic brain injury, and sepsis. Bibliographies of included articles were also searched to identify additional relevant studies. STUDY SELECTION: English-language systematic reviews, meta-analyses, randomized trials, observational studies, and nonhuman data were reviewed, with a focus on the most recent randomized control trial evidence. DATA EXTRACTION: Data regarding study methodology, patient population, temperature management strategy, and clinical outcomes were qualitatively assessed. DATA SYNTHESIS: Temperature management is common in critically ill patients, and multiple large trials have been conducted to elucidate temperature targets, management strategies, and timing. The strongest data concerning the use of therapeutic hypothermia exist in comatose survivors of cardiac arrest, and recent trials suggest that appropriate postarrest temperature targets between 33 degrees C and 37.5 degrees C are reasonable. Targeted temperature management in other critical illnesses, including acute stroke, traumatic brain injury, and sepsis, has not shown benefit in large clinical trials. Likewise, trials of pharmacologic antipyretic therapy have not demonstrated improved outcomes, although national guidelines do recommend treatment of fever in patients with stroke and traumatic brain injury based on observational evidence associating fever with worse outcomes. CONCLUSIONS: Body temperature management in critically ill patients remains an appealing therapy for several illnesses, and additional studies are needed to clarify management strategies and therapeutic pathways.}, keywords = {BODY-TEMPERATURE; FEVER; hypothermia; SUBARACHNOID HEMORRHAGE; TRAUMATIC BRAIN-INJURY; ACUTE ISCHEMIC-STROKE; CRITICALLY-ILL PATIENTS; intravenous thrombolysis; Cardiac arrest; induced; HOSPITAL CARDIAC-ARREST; ICUs; PARACETAMOL ACETAMINOPHEN; MILD THERAPEUTIC HYPOTHERMIA}, year = {2022}, eissn = {1530-0293}, pages = {1138-1147}, orcid-numbers = {Mohr, Nicholas M./0000-0003-0497-5828} } @{MTMT:34560000, title = {Monitoring Strategy for the Operating Room and Intensive Care Unit After Thoracic Injury}, url = {https://m2.mtmt.hu/api/publication/34560000}, author = {Duffy, C.C. and Bass, G.A. and Lane-Fall, M.}, booktitle = {Management of Chest Trauma: A Practical Guide}, doi = {10.1007/978-3-031-06959-8_21}, unique-id = {34560000}, year = {2022}, pages = {233-242} } @article{MTMT:34560004, title = {Initial neurocritical care of severe traumatic brain injury: New paradigms and old challenges}, url = {https://m2.mtmt.hu/api/publication/34560004}, author = {El-Swaify, S.T. and Kamel, M. and Ali, S.H. and Bahaa, B. and Refaat, M.A. and Amir, A. and Abdelrazek, A. and Beshay, P.W. and Moner, Basha A.K.M.}, doi = {10.25259/SNI_609_2022}, journal-iso = {SURG NEUR INT}, journal = {SURGICAL NEUROLOGY INTERNATIONAL}, volume = {13}, unique-id = {34560004}, issn = {2229-5097}, year = {2022}, eissn = {2152-7806} } @article{MTMT:34559998, title = {Value of ventricular intracranial pressure monitoring and process management for traumatic bifrontal contusions}, url = {https://m2.mtmt.hu/api/publication/34559998}, author = {Feng, X.-Y. and Jiao, W. and Chen, J.-H. and Shi, Z.-H. and Shi, Y.-Q. and Wang, Y.-H.}, doi = {10.3969/j.issn.1672-6731.2022.04.014}, journal-iso = {CHIN J CONTEMP NEUROLNEUROSURG}, journal = {ZHONGGUO XIANDAI SHENJING JIBING ZAZHI / CHINESE JOURNAL OF CONTEMPORARY NEUROLOGY AND NEUROSURGERY}, volume = {22}, unique-id = {34559998}, issn = {1672-6731}, year = {2022}, pages = {313-318} } @article{MTMT:33430527, title = {Optimal bispectral index level of sedation and cerebral oximetry in traumatic brain injury: a non-invasive individualized approach in critical care?}, url = {https://m2.mtmt.hu/api/publication/33430527}, author = {Froese, Logan and Gomez, Alwyn and Sainbhi, Amanjyot Singh and Batson, Carleen and Slack, Trevor and Stein, Kevin Y. and Mathieu, Francois and Zeiler, Frederick A.}, doi = {10.1186/s40635-022-00460-9}, journal-iso = {INTENSIVE CARE MED EXP}, journal = {INTENSIVE CARE MEDICINE EXPERIMENTAL}, volume = {10}, unique-id = {33430527}, abstract = {Background: Impaired cerebral autoregulation has been linked with worse outcomes, with literature suggesting that current therapy guidelines fail to significantly impact cerebrovascular reactivity. The cerebral oximetry index (COx_a) is a surrogate measure of cerebrovascular reactivity which can in theory be obtained non-invasively using regional brain tissue oxygen saturation and arterial blood pressure. The goal of this study was to assess the relationship between objectively measured depth of sedation through BIS and autoregulatory capacity measured through COx_a.Methods: In a prospectively maintained observational study, we collected continuous regional brain tissue oxygen saturation, intracranial pressure, arterial blood pressure and BIS in traumatic brain injury patients. COx_a was obtained using the Pearson's correlation between regional brain tissue oxygen saturation and arterial blood pressure and ranges from - 1 to 1 with higher values indicating impairment of cerebrovascular reactivity. Using BIS values and COx_a, a curve-fitting method was applied to determine the minimum value for the COx_a. The associated BIS value with the minimum COx_a is called BISopt. This BISopt was both visually and algorithmically determined, which were compared and assessed over the whole dataset.Results: Of the 42 patients, we observed that most had a parabolic relationship between BIS and COx_a. This suggests a potential "optimal" depth of sedation where COx_a is the most intact. Furthermore, when comparing the BISopt algorithm with visual inspection of BISopt, we obtained similar results. Finally, BISopt % yield (determined algorithmically) appeared to be independent from any individual sedative or vasopressor agent, and there was agreement between BISopt found with COx_a and the pressure reactivity index (another surrogate for cerebrovascular reactivity).Conclusions: This study suggests that COx_a is capable of detecting disruption in cerebrovascular reactivity which occurs with over-/under-sedation, utilizing a non-invasive measure of determination and assessment. This technique may carry implications for tailoring sedation in patients, focusing on individualized neuroprotection.}, keywords = {Cerebrovascular reactivity; traumatic brain injury; Depth of sedation; Cerebral oximetry index; Optimal bispectral index}, year = {2022}, eissn = {2197-425X}, orcid-numbers = {Froese, Logan/0000-0002-6076-0189; Gomez, Alwyn/0000-0002-3737-2065; Sainbhi, Amanjyot Singh/0000-0003-3231-5683; Mathieu, Francois/0000-0002-7894-2466} } @article{MTMT:33617977, title = {Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study}, url = {https://m2.mtmt.hu/api/publication/33617977}, author = {Gomez, Alwyn and Sekhon, Mypinder and Griesdale, Donald and Froese, Logan and Yang, Eleen and Thelin, Eric P. and Raj, Rahul and Aries, Marcel and Gallagher, Clare and Bernard, Francis and Kramer, Andreas H. and Zeiler, Frederick A.}, doi = {10.1186/s40635-022-00482-3}, journal-iso = {INTENSIVE CARE MED EXP}, journal = {INTENSIVE CARE MEDICINE EXPERIMENTAL}, volume = {10}, unique-id = {33617977}, abstract = {Background: Brain tissue oxygen tension (PbtO2) and cerebrovascular pressure reac-tivity monitoring have emerged as potential modalities to individualize care in moder-ate and severe traumatic brain injury (TBI). The relationship between these modalities has had limited exploration. The aim of this study was to examine the relationship between PbtO(2) and cerebral perfusion pressure (CPP) and how this relationship is modified by the state of cerebrovascular pressure reactivity.Methods: A retrospective multi-institution cohort study utilizing prospectively collected high-resolution physiologic data from the CAnadian High Resolution-TBI (CAHR-TBI) Research Collaborative database collected between 2011 and 2021 was performed. Included in the study were critically ill TBI patients with intracranial pres-sure (ICP), arterial blood pressure (ABP), and PbtO(2) monitoring treated in any one of three CAHR-TBI affiliated adult intensive care units (ICU). The outcome of interest was how PbtO2 and CPP are related over a cohort of TBI patients and how this relationship is modified by the state of cerebrovascular reactivity, as determined using the pressure reactivity index (PRx).Results: A total of 77 patients met the study inclusion criteria with a total of 377,744 min of physiologic data available for the analysis. PbtO2 produced a triphasic curve when plotted against CPP like previous population-based plots of cerebral blood flow (CBF) versus CPP. The triphasic curve included a plateau region flanked by regions of relative ischemia (hypoxia) and hyperemia (hyperoxia). The plateau region shortened when cerebrovascular pressure reactivity was disrupted compared to when it was intact.Conclusions: In this exploratory analysis of a multi-institution high-resolution physiology TBI database, PbtO(2) seems to have a triphasic relationship with CPP, over the entire cohort. The CPP range over which the plateau exists is modified by the state of cerebrovascular reactivity. This indicates that in critically ill TBI patients admitted to ICU, PbtO2 may be reflective of CBF.}, keywords = {MANAGEMENT; Cerebrovascular reactivity; traumatic brain injury; PERFUSION-PRESSURE; THRESHOLDS; CONSENSUS CONFERENCE; INTRACRANIAL-PRESSURE; multi-modal monitoring; Brain tissue oxygen tension}, year = {2022}, eissn = {2197-425X}, orcid-numbers = {Gomez, Alwyn/0000-0002-3737-2065; Zeiler, Frederick A./0000-0003-1737-0510} } @article{MTMT:33221407, title = {Update on the management of intracranial hypertension syndrome}, url = {https://m2.mtmt.hu/api/publication/33221407}, author = {Gonzalez-Johnson, Lucas and Zomosa, Gustavo and Valenzuela, Bayron and Maldonado, Felipe and Baabor, Marcos and Romero, Carlos}, doi = {10.4067/S0034-98872022000100078}, journal-iso = {REV MED CHILE}, journal = {REVISTA MEDICA DE CHILE}, volume = {150}, unique-id = {33221407}, issn = {0034-9887}, abstract = {Elevated intracranial pressure (ICP) is a devastating complication, with great impact on neurological status and high morbidity and mortality. Intracranial hypertension (ICH) has multiple etiologies. The natural history of this condition can lead to brain death. The successful management of patients with elevated ICP (> 20-25 mmHg) requires fast and timely recognition, judicious use of invasive monitoring and therapies aimed to reversing its underlying cause. Therefore, it must be managed as a neurological emergency. The objective of this review is to present in a friendly way the diagnostic approach and the management of ICH, focused on general practitioners. (Rev Med Chile 2022; 150: 78-87)}, keywords = {PRESSURE; Optimization; mannitol; hypothermia; neuroprotection; Intracranial Pressure; CARE; TRAUMATIC BRAIN-INJURY; Coma; Decompressive craniectomy; Decompressive craniectomy; hyperventilation; tissue oxygenation; CONSENSUS CONFERENCE; Saline solution; Cerebral autoregulation}, year = {2022}, eissn = {0717-6163}, pages = {78-87} } @article{MTMT:33435309, title = {The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis}, url = {https://m2.mtmt.hu/api/publication/33435309}, author = {Gouvea Bogossian, Elisa and Diosdado, Alberto and Barrit, Sami and Al Barajraji, Mejdeddine and Annoni, Filippo and Schuind, Sophie and Taccone, Fabio Silvio}, doi = {10.1007/s12028-022-01613-0}, journal-iso = {NEUROCRIT CARE}, journal = {NEUROCRITICAL CARE}, volume = {37}, unique-id = {33435309}, issn = {1541-6933}, abstract = {Traumatic brain injury (TBI) is a major public health burden, causing death and disability worldwide. Intracranial hypertension and brain hypoxia are the main mechanisms of secondary brain injury. As such, management strategies guided by intracranial pressure (ICP) and brain oxygen (PbtO(2)) monitoring could improve the prognosis of these patients. Our objective was to summarize the current evidence regarding the impact of PbtO(2)-guided therapy on the outcome of patients with TBI. We performed a systematic search of PubMed, Scopus, and the Cochrane library databases, following the protocol registered in PROSPERO. Only studies comparing PbtO(2)/ICP-guided therapy with ICP-guided therapy were selected. Primary outcome was neurological outcome at 3 and 6 months assessed by using the Glasgow Outcome Scale; secondary outcomes included hospital and long-term mortality, burden of intracranial hypertension, and brain tissue hypoxia. Out of 6254 retrieved studies, 15 studies (n = 37,245 patients, of who 2184 received PbtO(2)-guided therapy) were included in the final analysis. When compared with ICP-guided therapy, the use of combined PbO2/ICP-guided therapy was associated with a higher probability of favorable neurological outcome (odds ratio 2.21 [95% confidence interval 1.72-2.84]) and of hospital survival (odds ratio 1.15 [95% confidence interval 1.04-1.28]). The heterogeneity (I-2) of the studies in each analysis was below 40%. However, the quality of evidence was overall low to moderate. In this meta-analysis, PbtO(2)-guided therapy was associated with reduced mortality and more favorable neurological outcome in patients with TBI. The low-quality evidence underlines the need for the results from ongoing phase III randomized trials.}, keywords = {MORTALITY; head injury; Glasgow Outcome Scale; CEREBRAL OXYGENATION; Multimodal neuromonitoring}, year = {2022}, eissn = {1556-0961}, pages = {779-789}, orcid-numbers = {Gouvea Bogossian, Elisa/0000-0002-2062-465X} } @article{MTMT:33435324, title = {Intracranial pressure: current perspectives on physiology and monitoring}, url = {https://m2.mtmt.hu/api/publication/33435324}, author = {Hawryluk, Gregory W. J. and Citerio, Giuseppe and Hutchinson, Peter and Kolias, Angelos and Meyfroidt, Geert and Robba, Chiara and Stocchetti, Nino and Chesnut, Randall}, doi = {10.1007/s00134-022-06786-y}, journal-iso = {INTENS CARE MED}, journal = {INTENSIVE CARE MEDICINE}, volume = {48}, unique-id = {33435324}, issn = {0342-4642}, abstract = {Intracranial pressure (ICP) monitoring is now viewed as integral to the clinical care of many life-threatening brain insults, such as severe traumatic brain injury, subarachnoid hemorrhage, and malignant stroke. It serves to warn of expanding intracranial mass lesions, to prevent or treat herniation events as well as pressure elevation which impedes nutrient delivery to the brain. It facilitates the calculation of cerebral perfusion pressure (CPP) and the estimation of cerebrovascular autoregulatory status. Despite advancements in our knowledge emanating from a half century of experience with this technology, important controversies remain related even to fundamental aspects of ICP measurements, including indications for monitoring, ICP treatment thresholds, and management of intracranial hypertension. Here, we review the history of ICP monitoring, the underlying pathophysiology as well as current perspectives on why, when and how ICP monitoring is best used. ICP is typically assessed invasively but a number of emerging, non-invasive technologies with inherently lower risk are showing promise. In selected cases, additional neuromonitoring can be used to assist in the interpretation of ICP monitoring information and adapt directed treatment accordingly. Additional efforts to expand the evidence base relevant to ICP monitoring, related technologies and management remain a high priority in neurosurgery and neurocritical care.}, keywords = {physiology; MONITORING; traumatic brain injury; Intracranial Pressure; Intracranial Hypertension; Critical care; Non-invasive}, year = {2022}, eissn = {1432-1238}, pages = {1471-1481} } @article{MTMT:33435328, title = {Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury}, url = {https://m2.mtmt.hu/api/publication/33435328}, author = {Hawryluk, Gregory W. J. and Selph, Shelley and Lumba-Brown, Angela and Totten, Annette M. and Ghajar, Jamshid and Aarabi, Bizhan and Ecklund, James and Shackelford, Stacy and Adams, Britton and Adelson, David and Armonda, Rocco A. and Benjamin, John and Boone, Darrell and Brody, David and Dengler, Bradley and Figaji, Anthony and Grant, Gerald and Harris, Odette and Hoffer, Alan and Kitigawa, Ryan and Latham, Kerry and Neal, Christopher and Okonkwo, David O. and Pannell, Dylan and Rosenfeld, Jeffrey V and Rosenthal, Guy and Rubiano, Andres and Stein, Deborah M. and Stippler, Martina and Talbot, Max and Valadka, Alex and Wright, David W. and Davis, Shelton and Bell, Randy}, doi = {10.1089/neur.2022.0008}, journal-iso = {NEUROTRAUMA REP}, journal = {NEUROTRAUMA REPORTS}, volume = {3}, unique-id = {33435328}, abstract = {Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.}, keywords = {traumatic brain injury; GUIDELINES; Head trauma; blast injury; penetrating brain injury}, year = {2022}, eissn = {2689-288X}, pages = {240-247}, orcid-numbers = {Lumba-Brown, Angela/0000-0002-9102-8791} } @article{MTMT:33450352, title = {Deviations from PRx-derived optimal blood pressure are associated with mortality after cardiac arrest}, url = {https://m2.mtmt.hu/api/publication/33450352}, author = {Kirschen, Matthew P. and Majmudar, Tanmay and Diaz-Arrastia, Ramon and Berg, Robert and Abella, Benjamin S. and Topjian, Alexis and Balu, Ramani}, doi = {10.1016/j.resuscitation.2022.03.003}, journal-iso = {RESUSCITATION}, journal = {RESUSCITATION}, volume = {175}, unique-id = {33450352}, issn = {0300-9572}, abstract = {Aim: Pressure reactivity index (PRx) provides a surrogate measurement of cerebrovascular autoregulation (CAR). We determined whether deviations from PRx-derived optimal mean arterial pressure (MAP(opt)) were associated with in-hospital mortality after adult cardiac arrest.Methods: Retrospective analysis of post-cardiac arrest patients who had continuously recorded intracranial pressure (ICP) and MAP. PRx was calculated as a moving, linear correlation between ICP and MAP. Impaired CAR was defined as PRx >= 0.3. MAP(opt) was calculated using a multi-window weighted algorithm. The burdens of MAP < 5 mmHg below MAP(opt) (MAP(opt)-5) and > 5 mmHg above MAP(opt) (MAP(opt) + 5) were calculated by integrating the area between MAP and MAP(opt)-5 or MAP(opt) + 5 curves, respectively. Univariate logistic regression tested the association between burden of MAP < MAP(opt)-5 and outcome.Results: Twenty-two patients were analyzed. Thirteen (59%) patients died before hospital discharge. Time (median [IQR]) between ROSC and monitoring initiation was 16 [14, 21] hours and duration of monitoring was 35 [22, 48] hours; neither differed between survivors and non-survivors. Median MAP(opt) was 89 [85, 97] mmHg and did not differ between survivors and non-survivors (89 [83, 94] vs. 91 [85, 105] mmHg, p = 0.64). Burden of MAP < MAP(opt)-5 was greater for non-survivors compared to survivors (OR 3.6 [95% CI 1.2-15.6]). Range of intact CAR (upper-lower limit) was narrower for non-survivors when compared to survivors (5 [0, 22] vs. 24 [7, 36] mmHg, p = 0.03).Conclusion: A greater burden of MAP below PRx-derived MAP(opt)-5 was associated with mortality after cardiac arrest. Non-survivors had a narrower range of intact CAR than survivors.}, keywords = {Intracranial Pressure; Cerebral autoregulation; Cardiac arrest; PRx; Post-cardiac arrest care; Optimal blood pressure}, year = {2022}, eissn = {1873-1570}, pages = {81-87}, orcid-numbers = {Majmudar, Tanmay/0000-0001-5659-8070} } @article{MTMT:33450356, title = {The Effect of Fluid Challenge Test on Optic Nerve Sheath Diameter}, url = {https://m2.mtmt.hu/api/publication/33450356}, author = {Komurcu, Ozgur and Dost, Burhan and Akdemir, Neslihan Unal and Ulger, Fatma}, doi = {10.29271/jcpsp.2022.09.1116}, journal-iso = {JCPSP-J COLL PHYSICI}, journal = {JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN}, volume = {32}, unique-id = {33450356}, issn = {1022-386X}, abstract = {Objective: To investigate the effect of the fluid challenge test on the optic nerve sheath diameter (ONSD) change. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesiology and Reanimation, Ondokuz Mayis University Hospital, Samsun, Turkey, from January to November 2021. Methodology: A fluid challenge was defined as a 500 mL crystalloid infusion administered over 10 minutes, and fluid responsiveness was defined as a subsequent increase in stroke volume of at least 15% administered to the ICU patients. The ONSD and hemodynamic variables were measured by ultrasonography before (T0), at the end (T1), and 30 min after the fluid challenge (T2). The primary outcome of the study was the change in ONSD measurements associated with the fluid challenge, and the secondary outcome was the relationship between fluid responsiveness and the change in ONSD. Results: A total of 60 patients were included. The ONSD (mm) value was significantly higher at T1 compared to T0 (mean & PLUSMN; standard deviation: 5.12 & PLUSMN;0.30 mm vs. 5.10 & PLUSMN;0.32 mm; p=0.011). However, at T2, the ONSD was similar to that at T0 (5.10 & PLUSMN;0.31 mm vs. 5.10 & PLUSMN;0.32 mm; p=0.662). The stroke volume (mL) was also significantly higher at T1 and T2 compared to T0 [median IQR 60 (6) mL vs. 60 (4.7) mL vs. 52 (5) mL, respectively, p < 0.01]. No significant relationship was found between the ONSD and the change in fluid responsiveness (p=0.621). Conclusion: The fluid challenge test increases ONSD and may cause an increase in intracranial pressure.}, keywords = {Stroke Volume; Ultrasonography; fluid therapy; Intracranial Pressure; optic nerve sheath diameter}, year = {2022}, eissn = {1681-7168}, pages = {1116-1121} } @article{MTMT:33450363, title = {Cerebral circulation II: pathophysiology and monitoring}, url = {https://m2.mtmt.hu/api/publication/33450363}, author = {Lavinio, Andrea}, doi = {10.1016/j.bjae.2022.02.005}, journal-iso = {BJA EDUCATION}, journal = {BJA EDUCATION}, volume = {22}, unique-id = {33450363}, issn = {2058-5349}, keywords = {Cerebrovascular Circulation; delirium; Anaesthesia}, year = {2022}, eissn = {2058-5357}, pages = {282-288} }