TY - JOUR AU - Banco, P. AU - Taccone, F.S. AU - Sourd, D. AU - Privitera, C. AU - Bosson, J.-L. AU - Teixeira, T.L. AU - Adolle, A. AU - Payen, J.-F. AU - Bouzat, P. AU - Gauss, T. TI - Prediction of neurocritical care intensity through automated infrared pupillometry and transcranial doppler in blunt traumatic brain injury: the NOPE study JF - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY J2 - EUR J TRAUMA EMERG S PY - 2024 SN - 1863-9933 DO - 10.1007/s00068-023-02435-1 UR - https://m2.mtmt.hu/api/publication/34559957 ID - 34559957 N1 - Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble, and Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, 38000, France Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium Department of Public Health, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA, United States Export Date: 6 February 2024 Correspondence Address: Gauss, T.; Department of Anaesthesia and Intensive Care, France; email: tgauss@chu-grenoble.fr LA - English DB - MTMT ER - TY - JOUR AU - Brasil, Sergio AU - Salvagno, Michele AU - Baggiani, Marta AU - Taccone, Fabio Silvio TI - Early-Goal Directed Therapy for Brain-Injured Patients JF - CURRENT ANESTHESIOLOGY REPORTS J2 - CURR ANESTHESIOL REP PY - 2024 PG - 10 SN - 1523-3855 DO - 10.1007/s40140-024-00615-2 UR - https://m2.mtmt.hu/api/publication/34643324 ID - 34643324 N1 - Export Date: 28 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Chesnut, R. AU - Temkin, N. AU - Pridgeon, J. AU - Sulzbacher, S. AU - Lujan, S. AU - Videtta, W. AU - Moya-Barquín, L. AU - Chaddock, K. AU - Bonow, R. AU - Petroni, G. AU - Guadagnoli, N. AU - Hendrickson, P. AU - Ramírez, Cortez G. AU - Carreazo, N.Y. AU - Vargas, Aymituma A. AU - Anchante, D. AU - Caqui, P. AU - Ramírez, A. AU - Munaico, Abanto M. AU - Ortiz, Chicchon M. AU - Cenzano, Ramos J. AU - Mazate-Mazariegos, A. AU - Castro, Darce M.D.C. AU - Sierra, Morales R. AU - Brol, Lopez P. AU - Menendez, W. AU - Posadas, Gutierrez S. AU - Kevin, V. AU - Mazariegos, A. AU - De, Leon E. AU - Rodas, Barrios R.E. AU - Rodríguez, S. AU - Flores, S. AU - Alvarado, O. AU - Guzman, Flores L.J. AU - Moisa, Martinez M. AU - Gonzalez, P. TI - 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 JF - NEUROSURGERY J2 - NEUROSURGERY VL - 94 PY - 2024 IS - 1 SP - 65 EP - 71 PG - 7 SN - 0148-396X DO - 10.1227/neu.0000000000002582 UR - https://m2.mtmt.hu/api/publication/34559972 ID - 34559972 N1 - Department of Neurological Surgery, University of Washington, Seattle, WA, United States Department of Orthopaedic Surgery, University of Washington, Seattle, WA, United States School of Global Health, University of Washington, Seattle, WA, United States Harborview Medical Center, University of Washington, Seattle, WA, United States Department of Biostatistics, University of Washington, Seattle, WA, United States Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle, WA, United States Hospital Emergencia, Dr. Clemente Alvarez, Rosario, Argentina Centro de Informatica e Investigacion Clinica, Rosario, Argentina Medicina Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina Hospital General San Juan de Dios, Guatemala City, Guatemala Hospital de Emergencias Pediátricas, Lima, Peru Instituto Nacional de Salud Del Niño-San Borja, Lima, Peru Hospital Edgardo Rebagliati Martins, Lima, Peru Hospital Regional de Esquintla, Esquintla, Guatemala Hospital Regional de Occidente San Juan de Dios, Quetzaltenango, Guatemala Hospital Escuela Universitario, Tegucigalpa, Honduras Hospital de Niños Benjamín Bloom, San Salvador, El Salvador Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru Export Date: 6 February 2024 CODEN: NRSRD Correspondence Address: Chesnut, R.; Department of Neurological Surgery, Mailstop 359766, 325 Ninth Ave, United States; email: chesnutr@uw.edu LA - English DB - MTMT ER - TY - JOUR AU - Chesnut, Randall AU - Temkin, Nancy AU - Pridgeon, James AU - Sulzbacher, Stephen AU - Lujan, Silvia AU - Videtta, Walter AU - Moya-Barquin, Luis AU - Chaddock, Kelley AU - Bonow, Robert H. AU - Petroni, Gustavo AU - Guadagnoli, Nahuel AU - Hendrickson, Peter AU - Cortez, Grimaldo Ramirez AU - Carreazo, Nilton Yhuri AU - Aymituma, Alcides Vargas AU - Anchante, Daniel AU - Caqui, Patrick AU - Ramirez, Alberto AU - Abanto, Manuel Munaico AU - Chicchon, Manuel Ortiz AU - Ramos, Jose Cenzano AU - Darce, Maria del Carmen Castro AU - Morales, Roberto Sierra AU - Lopez, Pedro Brol AU - Menendez, Willy AU - Gutierrez, Sofia Posadas AU - Kevin, Vicente AU - Mazariegos, Andrea AU - de Leon, Elie AU - Barrios, Rodolfo Enrique Rodas AU - Rodriguez, Sandra AU - Flores, Sandra AU - Alvarado, Ovidio AU - Flores, Luis Jose Guzman AU - Martinez, Melvin Moisa AU - Gonzalez, Pablo TI - 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 JF - NEUROSURGERY J2 - NEUROSURGERY VL - 94 PY - 2024 IS - 1 SP - 72 EP - 79 PG - 8 SN - 0148-396X DO - 10.1227/neu.0000000000002760 UR - https://m2.mtmt.hu/api/publication/34640246 ID - 34640246 N1 - Export Date: 28 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Domensino, A.-F. AU - Tas, J. AU - Donners, B. AU - Kooyman, J. AU - van, der Horst I.C.C. AU - Haeren, R. AU - Ariës, M.J.H. AU - van, Heugten C. TI - Long-Term Follow-Up of Critically Ill Patients With Traumatic Brain Injury: From Intensive Care Parameters to Patient and Caregiver-Reported Outcome JF - JOURNAL OF NEUROTRAUMA J2 - J NEUROTRAUM VL - 41 PY - 2024 IS - 1-2 SP - 123 EP - 134 PG - 12 SN - 0897-7151 DO - 10.1089/neu.2022.0474 UR - https://m2.mtmt.hu/api/publication/34559958 ID - 34559958 N1 - School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, Netherlands Limburg Brain Injury Centre, Maastricht, Netherlands Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Center+, Maastricht, Netherlands Department of Neurosurgery, Maastricht University, Maastricht University Medical Center+, Maastricht, Netherlands Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands Cited By :1 Export Date: 6 February 2024 CODEN: JNEUE Correspondence Address: Domensino, A.-F.; School for Mental Health and Neuroscience (MHeNS), Netherlands Correspondence Address: Tas, J.; School for Mental Health and Neuroscience (MHeNS), Netherlands; email: tasjeanette@gmail.com LA - English DB - MTMT ER - TY - JOUR AU - Robba, Chiara AU - Battaglini, Denise AU - Abbas, Abbas AU - Sarrio, Ezequiel AU - Cinotti, Raphael AU - Asehnoune, Karim AU - Taccone, Fabio S. AU - Rocco, Patricia R. AU - Schultz, Marcus J. AU - Citerio, Giuseppe AU - Stevens, Robert David AU - Badenes, Rafael TI - Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED PY - 2024 PG - 13 SN - 0342-4642 DO - 10.1007/s00134-023-07305-3 UR - https://m2.mtmt.hu/api/publication/34640248 ID - 34640248 LA - English DB - MTMT ER - TY - JOUR AU - Routkevitch, D. AU - Soulé, Z. AU - Kats, N. AU - Baca, E. AU - Hersh, A.M. AU - Kempski-Leadingham, K.M. AU - Menta, A.K. AU - Bhimreddy, M. AU - Jiang, K. AU - Davidar, A.D. AU - Smit, C. AU - Theodore, N. AU - Thakor, N.V. AU - Manbachi, A. TI - Non-contrast ultrasound image analysis for spatial and temporal distribution of blood flow after spinal cord injury JF - SCIENTIFIC REPORTS J2 - SCI REP VL - 14 PY - 2024 IS - 1 SN - 2045-2322 DO - 10.1038/s41598-024-51281-7 UR - https://m2.mtmt.hu/api/publication/34559955 ID - 34559955 N1 - Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, United States Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States Export Date: 6 February 2024 Correspondence Address: Manbachi, A.; Department of Biomedical Engineering, United States; email: amir.manbachi@jhu.edu LA - English DB - MTMT ER - TY - JOUR AU - Shibahashi, Keita AU - Ohbe, Hiroyuki AU - Matsui, Hiroki AU - Yasunaga, Hideo TI - Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury: A Propensity Score Matching Analysis Using a Nationwide Inpatient Database in Japan JF - NEUROSURGERY J2 - NEUROSURGERY VL - 94 PY - 2024 IS - 1 SP - 99 EP - 107 PG - 9 SN - 0148-396X DO - 10.1227/neu.0000000000002611 UR - https://m2.mtmt.hu/api/publication/34643323 ID - 34643323 N1 - Export Date: 28 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Sigman, E.J. AU - Laghari, F.J. AU - Sarwal, A. TI - Neuro Point-of-Care Ultrasound JF - SEMINARS IN ULTRASOUND CT AND MRI J2 - SEMIN ULTRASOUND CT PY - 2024 SN - 0887-2171 DO - 10.1053/j.sult.2023.12.005 UR - https://m2.mtmt.hu/api/publication/34559956 ID - 34559956 N1 - Export Date: 6 February 2024 CODEN: SUCME Correspondence Address: Sigman, E.J.; Erika J. Sigman, 1364 E. Clifton Rd, United States; email: esigman@emory.edu LA - English DB - MTMT ER - TY - CHAP AU - Abdildin, Y. AU - Jyeniskhan, N. AU - Salamat, A. AU - Tungushpayev, M. AU - Viderman, D. TI - Effect of Barbiturate Coma Therapy on Patients with Resistant Intracranial Hypertension: A Meta-Analysis T2 - 2023 International Conference on Decision Aid Sciences and Applications (DASA) PB - IEEE SN - 9798350342055 PY - 2023 SP - 485 EP - 488 PG - 4 DO - 10.1109/DASA59624.2023.10286695 UR - https://m2.mtmt.hu/api/publication/34559987 ID - 34559987 N1 - School of Engineering and Digital Sciences, Nazarbayev University, Department of Mechanical and Aerospace Engineering, Astana, Kazakhstan School of Medicine, Nazarbayev University, Department of Surgery, Section Anesthesiology, Intensive Care, and Pain Medicine, Astana, Kazakhstan Export Date: 6 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Addis, Alberto AU - Baggiani, Marta AU - Citerio, Giuseppe TI - Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 39 PY - 2023 IS - 1 SP - 59 EP - 69 PG - 11 SN - 1541-6933 DO - 10.1007/s12028-023-01752-y UR - https://m2.mtmt.hu/api/publication/34330741 ID - 34330741 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Anderloni, Marco AU - Schuind, Sophie AU - Salvagno, Michele AU - Donadello, Katia AU - Peluso, Lorenzo AU - Annoni, Filippo AU - Taccone, Fabio Silvio AU - Bogossian, Elisa Gouvea TI - Brain Oxygenation Response to Hypercapnia in Patients with Acute Brain Injury JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE PY - 2023 PG - 9 SN - 1541-6933 DO - 10.1007/s12028-023-01833-y UR - https://m2.mtmt.hu/api/publication/34333924 ID - 34333924 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Ayasse, Timothee AU - Duranteau, Jacques AU - Harrois, Anatole AU - Pochard, Jonas TI - Cerebral autoregulation: every step counts JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 2 SN - 1364-8535 DO - 10.1186/s13054-023-04595-3 UR - https://m2.mtmt.hu/api/publication/34333926 ID - 34333926 N1 - Export Date: 28 November 2023; CODEN: CRCAF LA - English DB - MTMT ER - TY - JOUR AU - Barra, M.E. AU - Zink, E.K. AU - Bleck, T.P. AU - Cáceres, E. AU - Farrokh, S. AU - Foreman, B. AU - Cediel, E.G. AU - Hemphill, J.C. AU - Nagayama, M. AU - Olson, D.W.M. AU - Suarez, J.I. AU - Aiyagari, V. AU - Akbari, Y. AU - Al-Mufti, F. AU - Alexander, S. AU - Alexandrov, A. AU - Alkhachroum, A. AU - Amiri, M. AU - Appavu, B. AU - Gebre, M.A. AU - Bader, M.K. AU - Badjiata, N. AU - Balu, R. AU - Beekman, R. AU - Beghi, E. AU - Bell, K. AU - Beqiri, E. AU - Berlin, T. AU - Bodien, Y. AU - Boerwinkle, V. AU - Boly, M. AU - Bonnel, A. AU - Brown, E. AU - Carroll, E. AU - Chou, S. AU - Citerio, G. AU - Classen, J. AU - Condie, C. AU - Cosmas, K. AU - Creutzfeldt, C. AU - Dangayach, N. AU - DeGeorgia, M. AU - Der-Nigoghoss, C. AU - Desai, M. AU - Diringer, M. AU - Dullaway, J. AU - Edlow, B. AU - Ercole, A. AU - Estraneo, A. AU - Falcone, G. AU - Padayachy, L. AU - Park, S. AU - Pergakis, M. AU - Polizzotto, L. AU - Pouratian, N. AU - Spivack, M.P. AU - Prisco, L. AU - Provencio, J. AU - Puybasset, L. AU - Rasmussen, L. AU - Rass, V. AU - Richardson, R. AU - Shinots, C.R. AU - Robba, C. AU - Robertson, C. AU - Rohaut, B. AU - Rolston, J. AU - Rosanova, M. AU - Rosenthal, E. AU - Russell, M.B. AU - Silva, G.S. AU - Sanz, L. AU - Sarasso, S. AU - Sarwal, A. AU - Schiff, N. AU - Schnakers, C. AU - Seder, D. AU - Shah, V.A. AU - Shapiro-Rosen, A. AU - Shapshak, A. AU - Sharma, K. AU - Sharshar, T. AU - Shutter, L. AU - Sitt, J. AU - Slomine, B. AU - Smielewski, P. AU - Smith, W. AU - Stamatakis, E. AU - Steinberg, A. AU - Ferioli, S. AU - Fernandez-Esp, D. AU - Fink, E. AU - Fins, J. AU - Frontera, J. AU - Ganesan, R. AU - Ghavam, A. AU - Giacino, J. AU - Gibbons, C. AU - Gilmore, E. AU - Gosseries, O. AU - Green, T. AU - Greer, D. AU - Guanci, M. AU - Hahn, C. AU - Hakimi, R. AU - Hanley, D.F. AU - Hartings, J. AU - Hassan, A. AU - Hinson, H. AU - Hirsch, K. AU - Hocker, S. AU - Hu, P. AU - Hu, X. AU - Human, T. AU - Hwang, D. AU - Illes, J. AU - Jaffa, M. AU - James, M.L. AU - Janas, A. AU - Jones, M. AU - Keller, E. AU - Keogh, M. AU - Kim, J. AU - Kim, K. AU - Kirsch, H. AU - Kirschen, M. AU - Ko, N. AU - Kondziella, D. AU - Kreitzer, N. AU - Stevens, R. AU - Sussman, B. AU - Taran, S. AU - Thibaut, A. AU - Threlkeld, Z. AU - Tinti, L. AU - Toker, D. AU - Torbey, M. AU - Trevick, S. AU - Turgeon, A. AU - Udy, A. AU - Varelas, P. AU - Venkatasubba, C. AU - Vespa, P. AU - Videtta, W. AU - Voss, H. AU - Vox, F. AU - Wagner, A. AU - Wainwright, M. AU - Whyte, J. AU - Witherspoon, B. AU - Yakhind, A. AU - Zafonte, R. AU - Zahuranec, D. AU - Zammit, C. AU - Zhang, B. AU - Ziai, W. AU - Zimmerman, L. AU - Kromm, J. AU - Kumar, A. AU - Kurtz, P. AU - Laureys, S. AU - Lawson, T. AU - Lejeune, N. AU - Lewis, A. AU - Liang, J. AU - Ling, G. AU - Livesay, S. AU - Luppi, A. AU - Madden, L. AU - Maddux, C. AU - Mahanes, D. AU - Mainali, S. AU - Maldonado, N. AU - Ribeiro, R.M. AU - Massimini, M. AU - Mayer, S. AU - McCredie, V. AU - McNett, M. AU - Mejia-Mantill, J. AU - Menon, D. AU - Meyfroidt, G. AU - Mijangos, J. AU - Moberg, D. AU - Moheet, A. AU - Molteni, E. AU - Monti, M. AU - Morrison, C. AU - Muehlschlegel, S. AU - Murtaugh, B. AU - Naccache, L. AU - Nairon, E. AU - Natarajan, G. AU - Newcombe, V. AU - Nielsen, N. AU - Noronha-Falc‹, F. AU - Nyquist, P. AU - Othman, M. AU - Owen, A. AU - Curing, Coma Campaign its contributing members TI - Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Hospital Course, Confounders, and Medications JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 39 PY - 2023 IS - 3 SP - 586 EP - 592 PG - 7 SN - 1541-6933 DO - 10.1007/s12028-023-01803-4 UR - https://m2.mtmt.hu/api/publication/34559961 ID - 34559961 N1 - Massachusetts General Hospital, Boston, MA, United States Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, The Johns Hopkins University and The Johns Hopkins Hospital, Baltimore, MD, United States Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States Universidad de La Sabana, Chía, Colombia Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States Division of Neurosurgery, Clínica de Marly Jorge Cavelier Gaviria, Chía, Colombia Department of Neurology, UCSF Weill Institute for Neurosciences, San Francisco, CA, United States Department of Neurology, International University of Health and Welfare Graduate School of Medicine, Narita, Japan Department of Neurology and Neurosurgery, UT Southwestern, Dallas, TX, United States Cited By :1 Export Date: 6 February 2024 Correspondence Address: Suarez, J.I.; Division of Neurosciences Critical Care, United States; email: jsuarez5@jhmi.edu LA - English DB - MTMT ER - TY - JOUR AU - Barrero, J. AU - Carreño, J.N. AU - Pomar, Hoyos M. AU - Vargas, A. TI - Survey on red blood cell transfusion criteria in the intensive care unit JF - ACTA COLOMBIANA DE CUIDADO iNTENSIVO J2 - ACTA COLOMB DE CUID INTENSIVO VL - 23 PY - 2023 IS - 1 SP - 1 EP - 7 PG - 7 SN - 0122-7262 DO - 10.1016/j.acci.2022.09.003 UR - https://m2.mtmt.hu/api/publication/34559992 ID - 34559992 N1 - Export Date: 6 February 2024 Correspondence Address: Barrero, J.; Medicina Critica y Cuidado Intensivo, Colombia; email: jhonbarreros@gmail.com LA - Spanish DB - MTMT ER - TY - JOUR AU - Battaglini, Denise AU - Bogossian, Elisa Gouvea AU - Anania, Pasquale AU - Premraj, Lavienraj AU - Cho, Sung-Min AU - Taccone, Fabio Silvio AU - Sekhon, Mypinder AU - Robba, Chiara TI - Monitoring of Brain Tissue Oxygen Tension in Cardiac Arrest: a Translational Systematic Review from Experimental to Clinical Evidence JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE PY - 2023 PG - 15 SN - 1541-6933 DO - 10.1007/s12028-023-01721-5 UR - https://m2.mtmt.hu/api/publication/33944157 ID - 33944157 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Bellettieri, Michele Pio Giovanni AU - Anderloni, Marco AU - Rass, Verena AU - Kindl, Philipp AU - Donadello, Katia AU - Taccone, Fabio Silvio AU - Helbok, Raimund AU - Bogossian, Elisa Gouvea TI - Cerebrospinal fluid analysis of metabolites is not correlated to microdialysis measurements in acute brain injured patients JF - CLINICAL NEUROLOGY AND NEUROSURGERY J2 - CLIN NEUROL NEUROSUR VL - 234 PY - 2023 PG - 6 SN - 0303-8467 DO - 10.1016/j.clineuro.2023.108011 UR - https://m2.mtmt.hu/api/publication/34555689 ID - 34555689 N1 - Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium Department of Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Ginaecology and Paediatrics, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria Export Date: 6 February 2024 CODEN: CNNSB Correspondence Address: Gouvea Bogossian, E.; Department of Intensive Care, Route de Lennik, 808, Belgium; email: elisagobog@gmail.com AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Beqiri, Erta AU - Smielewski, Peter AU - Guerin, Claude AU - Czosnyka, Marek AU - Robba, Chiara AU - Bjertnaes, Lars AU - Frisvold, Shirin K. TI - Neurological and respiratory effects of lung protective ventilation in acute brain injury patients without lung injury: brain vent, a single centre randomized interventional study JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 12 SN - 1364-8535 DO - 10.1186/s13054-023-04383-z UR - https://m2.mtmt.hu/api/publication/33937372 ID - 33937372 N1 - Funding Agency and Grant Number: UiT The Arctic University of Norway (incl University Hospital of North Norway); Northern Norway Regional Health Authority [181021]; ESICM clinical award; Medical Research Council [MR N013433-1]; Gates Cambridge Scholarship Funding text: Open access funding provided by UiT The Arctic University of Norway (incl University Hospital of North Norway). This research was funded in whole by the Northern Norway Regional Health Authority (181021) and ESICM clinical award 2018. Erta Beqiri is supported by the Medical Research Council (Grant No.: MR N013433-1) and by the Gates Cambridge Scholarship AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Bernard, Francis TI - Neurotrauma and Intracranial Pressure Management JF - CRITICAL CARE CLINICS J2 - CRIT CARE CLIN VL - 39 PY - 2023 IS - 1 SP - 103 EP - 121 PG - 19 SN - 0749-0704 DO - 10.1016/j.ccc.2022.08.002 UR - https://m2.mtmt.hu/api/publication/33435300 ID - 33435300 N1 - Export Date: 21 January 2023 CODEN: CCCLE LA - English DB - MTMT ER - TY - CHAP AU - Bertolini, G. AU - Cattani, L. AU - Iaccarino, C. AU - Fornaciari, A. AU - Picetti, E. ED - Catena, Fausto ED - Coccolini, Federico TI - Head and Brain Trauma T2 - Textbook of Emergency General Surgery PB - Springer International Publishing CY - Cham SN - 9783031225994 PY - 2023 SP - 581 EP - 604 PG - 24 DO - 10.1007/978-3-031-22599-4_39 UR - https://m2.mtmt.hu/api/publication/34559908 ID - 34559908 N1 - Department of Neurological Surgery, Parma University Hospital, Parma, Italy Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy Export Date: 6 February 2024 Correspondence Address: Picetti, E.; Department of Anesthesia and Intensive Care, Italy LA - English DB - MTMT ER - TY - JOUR AU - Chen, Patrick M. M. AU - Shah, Ishan AU - Manning, Conrad AU - Lekawa, Michael AU - Chen, Jefferson W. W. TI - Considerations for Intracranial Monitoring and Surgery in Severe Traumatic Brain Injury with Temporal Lobe Contusion JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 39 PY - 2023 IS - 2 SP - 527 EP - 529 PG - 3 SN - 1541-6933 DO - 10.1007/s12028-023-01756-8 UR - https://m2.mtmt.hu/api/publication/34333928 ID - 34333928 N1 - Export Date: 28 November 2023 LA - English DB - MTMT ER - TY - JOUR AU - Chesnut, Randall M. AU - Aguilera, Sergio AU - Buki, Andras AU - Bulger, Eileen M. AU - Citerio, Giuseppe AU - Cooper, D. Jamie AU - Arrastia, Ramon Diaz AU - Diringer, Michael AU - Figaji, Anthony AU - Gao, Guoyi AU - Geocadin, Romergryko G. AU - Ghajar, Jamshid AU - Harris, Odette AU - Hawryluk, Gregory W. J. AU - Hoffer, Alan AU - Hutchinson, Peter AU - Joseph, Mathew AU - Kitagawa, Ryan AU - Manley, Geoffrey AU - Mayer, Stephan AU - Menon, David K. AU - Meyfroidt, Geert AU - Michael, Daniel B. AU - Oddo, Mauro AU - Okonkwo, David O. AU - Patel, Mayur B. AU - Robertson, Claudia AU - Rosenfeld, Jeffrey V. AU - Rubiano, Andres M. AU - Sahuquillo, Juain AU - Servadei, Franco AU - Shutter, Lori AU - Stein, Deborah M. AU - Stocchetti, Nino AU - Taccone, Fabio Silvio AU - Timmons, Shelly D. AU - Tsai, Eve C. AU - Ullman, Jamie S. AU - Videtta, Walter AU - Wright, David W. AU - Zammit, Christopher TI - Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations JF - NEUROSURGERY J2 - NEUROSURGERY VL - 93 PY - 2023 IS - 2 SP - 399 EP - 408 PG - 10 SN - 0148-396X DO - 10.1227/neu.0000000000002516 UR - https://m2.mtmt.hu/api/publication/34280470 ID - 34280470 N1 - Funding Agency and Grant Number: original SIBICC consensus conference effort who include Adler/Geirsch Attorney at Law; American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard; Brain Trauma Foundation; DePuy; Hemedex; Integra; Neurointensive Care Section of the European Society of Intensive Care Medicine; Neurosurgery Society of Australasia; Medtronic; Moberg Research; Natus; Neuroptics; Raumdic; Sophysa; Stryker; Zoll; NIHR Funding text: All authors contributed to the study conception and contributed equally to the consensus process. Material preparation, data collection, and analysis were performed by Randall M Chesnut, with the kind assistance of Nancy Temkin and Jason Barber. The first draft of the manuscript was written by Randall M Chesnut, and all authors commented on the three iterations of the manuscript. All authors read and approved the final manuscript. The authors wish to acknowledge Nancy Temkin, PhD, for assistance with statistical analyses; Peter Hendrickson, PhD, for managing our web-based surveys; Jason Barber MS for assistance with statistical analyses and matrix design; and Kelley Chaddock, BA, for organizational and managerial help. We also wish to thank our financial supporters for the original SIBICC consensus conference effort who include Adler/Geirsch Attorney at Law, the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard, the Brain Trauma Foundation, DePuy, Hemedex, Integra, the Neurointensive Care Section of the European Society of Intensive Care Medicine, Neurosurgery Society of Australasia, Medtronic, Moberg Research, Natus, Neuroptics, Raumdic, Sophysa, Stryker, and Zoll. PJH is supported by the NIHR (Research Professorship, Cambridge BRC and Global Health Research Group on Neurotrauma), and DKM is an Emeritus Senior Investigator of the National Institute of Health Research (UK). AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Ciliberti, Pietro AU - Cardim, Danilo AU - Giardina, Alberto AU - Groznik, Matjaz AU - Ball, Lorenzo AU - Giovannini, Martina AU - Battaglini, Denise AU - Beqiri, Erta AU - Matta, Basil AU - Smielewski, Peter AU - Czosnyka, Marek AU - Pelosi, Paolo AU - Robba, Chiara TI - Effects of short-term hyperoxemia on cerebral autoregulation and tissue oxygenation in acute brain injured patients JF - FRONTIERS IN PHYSIOLOGY J2 - FRONT PHYSIOL VL - 14 PY - 2023 PG - 10 SN - 1664-042X DO - 10.3389/fphys.2023.1113386 UR - https://m2.mtmt.hu/api/publication/33917212 ID - 33917212 N1 - Export Date: 9 October 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Denchev, K. AU - Gomez, J. AU - Chen, P. AU - Rosenblatt, K. TI - Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring JF - ANESTHESIOLOGY CLINICS J2 - ANESTHESIOLOGY CLINICS VL - 41 PY - 2023 IS - 1 SP - 39 EP - 78 PG - 40 SN - 1932-2275 DO - 10.1016/j.anclin.2022.11.003 UR - https://m2.mtmt.hu/api/publication/34559983 ID - 34559983 N1 - Cited By :1 Export Date: 6 February 2024 Correspondence Address: Rosenblatt, K.; Department of Anesthesiology & Critical Care Medicine, 600 North Wolfe Street, Phipps 455, United States; email: krosenb3@jhmi.edu LA - English DB - MTMT ER - TY - JOUR AU - De Vlieger, Greet AU - Meyfroidt, Geert TI - Kidney Dysfunction After Traumatic Brain Injury: Pathophysiology and General Management JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 38 PY - 2023 IS - 2 SP - 504 EP - 516 PG - 13 SN - 1541-6933 DO - 10.1007/s12028-022-01630-z UR - https://m2.mtmt.hu/api/publication/33430630 ID - 33430630 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Dietvorst, Sofie AU - Depreitere, Bart AU - Meyfroidt, Geert TI - Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury JF - CURRENT OPINION IN CRITICAL CARE J2 - CURR OPIN CRIT CARE VL - 29 PY - 2023 IS - 2 SP - 85 EP - 88 PG - 4 SN - 1070-5295 DO - 10.1097/MCC.0000000000001026 UR - https://m2.mtmt.hu/api/publication/33940231 ID - 33940231 N1 - Export Date: 28 November 2023; CODEN: COCCF AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Di, Matteo M. AU - Corbella, D. ED - Catena, Fausto ED - Coccolini, Federico TI - Critical Care Medicine T2 - Textbook of Emergency General Surgery PB - Springer International Publishing CY - Cham SN - 9783031225994 PY - 2023 SP - 159 EP - 181 PG - 23 DO - 10.1007/978-3-031-22599-4_13 UR - https://m2.mtmt.hu/api/publication/34562105 ID - 34562105 N1 - Export Date: 6 February 2024 Correspondence Address: Corbella, D.; NeuroTrauma Intensive Care Unit, Italy; email: dcorbella@asst-pg23.it LA - English DB - MTMT ER - TY - JOUR AU - Figaji, A. TI - An update on pediatric traumatic brain injury JF - CHILDS NERVOUS SYSTEM J2 - CHILD NERV SYST VL - 39 PY - 2023 IS - 11 SP - 3071 EP - 3081 PG - 11 SN - 0256-7040 DO - 10.1007/s00381-023-06173-y UR - https://m2.mtmt.hu/api/publication/34559965 ID - 34559965 N1 - Export Date: 6 February 2024 CODEN: CNSYE Correspondence Address: Figaji, A.; Division of Neurosurgery and Neurosciences Institute, South Africa; email: Anthony.Figaji@uct.ac.za LA - English DB - MTMT ER - TY - JOUR AU - Filipovic, M.G. AU - Luedi, M.M. TI - Transfusion strategies in traumatic brain injury – A clinical debate JF - JOURNAL OF CLINICAL ANESTHESIA J2 - J CLIN ANESTH VL - 90 PY - 2023 PG - 3 SN - 0952-8180 DO - 10.1016/j.jclinane.2023.111233 UR - https://m2.mtmt.hu/api/publication/34181758 ID - 34181758 N1 - Export Date: 1 February 2024 CODEN: JCLBE Correspondence Address: Filipovic, M.G.; Department of Anaesthesiology and Pain Medicine, Freiburgstrasse 18, Switzerland; email: mark.filipovic@insel.ch LA - English DB - MTMT ER - TY - JOUR AU - Foreman, Brandon AU - Kapinos, Gregory AU - Wainwright, Mark S. AU - Ngwenya, Laura B. AU - O'Phelan, Kristine H. AU - LaRovere, Kerri L. AU - Kirschen, Matthew P. AU - Appavu, Brian AU - Lazaridis, Christos AU - Alkhachroum, Ayham AU - Maciel, Carolina B. AU - Amorim, Edilberto AU - Chang, Jason J. AU - Gilmore, Emily J. AU - Rosenthal, Eric S. AU - Park, Soojin TI - Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process JF - CRITICAL CARE MEDICINE J2 - CRIT CARE MED VL - 51 PY - 2023 IS - 12 SP - 1740 EP - 1753 PG - 14 SN - 0090-3493 DO - 10.1097/CCM.0000000000006016 UR - https://m2.mtmt.hu/api/publication/34555686 ID - 34555686 N1 - Funding Agency and Grant Number: U.S. Department of Defense [W81XWH-18-DMRDP-PTCRA]; National Institutes of Health [OD OT2OD032701]; U.S. Department of Defense (DoD); Marinus Pharmaceuticals; U.S. Army; UCB Pharma; SAGE Therapeutics; Abbott; Biogen; General Dynamics Information Technology/DoD; Bard Medical CEC; U.S. National Phase Applications [17/601, 603, US-2022-0181008-A1, 21233 CMCC, 3440 WGS, M0437.70143US01]; U.S. DoD Congressionally Directed Medical Research Programs; American Heart Association (AHA); National Institutes of Health (NIH); AHA [20CDA35310297, 83457]; CURE Epilepsy Foundation (Taking Flight Award); NIH [1K23NS090900, UG3 NS123307]; Hellman Fellows Fund; Regents of the University of California (Resource Allocation Program); Cures Within Reach; Zoll Foundation; American Academy of Neurology and Caring Analytics Platform (CARPL.ai); Moberg Analytics Funding text: Funding was provided by U.S. Department of Defense (W81XWH-18-DMRDP-PTCRA; to Drs. Foreman and Rosenthal) and by the National Institutes of Health (OD OT2OD032701; to Dr. Rosenthal).Dr. Foreman's institution received funding from the U.S. Department of Defense (DoD) (W81XWH-18-DMRDP-PTCRA); he received funding from Marinus Pharmaceuticals; he disclosed that he is on the Scientific Advisory Committee for the Neurocritical Care Society Curing Coma Campaign. Drs. Foreman and Appavu perform dedicated neuromonitoring services locally. Drs. Foreman and Rosenthal received Institutional support through U.S. Army W81XWH-18-DMRDP-PTCRA through parent award to Moberg Analytics. Drs. Foreman and Gilmore received funding from UCB Pharma. Drs. Foreman and Wainwright received funding from SAGE Therapeutics. Dr. Ngwenya's institution received funding from Abbott and Biogen; she received funding from General Dynamics Information Technology/DoD. Dr. O'Phelan received funding from Bard Medical CEC. Dr. La Rovere disclosed that she has U.S. National Phase Applications (No.: 17/601, 603, No.: US-2022-0181008-A1, Ref. No.: 21233 CMCC, Ref. No.: 3440 WGS, Ref. No.: M0437.70143US01 Patent-Issued). Dr. Appavu's institution received funding from the U.S. DoD Congressionally Directed Medical Research Programs and the American Heart Association (AHA). Drs. Alkhachroum and Rosenthal received support for article research from the National Institutes of Health (NIH). Dr. Amorim received funding from the AHA (20CDA35310297, 83457), the CURE Epilepsy Foundation (Taking Flight Award), the NIH (1K23NS090900), the Hellman Fellows Fund, the Regents of the University of California (Resource Allocation Program), Cures Within Reach, and the Zoll Foundation. Dr. Gilmore received funding from the American Academy of Neurology and Caring Analytics Platform (CARPL.ai); she serves as Director of Neuromonitoring locally; co-founded Intracranial Bio Analytics; and holds NIH grant funding for development of a multimodal intracranial monitoring device and data visualization platform (UG3 NS123307). Dr. Rosenthal's institution received funding from the NIH, the U.S. Army, Moberg Analytics, and Marinus Pharmaceuticals. The remaining authors have disclosed that they do not have any potential conflicts of interest. AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Friess, Stuart H. H. TI - Pressure Reactivity Index in Children With Severe Traumatic Brain Injury: Are We Getting Closer to Goldilocks Management? JF - CRITICAL CARE MEDICINE J2 - CRIT CARE MED VL - 51 PY - 2023 IS - 5 SP - 680 EP - 682 PG - 3 SN - 0090-3493 DO - 10.1097/CCM.0000000000005813 UR - https://m2.mtmt.hu/api/publication/33944155 ID - 33944155 N1 - Export Date: 28 November 2023; CODEN: CCMDC LA - English DB - MTMT ER - TY - JOUR AU - Frisvold, S. AU - Coppola, S. AU - Ehrmann, S. AU - Chiumello, D. AU - Guerin, Claude TI - Respiratory challenges and ventilatory management in different types of acute brain-injured patients JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 11 SN - 1364-8535 DO - 10.1186/s13054-023-04532-4 UR - https://m2.mtmt.hu/api/publication/34333927 ID - 34333927 N1 - Export Date: 28 November 2023; CODEN: CRCAF AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Froese, Logan AU - Gomez, Alwyn AU - Sainbhi, Amanjyot Singh AU - Vakitbilir, Nuray AU - Marquez, Izabella AU - Amenta, Fiorella AU - Stein, Kevin Y. AU - Zeiler, Frederick A. TI - Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis JF - INTENSIVE CARE MEDICINE EXPERIMENTAL J2 - INTENSIVE CARE MED EXP VL - 11 PY - 2023 IS - 1 PG - 15 SN - 2197-425X DO - 10.1186/s40635-023-00515-5 UR - https://m2.mtmt.hu/api/publication/34288229 ID - 34288229 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Froese, Logan AU - Hammarlund, Emma AU - Akerlund, Cecilia A. I. AU - Tjerkaski, Jonathan AU - Hong, Erik AU - Lindblad, Caroline AU - Nelson, David W. AU - Thelin, Eric P. AU - Zeiler, Frederick A. TI - The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury JF - INTENSIVE CARE MEDICINE EXPERIMENTAL J2 - INTENSIVE CARE MED EXP VL - 11 PY - 2023 IS - 1 PG - 12 SN - 2197-425X DO - 10.1186/s40635-023-00524-4 UR - https://m2.mtmt.hu/api/publication/34288225 ID - 34288225 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Godoy, Daniel Agustin AU - Rubiano, Andres M. AU - Paranhos, Jorge AU - Robba, Chiara AU - Lazaridis, Christos TI - Avoiding brain hypoxia in severe traumatic brain injury in settings with limited resources-A pathophysiological guide JF - JOURNAL OF CRITICAL CARE J2 - J CRIT CARE VL - 75 PY - 2023 PG - 9 SN - 0883-9441 DO - 10.1016/j.jcrc.2023.154260 UR - https://m2.mtmt.hu/api/publication/33944160 ID - 33944160 N1 - Export Date: 28 November 2023; CODEN: JCCAE AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Godoy, Daniel Agustin AU - Brasil, Sergio AU - Iaccarino, Corrado AU - Paiva, Wellingson AU - Rubiano, Andres M. TI - The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 9 SN - 1364-8535 DO - 10.1186/s13054-023-04427-4 UR - https://m2.mtmt.hu/api/publication/33944158 ID - 33944158 N1 - Export Date: 28 November 2023; CODEN: CRCAF AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Godoy, Daniel Agustin AU - Murillo-Cabezas, Francisco AU - Suarez, Jose Ignacio AU - Badenes, Rafael AU - Pelosi, Paolo AU - Robba, Chiara TI - "THE MANTLE" bundle for minimizing cerebral hypoxia in severe traumatic brain injury JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 8 SN - 1364-8535 DO - 10.1186/s13054-022-04242-3 UR - https://m2.mtmt.hu/api/publication/33917231 ID - 33917231 N1 - Export Date: 28 November 2023; CODEN: CRCAF AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Gomez, Alwyn AU - Sainbhi, Amanjyot Singh AU - Stein, Kevin Y. AU - Vakitbilir, Nuray AU - Froese, Logan AU - Zeiler, Frederick A. TI - 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 JF - INTENSIVE CARE MEDICINE EXPERIMENTAL J2 - INTENSIVE CARE MED EXP VL - 11 PY - 2023 IS - 1 PG - 13 SN - 2197-425X DO - 10.1186/s40635-023-00541-3 UR - https://m2.mtmt.hu/api/publication/34329822 ID - 34329822 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Gomez, Alwyn AU - Griesdale, Donald AU - Froese, Logan AU - Yang, Eleen AU - Thelin, Eric P. AU - Raj, Rahul AU - Aries, Marcel AU - Gallagher, Clare AU - Bernard, Francis AU - Kramer, Andreas H. AU - Zeiler, Frederick A. TI - 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 JF - BIOENGINEERING J2 - BIOENGINEERING-BASEL VL - 10 PY - 2023 IS - 10 PG - 19 SN - 2306-5354 DO - 10.3390/bioengineering10101124 UR - https://m2.mtmt.hu/api/publication/34497609 ID - 34497609 N1 - Funding Agency and Grant Number: Endowed Manitoba Public Insurance (MPI) Chair in Neuroscience; NSERC; [DGECR-2022-00260]; [RGPIN-2022-03621]; [ALLRP-578524-22]; [ALLRP-576386-22]; [ALLRP 586244-23] Funding text: This work was directly supported through the Endowed Manitoba Public Insurance (MPI) Chair in Neuroscience, and NSERC (DGECR-2022-00260, RGPIN-2022-03621, ALLRP-578524-22, ALLRP-576386-22, ALLRP 586244-23) AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Guo, Shaochun AU - Han, Ruili AU - Chen, Fan AU - Ji, Peigang AU - Liu, Jinghui AU - Zhai, Yulong AU - Chao, Min AU - Zhao, Wenjian AU - Jiao, Yang AU - Fan, Chao AU - Huang, Tao AU - Wang, Na AU - Ge, Shunnan AU - Qu, Yan AU - Wang, Yuan AU - Wang, Liang TI - Epidemiological characteristics for patients with traumatic brain injury and the nomogram model for poor prognosis: an 18-year hospital-based study JF - FRONTIERS IN NEUROLOGY J2 - FRONT NEUR VL - 14 PY - 2023 PG - 14 SN - 1664-2295 DO - 10.3389/fneur.2023.1138217 UR - https://m2.mtmt.hu/api/publication/34307964 ID - 34307964 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Harder, Tyler J. AU - Leary, Owen P. AU - Yang, Zhihui AU - Lucke-Wold, Brandon AU - Liu, David D. AU - Still, Megan E. H. AU - Zhang, Miao AU - Yeatts, Sharon D. AU - Allen, Jason W. AU - Wright, David W. AU - Merck, Derek AU - Merck, Lisa H. TI - 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 JF - JOURNAL OF NEUROTRAUMA J2 - J NEUROTRAUM PY - 2023 PG - 11 SN - 0897-7151 DO - 10.1089/neu.2022.0433 UR - https://m2.mtmt.hu/api/publication/34330034 ID - 34330034 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Hartings, Jed A. AU - Dreier, Jens P. AU - Ngwenya, Laura B. AU - Balu, Ramani AU - Carlson, Andrew P. AU - Foreman, Brandon TI - Improving Neurotrauma by Depolarization Inhibition With Combination Therapy: A Phase 2 Randomized Feasibility Trial JF - NEUROSURGERY J2 - NEUROSURGERY VL - 93 PY - 2023 IS - 4 SP - 924 EP - 931 PG - 8 SN - 0148-396X DO - 10.1227/neu.0000000000002509 UR - https://m2.mtmt.hu/api/publication/34548394 ID - 34548394 N1 - Funding Agency and Grant Number: Congressionally Directed Medical Research Programs (CDMRP); DFG [W81XWH-21-C-0075]; Era-Net NeuronEBio2; BMBF; NIH [DR 323/10-1]; [P20GM109089] Funding text: This material is based on the work supported by the Congressionally Directed Medical Research Programs (CDMRP) under Contract No.W81XWH-21-C-0075. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the CDMRP. Jens P. Dreier ac-knowledges support from DFG DR 323/10-1 and Era-Net NeuronEBio2, with funds from BMBF (01EW2004). Andrew P. Carlson received funding from NIH P20GM109089. AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Hawryluk, G.W.J. AU - Lulla, A. AU - Bell, R. AU - Jagoda, A. AU - Mangat, H.S. AU - Bobrow, B.J. AU - Ghajar, J. TI - Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary JF - NEUROSURGERY J2 - NEUROSURGERY VL - 93 PY - 2023 IS - 6 SP - E159 EP - E169 SN - 0148-396X DO - 10.1227/neu.0000000000002672 UR - https://m2.mtmt.hu/api/publication/34559960 ID - 34559960 N1 - Export Date: 6 February 2024 CODEN: NRSRD Correspondence Address: Hawryluk, G.W.J.; Neurological Institute, 762S Cleveland Massillon Rd, United States; email: hawrylg@ccf.org LA - English DB - MTMT ER - TY - JOUR AU - Hossain, I. AU - Rostami, E. AU - Marklund, N. TI - The management of severe traumatic brain injury in the initial postinjury hours - Current evidence and controversies JF - CURRENT OPINION IN CRITICAL CARE J2 - CURR OPIN CRIT CARE VL - 29 PY - 2023 IS - 6 SP - 650 EP - 658 PG - 9 SN - 1070-5295 DO - 10.1097/MCC.0000000000001094 UR - https://m2.mtmt.hu/api/publication/34559905 ID - 34559905 N1 - Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden Department of Neuroscience, Karolinska Institute, Stockholm, Sweden Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden Cited By :1 Export Date: 6 February 2024 CODEN: COCCF Correspondence Address: Marklund, N.; Department of Clinical Sciences Lund, Sweden; email: niklas.marklund@med.lu.se LA - English DB - MTMT ER - TY - JOUR AU - Husain-Syed, Faeq AU - Takeuchi, Tomonori AU - Neyra, Javier A. AU - Ramirez-Guerrero, Gonzalo AU - Rosner, Mitchell H. AU - Ronco, Claudio AU - Tolwani, Ashita J. TI - Acute kidney injury in neurocritical care JF - CRITICAL CARE J2 - CRIT CARE VL - 27 PY - 2023 IS - 1 PG - 14 SN - 1364-8535 DO - 10.1186/s13054-023-04632-1 UR - https://m2.mtmt.hu/api/publication/34243470 ID - 34243470 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Jirlow, Unni AU - Arvidsson, Lisa AU - Magneli, Sara AU - Cesarini, Kristina AU - Rostami, Elham TI - Evaluation of Miethke M.scio Device Implantation for Intracranial Pressure Monitoring in Patients with Cerebrospinal Fluid Disorders JF - WORLD NEUROSURGERY J2 - WORLD NEUROSURG VL - 179 PY - 2023 SP - E63 EP - E74 PG - 12 SN - 1878-8750 DO - 10.1016/j.wneu.2023.07.102 UR - https://m2.mtmt.hu/api/publication/34555688 ID - 34555688 N1 - Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden Export Date: 6 February 2024 Correspondence Address: Rostami, E.; Department of Medical Sciences, Sweden; email: Elham.rostami@neuro.uu.se AB - -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. LA - English DB - MTMT ER - TY - JOUR AU - Karagianni, Maria D. AU - Tasiou, Anastasia AU - Brotis, Alexandros G. AU - Tzerefos, Christos AU - Lambrianou, Xanthoula AU - Alkiviadis, Tzannis AU - Kalogeras, Adamantios AU - Spiliotopoulos, Theodosis AU - Arvaniti, Christina AU - Papageorgakopoulou, Manthia AU - Gatos, Charalambos AU - Fountas, Konstantinos N. TI - Critical Assessment of the Guidelines-Based Management of Severe Traumatic Brain with the of Guidelines for Research and Evaluation II JF - WORLD NEUROSURGERY J2 - WORLD NEUROSURG VL - 176 PY - 2023 SP - 179 EP - 188 PG - 10 SN - 1878-8750 DO - 10.1016/j.WNEU.2023.01.054 UR - https://m2.mtmt.hu/api/publication/34280473 ID - 34280473 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Lu, Yiming AU - Chen, Yiming AU - Xu, Siyi AU - Wei, Liang AU - Zhang, Yanfei AU - Chen, Wei AU - Liu, Min AU - Zhong, Chunlong TI - HDAC inhibitor attenuates rat traumatic brain injury induced neurological impairments JF - HELIYON J2 - HELIYON VL - 9 PY - 2023 IS - 8 PG - 9 SN - 2405-8440 DO - 10.1016/j.heliyon.2023.e18485 UR - https://m2.mtmt.hu/api/publication/34329874 ID - 34329874 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Moyer, J.-D. AU - Elouahmani, S. AU - Codorniu, A. AU - Abback, P.-S. AU - Jeantrelle, C. AU - Goutagny, S. AU - Gauss, T. AU - Sigaut, S. TI - External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful? JF - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY J2 - EUR J TRAUMA EMERG S VL - 49 PY - 2023 IS - 3 SP - 1227 EP - 1234 PG - 8 SN - 1863-9933 DO - 10.1007/s00068-022-01903-4 UR - https://m2.mtmt.hu/api/publication/34782675 ID - 34782675 N1 - Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, Clichy, 92110, France Department of Neurosurgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France Université de Paris, UFR de Médecine Paris Nord, Paris, France NeuroDiderot, Inserm U1141, Université de Paris, Paris, France Export Date: 11 April 2024; Cited By: 3; Correspondence Address: J.-D. Moyer; Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Clichy, 100 boulevard du Général Leclerc, 92110, France; email: Jean-denis.moyer@aphp.fr LA - English DB - MTMT ER - TY - JOUR AU - Moyer, Jean-Denis AU - Leger, Maxime AU - Trolonge, Baptiste AU - Codorniu, Anais AU - Lhermitte, Amaury AU - Gaberel, Thomas AU - Jeantrelle, Caroline AU - Gakuba, Clement TI - Impact of early external ventricular drainage on functional outcome after traumatic brain injury: a bicentric retrospective cohort analysis JF - NEUROCHIRURGIE J2 - NEUROCHIRURGIE VL - 69 PY - 2023 IS - 6 PG - 7 SN - 0028-3770 DO - 10.1016/j.neuchi.2023.101487 UR - https://m2.mtmt.hu/api/publication/34333922 ID - 34333922 N1 - Export Date: 28 November 2023; CODEN: NUREB AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Olasveengen, Theresa Mariero AU - Stocchetti, Nino TI - Prehospital ventilation targets in severe traumatic brain injury JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED VL - 49 PY - 2023 IS - 5 SP - 554 EP - 555 PG - 2 SN - 0342-4642 DO - 10.1007/s00134-023-07044-5 UR - https://m2.mtmt.hu/api/publication/33941495 ID - 33941495 N1 - Export Date: 28 November 2023; CODEN: ICMED LA - English DB - MTMT ER - TY - JOUR AU - Payen, J.-F. AU - Launey, Y. AU - Chabanne, R. AU - Gay, S. AU - Francony, G. AU - Gergele, L. AU - Vega, E. AU - Montcriol, A. AU - Couret, D. AU - Cottenceau, V. AU - Pili-Floury, S. AU - Gakuba, C. AU - Hammad, E. AU - Audibert, G. AU - Pottecher, J. AU - Dahyot-Fizelier, C. AU - Abdennour, L. AU - Gauss, T. AU - Richard, M. AU - Vilotitch, A. AU - Bosson, J.-L. AU - Bouzat, P. AU - Fevre, M.-C. AU - SCHILTE, C. AU - Vincent, O. AU - Hérault, M.-C. AU - Mistral, T. AU - Trouve-Buisson, T. AU - Picard, J. AU - Falcon, D. AU - Bersinger, S. AU - Mourey, C. AU - Adolle, A. AU - Salah, S. AU - Manhes, P. AU - Pollet, A. AU - GRECO, F. AU - CHALARD, K. AU - Andréa, B. AU - Velly, L. AU - Bruder, N. AU - Inal, I. AU - Magand, C. AU - Burnol, L. AU - Morel, J. AU - PREGNY, A. AU - FERRE, J.-C. AU - Bannier, E. AU - Lebouvier, T. AU - Caradec, S. AU - Drevet, C.-M. AU - Nadji, A. AU - Lewandowski, R. AU - DAILLER, F. AU - CARRILLON, R. AU - GOBERT, F. AU - RITZENTHALER, T. AU - LECLERCQ, M. AU - Dumont, N. AU - Charpentier, C. AU - Alb, I. AU - De, Sa N. AU - Declerck, N. AU - Boussemart, P. AU - Bellet, J. AU - MEAUDRE-DESGOUTTES, E. AU - D'ARANDA, E. AU - ESNAULT, P. AU - CHARRUAU, C. AU - BELLIER, R. AU - BENARD, T. AU - Carise, E. AU - SEGUIN, S. AU - Lefrant, J.Y. AU - Daurat, A. AU - Ambert, A. AU - Lebouc, M. AU - Hautefeuille, S. AU - Escudier, E. AU - Bing, F. AU - Cosserant, B. AU - Grobost, R. AU - Boissy, C. AU - Begard, M. AU - Guyot, A. AU - Lagarde, K. AU - Caumon, E. AU - Geeraerts, T. AU - POMMIER, M. AU - NABOULSI, E. AU - BEILVERT, M. AU - PARRY, E. AU - Leone, M. AU - Zieleskiewicz, L. AU - Duclos, G. AU - Arbelot, C. AU - Carole, I. AU - Hervé, Q. AU - Aminata, D. AU - Puybasset, L. AU - Torkomian, G. AU - Szczot, M. AU - Kremer, S. AU - Becker, G. AU - Hecketsweiler, S. AU - ILIC, D. AU - VETTORETTI, L. AU - Grisotto, C. AU - Asmolov, R. AU - Ehinger, V. AU - Laquay, N. AU - Chevallier, V. AU - Mahlal, Z. AU - LASOCKI, S. AU - SCHOLASTIQUE, A.-S. AU - GAILLARD, T. AU - GERGAUD, S. AU - BARBIER, E. AU - TAHON, F. AU - KRAINIK, A. AU - DOJAT, M. AU - TROPRES, I. AU - VIGUE, B. AU - LEO, L. AU - Piriou, V. AU - Coquerel, A. AU - Cracowski, J.-L. AU - Proust, F. AU - Mallaret, M. AU - OXY-TC, trial collaborators TI - 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 JF - LANCET NEUROLOGY J2 - LANCET NEUROL VL - 22 PY - 2023 IS - 11 SP - 1005 EP - 1014 PG - 10 SN - 1474-4422 DO - 10.1016/S1474-4422(23)00290-9 UR - https://m2.mtmt.hu/api/publication/34559962 ID - 34559962 N1 - Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France Department of Public Health, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Rennes, Rennes, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France Department of Intensive Care, Centre Hospitalier Annecy Genevois, Annecy, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Lille, Lille, France Department of Intensive Care, Hopital Instruction des Armées Saint-Anne, Toulon, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Sud, Reunion, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Besançon, Besançon, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Caen Normandie, Caen, France Department of Anaesthesia and Intensive Care, Hôpital Nord, Assistance Publique des Hopitaux de Marseille, Marseille, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Nancy, Nancy, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Poitiers, Poitiers, France Department of Anaesthesia and Intensive Care, Hôpital Pitie-Salpetriere, Assistance Publique des Hôpitaux de Paris, Paris, France Cited By :3 Export Date: 6 February 2024 CODEN: LNAEA Correspondence Address: Payen, J.-F.; Department of Anaesthesia and Intensive Care, France; email: jfpayen@univ-grenoble-alpes.fr LA - English DB - MTMT ER - TY - JOUR AU - Petrov, Dmitriy AU - Miranda, Stephen P. AU - Balu, Ramani AU - Wathen, Connor AU - Vaz, Alex AU - Mohan, Vinodh AU - Colon, Christian AU - Diaz-Arrastia, Ramon TI - Prediction of intracranial pressure crises after severe traumatic brain injury using machine learning algorithms JF - JOURNAL OF NEUROSURGERY J2 - J NEUROSURG VL - 139 PY - 2023 IS - 2 SP - 528 EP - 535 PG - 8 SN - 0022-3085 DO - 10.3171/2022.12.JNS221860 UR - https://m2.mtmt.hu/api/publication/34280471 ID - 34280471 N1 - Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States IBM Corp., Armonk, NY, United States University of Pennsylvania, Philadelphia, PA, United States Cited By :1 Export Date: 1 February 2024 CODEN: JONSA AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Pinggera, D. AU - Geiger, P. AU - Thomé, C. TI - Traumatic brain injury JF - NERVENARZT J2 - NERVENARZT VL - 94 PY - 2023 IS - 10 SP - 960 EP - 972 PG - 13 SN - 0028-2804 DO - 10.1007/s00115-023-01546-9 UR - https://m2.mtmt.hu/api/publication/34559968 ID - 34559968 N1 - Export Date: 6 February 2024 CODEN: NERVA Correspondence Address: Pinggera, D.; Universitätsklinik für Neurochirurgie, Anichstraße 35, Austria; email: daniel.pinggera@tirol-kliniken.at LA - German DB - MTMT ER - TY - JOUR AU - Prasad, Ayush AU - Gilmore, Emily J. AU - Kim, Jennifer A. AU - Begunova, Liza AU - Olexa, Madelynne AU - Beekman, Rachel AU - Falcone, Guido J. AU - Matouk, Charles AU - Ortega-Gutierrez, Santiago AU - Temkin, Nancy R. AU - Barber, Jason AU - Diaz-Arrastia, Ramon AU - de, Havenon Adam AU - Petersen, Nils H. TI - Impact of Therapeutic Interventions on Cerebral Autoregulatory Function Following Severe Traumatic Brain Injury: A Secondary Analysis of the BOOST-II Study JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE PY - 2023 PG - 9 SN - 1541-6933 DO - 10.1007/s12028-023-01896-x UR - https://m2.mtmt.hu/api/publication/34555685 ID - 34555685 N1 - Funding Agency and Grant Number: National Institutes of Health - National Institute of Neurological Disorders and Stroke (NIH-NINDS) [K23NS110980]; Liminal Sciences; NIH-NINDS [K23NS105924, R01NS117904, R01NS127114, R03NS1202228, R21NS119992, U01NS099084]; AAN; Stryker Neurovascular; Medtronic; Microvention; Methinks; VizAi; Society of Vascular and Interventional Neurology Funding text: NHP is supported by the National Institutes of Health - National Institute of Neurological Disorders and Stroke (NIH-NINDS) (K23NS110980) and has received clinical research funding from Liminal Sciences. ADH is supported by NIH-NINDS (K23NS105924), has received investigator-initiated clinical research funding from the AAN, has received consultant fees from Integra and Novo Nordisk, has equity in TitinKM and Certus, and receives author fees from UpToDate. EJG is supported by NIH-NINDS (R01NS117904) and receives consulting fees from UCB. SOG is supported by NIH-NINDS (R01NS127114, R03NS1202228), industry investigator-initiated grants from Stryker Neurovascular, Medtronic, Microvention, Methinks, and VizAi, and Society of Vascular and Interventional Neurology, and consulting fees from Medtronic, Stryker, and Microvention. CCM is supported by NIH-NINDS R21NS119992, receives consulting fees from Microvention-Terumo and Stryker, and speaker fees from Penumbra and Silk Road Medical. NRT and JB are supported by NIH-NINDS (U01NS099084) AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Robba, Chiara AU - Camporota, Luigi AU - Citerio, Giuseppe TI - Acute respiratory distress syndrome complicating traumatic brain injury. Can opposite strategies converge? JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED VL - 49 PY - 2023 IS - 5 SP - 583 EP - 586 PG - 4 SN - 0342-4642 DO - 10.1007/s00134-023-07043-6 UR - https://m2.mtmt.hu/api/publication/33944159 ID - 33944159 N1 - Export Date: 28 November 2023; CODEN: ICMED LA - English DB - MTMT ER - TY - JOUR AU - Robba, Chiara AU - Battaglini, Denise AU - Cinotti, Raphael AU - Asehnoune, Karim AU - Stevens, Robert AU - Taccone, Fabio Silvio AU - Badenes, Rafael AU - Pelosi, Paolo TI - Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE PY - 2023 PG - 14 SN - 1541-6933 DO - 10.1007/s12028-023-01761-x UR - https://m2.mtmt.hu/api/publication/34320830 ID - 34320830 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Robba, Chiara AU - Graziano, Francesca AU - Guglielmi, Angelo AU - Rebora, Paola AU - Galimberti, Stefania AU - Taccone, Fabio AU - Citerio, Giuseppe AU - SYNAPSE-ICU, Investigators TI - Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED VL - 49 PY - 2023 IS - 1 SP - 50 EP - 61 PG - 12 SN - 0342-4642 DO - 10.1007/s00134-022-06937-1 UR - https://m2.mtmt.hu/api/publication/33622909 ID - 33622909 N1 - Funding Agency and Grant Number: Universita degli Studi di Milano - Bicocca within the CRUI-CARE Agreement; University of Milano-Bicocca; European Society of Intensive Care Medicine (ESICM) Funding text: Open access funding provided by Universita degli Studi di Milano - Bicocca within the CRUI-CARE Agreement. University of Milano-Bicocca is the sponsor of the SYNAPSE-ICU study. The European Society of Intensive Care Medicine (ESICM) endorsed and partially funded the study on January 31st, 2017. The ESICM contributed to the electronic Case Report Form (eCRF) design and testing. No further funding was obtained for this sub-analysis. AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Roman, Gal AU - Hrdy, Ondrej AU - Vrbica, Kamil AU - Hudec, Jan AU - Mrlian, Andrej AU - Smrcka, Martin TI - Brain Tissue Oxygen Levels as a Perspective Therapeutic Target in Traumatic Brain Injury. Retrospective Cohort Study JF - THE JOURNAL OF CRITICAL CARE MEDICINE J2 - J CRIT CARE MED VL - 9 PY - 2023 IS - 1 SP - 12 EP - 19 PG - 8 SN - 2393-1809 DO - 10.2478/jccm-2023-0001 UR - https://m2.mtmt.hu/api/publication/33944161 ID - 33944161 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Roshdy, Ashraf TI - Respiratory Monitoring During Mechanical Ventilation: The Present and the Future JF - JOURNAL OF INTENSIVE CARE MEDICINE J2 - J INTENSIVE CARE MED VL - 38 PY - 2023 IS - 5 SP - 407 EP - 417 PG - 11 SN - 0885-0666 DO - 10.1177/08850666231153371 UR - https://m2.mtmt.hu/api/publication/33944162 ID - 33944162 N1 - Export Date: 28 November 2023; CODEN: JICME AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Sarigul, Buse AU - Bell, Randy S. AU - Chesnut, Randall AU - Aguilera, Sergio AU - Buki, Andras AU - Citerio, Giuseppe AU - Cooper, D. Jamie AU - Diaz-Arrastia, Ramon AU - Diringer, Michael AU - Figaji, Anthony AU - Gao, Guoyi AU - Geocadin, Romergryko G. AU - Ghajar, Jamshid AU - Harris, Odette AU - Hoffer, Alan AU - Hutchinson, Peter AU - Joseph, Mathew AU - Kitagawa, Ryan AU - Manley, Geoffrey AU - Mayer, Stephan A. AU - Menon, David K. AU - Meyfroidt, Geert AU - Michael, Daniel B. AU - Oddo, Mauro AU - Okonkwo, David O. AU - Patel, Mayur B. AU - Robertson, Claudia AU - Rosenfeld, Jeffrey V. AU - Rubiano, Andres M. AU - Sahuquillo, Juan AU - Servadei, Franco AU - Shutter, Lori AU - Stein, Deborah D. AU - Stocchetti, Nino AU - Taccone, Fabio Silvio AU - Timmons, Shelly D. AU - Tsai, Eve AU - Ullman, Jamie S. AU - Vespa, Paul AU - Videtta, Walter AU - Wright, David W. AU - Zammit, Christopher AU - Hawryluk, Gregory W. J. TI - 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 JF - JOURNAL OF NEUROTRAUMA J2 - J NEUROTRAUM VL - 40 PY - 2023 IS - 15-16 SP - 1707 EP - 1717 PG - 11 SN - 0897-7151 DO - 10.1089/neu.2022.0414 UR - https://m2.mtmt.hu/api/publication/33941494 ID - 33941494 N1 - Export Date: 28 November 2023; CODEN: JNEUE AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Sarwal, Aarti AU - Robba, Chiara AU - Venegas, Carla AU - Ziai, Wendy AU - Czosnyka, Marek AU - Sharma, Deepak TI - Are We Ready for Clinical Therapy based on Cerebral Autoregulation? A Pro-con Debate JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE PY - 2023 PG - 15 SN - 1541-6933 DO - 10.1007/s12028-023-01741-1 UR - https://m2.mtmt.hu/api/publication/33941491 ID - 33941491 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Sparling, Jamie L. AU - Martyn, J. A. Jeevendra TI - Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants JF - CURRENT ANESTHESIOLOGY REPORTS J2 - CURR ANESTHESIOL REP PY - 2023 PG - 10 SN - 1523-3855 DO - 10.1007/s40140-023-00584-y UR - https://m2.mtmt.hu/api/publication/34555687 ID - 34555687 N1 - Funding Agency and Grant Number: Shriners Hospitals Research Philanthropy [R01GM142042] Funding text: Supported in part by grants from the R01GM142042 and Shriners Hospitals Research Philanthropy (to J.A.J.M.) AB - 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). LA - English DB - MTMT ER - TY - JOUR AU - Vitt, Jeffrey R. AU - Loper, Nicholas E. AU - Mainali, Shraddha TI - Multimodal and autoregulation monitoring in the neurointensive care unit JF - FRONTIERS IN NEUROLOGY J2 - FRONT NEUR VL - 14 PY - 2023 PG - 20 SN - 1664-2295 DO - 10.3389/fneur.2023.1155986 UR - https://m2.mtmt.hu/api/publication/33940146 ID - 33940146 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Wilson, J.L. AU - Hoth, J.J. AU - Couture, D.E. TI - Traumatic brain injury: Imaging, operative and nonoperative care, and complications T2 - Current Therapy of Trauma and Surgical Critical Care PB - Elsevier SN - 9780323697873 T3 - Current Therapy of Trauma and Surgical Critical Care PY - 2023 SP - 161 EP - 168.e1 DO - 10.1016/B978-0-323-69787-3.00040-X UR - https://m2.mtmt.hu/api/publication/34559989 ID - 34559989 N1 - Export Date: 6 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Yue, John K. AU - Deng, Hansen TI - Traumatic Brain Injury: Contemporary Challenges and the Path to Progress JF - JOURNAL OF CLINICAL MEDICINE J2 - J CLIN MED VL - 12 PY - 2023 IS - 9 PG - 6 SN - 2077-0383 DO - 10.3390/jcm12093283 UR - https://m2.mtmt.hu/api/publication/33993231 ID - 33993231 N1 - Export Date: 28 November 2023 LA - English DB - MTMT ER - TY - JOUR AU - Yunlong, J. AU - Bingbing, G. AU - Jianhua, W. AU - Fangfang, H. TI - Research progress of treatment position in patients with severe craniocerebral injury JF - CHINESE JOURNAL OF PRACTICAL NURSING J2 - CHINESE JOURNAL OF PRACTICAL NURSING VL - 39 PY - 2023 IS - 30 SP - 2389 EP - 2393 PG - 5 SN - 1672-7088 DO - 10.3760/cma.j.cn211501-20220523-01591 UR - https://m2.mtmt.hu/api/publication/34559966 ID - 34559966 N1 - Department of Comprehensive Care Unit, Yuhang Campus, the First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 311121, China Department of Neurology, Yuhang Campus, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311121, China Surgical Care Unit of Qingchun Campus, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311121, China Export Date: 6 February 2024 Correspondence Address: Fangfang, H.; Department of Comprehensive Care Unit, China; email: 1372200696@qq.com LA - Chinese DB - MTMT ER - TY - JOUR AU - Zhang, T. AU - Ding, Y. AU - Yuan, L.-Q. TI - Application of percutaneous dilated tracheotomy under direct vision in severe neurosurgical patients JF - ZHONGGUO XIANDAI SHENJING JIBING ZAZHI / CHINESE JOURNAL OF CONTEMPORARY NEUROLOGY AND NEUROSURGERY J2 - CHIN J CONTEMP NEUROLNEUROSURG VL - 23 PY - 2023 IS - 6 SP - 503 EP - 508 PG - 6 SN - 1672-6731 DO - 10.3969/j.issn.1672-6731.2023.06.006 UR - https://m2.mtmt.hu/api/publication/34559976 ID - 34559976 N1 - Export Date: 6 February 2024 Correspondence Address: Yuan, L.-Q.; Department of Neurosurgery, Jiangsu, China; email: yuanliqun19810919@163.com LA - Chinese DB - MTMT ER - TY - JOUR AU - Zhu, Yuanrun AU - Zheng, Peidong AU - Lin, Yajun AU - Wang, Juehan AU - You, Wendong AU - Wang, Yadong AU - Zheng, Huiqing AU - Wen, Liang AU - Yang, Xiaofeng TI - The alteration of serum bile acid profile among traumatic brain injury patients: a small-scale prospective study JF - JOURNAL OF CLINICAL BIOCHEMISTRY AND NUTRITION J2 - J CLIN BIOCHEM NUTR VL - 73 PY - 2023 IS - 1 SP - 97 EP - 102 PG - 6 SN - 0912-0009 DO - 10.3164/jcbn.23-10 UR - https://m2.mtmt.hu/api/publication/34333929 ID - 34333929 N1 - Export Date: 28 November 2023; CODEN: JCBNE AB - 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. LA - English DB - MTMT ER - TY - JOUR TI - Progress in the treatment of refractory intracranial hypertension after craniocerebral trauma JF - CHINESE JOURNAL OF NEUROSURGERY J2 - CHINESE J NEUROSUR VL - 39 PY - 2023 IS - 6 SP - 641 EP - 644 PG - 4 SN - 1001-2346 DO - 10.3760/cma.j.cn112050-20211211-00580 UR - https://m2.mtmt.hu/api/publication/34559975 ID - 34559975 N1 - Export Date: 6 February 2024 LA - Chinese DB - MTMT ER - TY - JOUR AU - Almeida, C.A. AU - Torres-Espin, A. AU - Huie, J.R. AU - Sun, D. AU - Noble-Haeusslein, L.J. AU - Young, W. AU - Beattie, M.S. AU - Bresnahan, J.C. AU - Nielson, J.L. AU - Ferguson, A.R. TI - Excavating FAIR Data: the Case of the Multicenter Animal Spinal Cord Injury Study (MASCIS), Blood Pressure, and Neuro-Recovery JF - NEUROINFORMATICS J2 - NEUROINFORMATICS VL - 20 PY - 2022 IS - 1 SP - 39 EP - 52 PG - 14 SN - 1539-2791 DO - 10.1007/s12021-021-09512-z UR - https://m2.mtmt.hu/api/publication/34783507 ID - 34783507 N1 - Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, United States W.M. Keck Center for Collaborative Neuroscience, Rutgers University, New Brunswick, NJ, United States Department of Neurology, University of Texas, Austin, TX, United States Department of Psychology, University of Texas, Austin, TX, United States Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States Export Date: 11 April 2024; Cited By: 6; Correspondence Address: A.R. Ferguson; San Francisco Veterans Affairs Health Care System, San Francisco, United States; email: adam.ferguson@ucsf.edu; J.L. Nielson; Institute for Health Informatics, University of Minnesota, Minneapolis, United States; email: jnielson@umn.edu; CODEN: NEURK LA - English DB - MTMT ER - TY - JOUR AU - Asehnoune, Karim AU - Taccone, Fabio S. AU - Singer, Mervyn TI - High oxygen level in traumatic brain injury patients. Never ending story? JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED VL - 48 PY - 2022 IS - 12 SP - 1772 EP - 1774 PG - 3 SN - 0342-4642 DO - 10.1007/s00134-022-06903-x UR - https://m2.mtmt.hu/api/publication/33450354 ID - 33450354 N1 - Export Date: 21 January 2023 CODEN: ICMED LA - English DB - MTMT ER - TY - JOUR AU - Barrit, Sami AU - Al Barajraji, Mejdeddine AU - El Hadweh, Salim AU - Dewitte, Olivier AU - Torcida, Nathan AU - Andre, Joachim AU - Taccone, Fabio Silvio AU - Schuind, Sophie AU - Bogossian, Elisa Gouvea TI - Brain Tissue Oxygenation-Guided Therapy and Outcome in Traumatic Brain Injury: A Single-Center Matched Cohort Study JF - BRAIN SCIENCES J2 - BRAIN SCI VL - 12 PY - 2022 IS - 7 PG - 12 SN - 2076-3425 DO - 10.3390/brainsci12070887 UR - https://m2.mtmt.hu/api/publication/33435318 ID - 33435318 N1 - Export Date: 21 January 2023 AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Battaglini, D. AU - Robba, C. AU - Pelosi, P. TI - Traumatic brain injury and translational research: pharmacological and nonpharmacological perspectives T2 - Perioperative Neuroscience: Translational Research PB - Elsevier SN - 9780323910040 T3 - Perioperative Neuroscience: Translational Research PY - 2022 SP - 139 EP - 154 PG - 16 DO - 10.1016/B978-0-323-91003-3.00014-3 UR - https://m2.mtmt.hu/api/publication/34559673 ID - 34559673 N1 - Export Date: 6 February 2024 LA - English DB - MTMT ER - TY - JOUR AU - Battaglini, Denise AU - Premraj, Lavienraj AU - Huth, Samuel AU - Fanning, Jonathon AU - Whitman, Glenn AU - Arora, Rakesh C. AU - Bellapart, Judith AU - Porto, Diego Bastos AU - Taccone, Fabio Silvio AU - Suen, Jacky Y. AU - Li Bassi, Gianluigi AU - Fraser, John F. AU - Badenes, Rafael AU - Cho, Sung-Min AU - Robba, Chiara TI - Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis JF - FRONTIERS IN NEUROLOGY J2 - FRONT NEUR VL - 13 PY - 2022 PG - 11 SN - 1664-2295 DO - 10.3389/fneur.2022.814405 UR - https://m2.mtmt.hu/api/publication/33413069 ID - 33413069 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Battaglini, Denise AU - Ball, Lorenzo AU - Robba, Chiara AU - Maiani, Simona AU - Brunetti, Iole AU - Benedetti, Luana AU - Castellan, Lucio AU - Zona, Gianluigi AU - Pesce, Giampaola AU - Rocco, Patricia R. M. AU - Pelosi, Paolo TI - Patients With Suspected Severe Adverse Reactions to COVID-19 Vaccination Admitted to Intensive Care Unit: A Case Report JF - FRONTIERS IN MEDICINE J2 - FRONT MED VL - 9 PY - 2022 PG - 10 SN - 2296-858X DO - 10.3389/fmed.2022.823837 UR - https://m2.mtmt.hu/api/publication/33450372 ID - 33450372 N1 - Export Date: 21 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Bernard, Francis AU - Barsan, William AU - Diaz-Arrastia, Ramon AU - Merck, Lisa H. AU - Yeatts, Sharon AU - Shutter, Lori A. TI - 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 JF - BMJ OPEN J2 - BMJ OPEN VL - 12 PY - 2022 IS - 3 PG - 9 SN - 2044-6055 DO - 10.1136/bmjopen-2021-060188 UR - https://m2.mtmt.hu/api/publication/33047537 ID - 33047537 N1 - Funding Agency and Grant Number: National Institute of Neurological Disorders and Stroke (NINDS) [U01 NS099046] Funding text: This trial is funded by the National Institute of Neurological Disorders and Stroke (NINDS) (grant number U01 NS099046). AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Bouchereau, E. AU - Sharshar, T. AU - Legouy, C. TI - Delayed awakening in neurocritical care JF - REVUE NEUROLOGIQUE J2 - REV NEUROL-FRANCE VL - 178 PY - 2022 IS - 1-2 SP - 21 EP - 33 PG - 13 SN - 0035-3787 DO - 10.1016/j.neurol.2021.06.001 UR - https://m2.mtmt.hu/api/publication/34783395 ID - 34783395 N1 - G.H.U Paris Psychiatry & Neurosciences, Department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, Paris Cedex 14, 75674, France INSERM U1266, FHU NeuroVasc, Institut de Psychiatrie et Neuroscience de Paris, Paris, France Export Date: 11 April 2024; Cited By: 2; Correspondence Address: T. Sharshar; G.H.U Paris Psychiatry & Neurosciences, Department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, Paris Cedex 14, 1, rue Cabanis, 75674, France; email: t.sharshar@ghu-paris.fr; CODEN: RENEA LA - English DB - MTMT ER - TY - JOUR AU - Casault, Colin AU - Couillard, Philippe AU - Kromm, Julie AU - Rosenthal, Eric AU - Kramer, Andreas AU - Brindley, Peter TI - Multimodal brain monitoring following traumatic brain injury: A primer for intensive care practitioners JF - JOURNAL OF THE INTENSIVE CARE SOCIETY J2 - J INTENSIVE CARE SOC VL - 23 PY - 2022 IS - 2 SP - 191 EP - 202 PG - 12 SN - 1751-1437 DO - 10.1177/1751143720980273 UR - https://m2.mtmt.hu/api/publication/33619088 ID - 33619088 N1 - Department of Critical Care Medicine, University of Calgary, Calgary, Canada Department of Clinical Neurosciences, University of Calgary, Calgary, Canada Department of Critical Care Medicine, University of Alberta, Edmonton, Canada Department of Neurology, Harvard University, Boston, MA, United States Cited By :8 Export Date: 1 February 2024 Correspondence Address: Casault, C.; Department of Critical Care Medicine, Canada; email: ccasault@ucalgary.ca AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Citerio, Giuseppe TI - Big Data and Artificial Intelligence for Precision Medicine in the Neuro-ICU: Bla, Bla, Bla JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 37 PY - 2022 IS - Suppl. 2 SP - 163 EP - 165 PG - 3 SN - 1541-6933 DO - 10.1007/s12028-021-01427-6 UR - https://m2.mtmt.hu/api/publication/32689218 ID - 32689218 N1 - Supplement: 2 LA - English DB - MTMT ER - TY - JOUR AU - Coppalini, Giacomo AU - Duvigneaud, Elie AU - Diosdado, Alberto AU - Migliorino, Ernesto AU - Schuind, Sophie AU - Creteur, Jacques AU - Taccone, Fabio Silvio AU - Bogossian, Elisa Gouvea TI - Effect of inotropic agents on oxygenation and cerebral perfusion in acute brain injury JF - FRONTIERS IN NEUROLOGY J2 - FRONT NEUR VL - 13 PY - 2022 PG - 8 SN - 1664-2295 DO - 10.3389/fneur.2022.963562 UR - https://m2.mtmt.hu/api/publication/33450359 ID - 33450359 N1 - Export Date: 21 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Cruz Navarro, Jovany AU - Ponce Mejia, Lucido L. AU - Robertson, Claudia TI - A Precision Medicine Agenda in Traumatic Brain Injury JF - FRONTIERS IN PHARMACOLOGY J2 - FRONT PHARMACOL VL - 13 PY - 2022 PG - 20 SN - 1663-9812 DO - 10.3389/fphar.2022.713100 UR - https://m2.mtmt.hu/api/publication/33016767 ID - 33016767 N1 - Export Date: 3 August 2022 AB - 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. LA - English DB - MTMT ER - TY - BOOK AU - Davies, E. TI - The Final FFICM Structured Oral Examination Study Guide PB - CRC Press CY - Boca Raton, Florida PY - 2022 SP - 1 EP - 544 SP - 576 SN - 9781032153421 DO - 10.1201/9781003243694 UR - https://m2.mtmt.hu/api/publication/34152835 ID - 34152835 N1 - Export Date: 23 September 2023 Correspondence Address: Davies, E.; Intensive Care Medicine and AnaesthesiaUnited Kingdom AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Demers-Marcil, Simon AU - Coles, Jonathan P. TI - Cerebral metabolic derangements following traumatic brain injury JF - CURRENT OPINION IN ANAESTHESIOLOGY J2 - CURR OPIN ANESTHESIO VL - 35 PY - 2022 IS - 5 SP - 562 EP - 569 PG - 8 SN - 0952-7907 DO - 10.1097/ACO.0000000000001183 UR - https://m2.mtmt.hu/api/publication/33450358 ID - 33450358 N1 - Export Date: 21 January 2023 CODEN: COAEE AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Dibu, J.R. TI - Mechanical Ventilation in Neurocritical Care Patient T2 - Personalized Mechanical Ventilation: Improving Quality of Care PB - Springer International Publishing SN - 9783031141379 T3 - Personalized Mechanical Ventilation: Improving Quality of Care PY - 2022 SP - 329 EP - 349 PG - 21 DO - 10.1007/978-3-031-14138-6_25 UR - https://m2.mtmt.hu/api/publication/34560003 ID - 34560003 N1 - Export Date: 6 February 2024 Correspondence Address: Dibu, J.R.; Neurologic Critical Care Unit, United Arab Emirates; email: dibuj@clevelandclinicabudhabi.ae LA - English DB - MTMT ER - TY - JOUR AU - Di Filippo, Simone AU - Godoy, Daniel Agustin AU - Manca, Marina AU - Paolessi, Camilla AU - Bilotta, Federico AU - Meseguer, Ainhoa AU - Severgnini, Paolo AU - Pelosi, Paolo AU - Badenes, Rafael AU - Robba, Chiara TI - Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint JF - FRONTIERS IN NEUROLOGY J2 - FRONT NEUR VL - 13 PY - 2022 PG - 11 SN - 1664-2295 DO - 10.3389/fneur.2022.911460 UR - https://m2.mtmt.hu/api/publication/33435330 ID - 33435330 N1 - Export Date: 20 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Doron, Omer AU - Zadka, Yuliya AU - Rosenthal, Guy AU - Barnea, Ofer TI - Intracranial Pulsating Balloon-Based Cardiac-Gated ICP Modulation Impact on Brain Oxygenation: A Proof-of-Concept Study in a Swine Model JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 37 PY - 2022 IS - 3 SP - 689 EP - 696 PG - 8 SN - 1541-6933 DO - 10.1007/s12028-022-01541-z UR - https://m2.mtmt.hu/api/publication/33450362 ID - 33450362 N1 - Export Date: 21 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Drewry, Anne AU - Mohr, Nicholas M. TI - Temperature Management in the ICU JF - CRITICAL CARE MEDICINE J2 - CRIT CARE MED VL - 50 PY - 2022 IS - 7 SP - 1138 EP - 1147 PG - 10 SN - 0090-3493 DO - 10.1097/CCM.0000000000005556 UR - https://m2.mtmt.hu/api/publication/33026093 ID - 33026093 N1 - Funding Agency and Grant Number: Washington University Institute of Clinical and Translational Sciences [UL1TR000448, KL2TR000450]; National Institutes of Health [K23GM129660] Funding text: Dr. Drewry is supported by the Washington University Institute of Clinical and Translational Sciences (UL1TR000448 and KL2TR000450) and the National Institutes of Health (K23GM129660). Dr. Mohr disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: nicholas-mohr@ uiowa.edu AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Duffy, C.C. AU - Bass, G.A. AU - Lane-Fall, M. ED - Adam, M. Shiroff ED - Mark, J. Seamon ED - Lewis, J. Kaplan TI - Monitoring Strategy for the Operating Room and Intensive Care Unit After Thoracic Injury T2 - Management of Chest Trauma: A Practical Guide PB - Springer International Publishing CY - [s.l.] SN - 9783031069581 T3 - Management of Chest Trauma: A Practical Guide PY - 2022 SP - 233 EP - 242 PG - 10 DO - 10.1007/978-3-031-06959-8_21 UR - https://m2.mtmt.hu/api/publication/34560000 ID - 34560000 N1 - Export Date: 6 February 2024 Correspondence Address: Duffy, C.C.; Department of Anesthesia and Critical Care, United States; email: Caoimhe.duffy@pennmedicine.upenn.edu LA - English DB - MTMT ER - TY - JOUR AU - El-Swaify, S.T. AU - Kamel, M. AU - Ali, S.H. AU - Bahaa, B. AU - Refaat, M.A. AU - Amir, A. AU - Abdelrazek, A. AU - Beshay, P.W. AU - Moner, Basha A.K.M. TI - Initial neurocritical care of severe traumatic brain injury: New paradigms and old challenges JF - SURGICAL NEUROLOGY INTERNATIONAL J2 - SURG NEUR INT VL - 13 PY - 2022 SN - 2229-5097 DO - 10.25259/SNI_609_2022 UR - https://m2.mtmt.hu/api/publication/34560004 ID - 34560004 N1 - Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Egypt School of Medicine, Faculty of Medicine, Ain Shams University, Egypt Faculty of Medicine, Ain Shams University, Egypt Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt Cited By :2 Export Date: 6 February 2024 Correspondence Address: Moner Basha, A.K.M.; Department of Neurosurgery, Egypt; email: ahmedbasha@med.asu.edu.eg LA - English DB - MTMT ER - TY - JOUR AU - Feng, X.-Y. AU - Jiao, W. AU - Chen, J.-H. AU - Shi, Z.-H. AU - Shi, Y.-Q. AU - Wang, Y.-H. TI - Value of ventricular intracranial pressure monitoring and process management for traumatic bifrontal contusions JF - ZHONGGUO XIANDAI SHENJING JIBING ZAZHI / CHINESE JOURNAL OF CONTEMPORARY NEUROLOGY AND NEUROSURGERY J2 - CHIN J CONTEMP NEUROLNEUROSURG VL - 22 PY - 2022 IS - 4 SP - 313 EP - 318 PG - 6 SN - 1672-6731 DO - 10.3969/j.issn.1672-6731.2022.04.014 UR - https://m2.mtmt.hu/api/publication/34559998 ID - 34559998 N1 - Export Date: 6 February 2024 Correspondence Address: Wang, Y.-H.; Department of Neurosurgery, China; email: wangyuhai67@126.com LA - Chinese DB - MTMT ER - TY - JOUR AU - Froese, Logan AU - Gomez, Alwyn AU - Sainbhi, Amanjyot Singh AU - Batson, Carleen AU - Slack, Trevor AU - Stein, Kevin Y. AU - Mathieu, Francois AU - Zeiler, Frederick A. TI - Optimal bispectral index level of sedation and cerebral oximetry in traumatic brain injury: a non-invasive individualized approach in critical care? JF - INTENSIVE CARE MEDICINE EXPERIMENTAL J2 - INTENSIVE CARE MED EXP VL - 10 PY - 2022 IS - 1 PG - 17 SN - 2197-425X DO - 10.1186/s40635-022-00460-9 UR - https://m2.mtmt.hu/api/publication/33430527 ID - 33430527 N1 - Export Date: 21 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Gomez, Alwyn AU - Sekhon, Mypinder AU - Griesdale, Donald AU - Froese, Logan AU - Yang, Eleen AU - Thelin, Eric P. AU - Raj, Rahul AU - Aries, Marcel AU - Gallagher, Clare AU - Bernard, Francis AU - Kramer, Andreas H. AU - Zeiler, Frederick A. TI - 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 JF - INTENSIVE CARE MEDICINE EXPERIMENTAL J2 - INTENSIVE CARE MED EXP VL - 10 PY - 2022 IS - 1 PG - 14 SN - 2197-425X DO - 10.1186/s40635-022-00482-3 UR - https://m2.mtmt.hu/api/publication/33617977 ID - 33617977 N1 - Funding Agency and Grant Number: Natural Sciences and Engineering Research Council of Canada (NSERC) [DGECR-2022-00260, RGPIN-2022-03621, ALLRP-576386-22]; Manitoba Public Insurance (MPI) Neuroscience Research Operating Fund Funding text: This work was directly supported through the Natural Sciences and Engineering Research Council of Canada (NSERC) (DGECR-2022-00260, RGPIN-2022-03621 and ALLRP-576386-22) and the Manitoba Public Insurance (MPI) Neuroscience Research Operating Fund. AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Gonzalez-Johnson, Lucas AU - Zomosa, Gustavo AU - Valenzuela, Bayron AU - Maldonado, Felipe AU - Baabor, Marcos AU - Romero, Carlos TI - Update on the management of intracranial hypertension syndrome JF - REVISTA MEDICA DE CHILE J2 - REV MED CHILE VL - 150 PY - 2022 IS - 1 SP - 78 EP - 87 PG - 10 SN - 0034-9887 DO - 10.4067/S0034-98872022000100078 UR - https://m2.mtmt.hu/api/publication/33221407 ID - 33221407 N1 - Facultad de Medicina, Universidad de Chile, Santiago, Chile Departamento Neurologia y Neurocirugia, Hospital Clinico Universidad de Chile, Santiago, Chile Departamento de Anestesiologia y Medicina Perioperatoria, Hospital Clinico Universidad de Chile, Santiago, Chile Unidad de Pacientes Criticos, Departamento de Medicina Interna Norte, Hospital Clinico Universidad de Chile, Santiago, Chile Facultad de Medicina, Universidad de Chile, Hospital Clínico Universidad de Chile, Santiago, Chile Export Date: 29 January 2024 Correspondence Address: Romero, C.; Unidad de Pacientes Criticos, Chile; email: caromero@hcuch.cl AB - 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) LA - Spanish DB - MTMT ER - TY - JOUR AU - Gouvea Bogossian, Elisa AU - Diosdado, Alberto AU - Barrit, Sami AU - Al Barajraji, Mejdeddine AU - Annoni, Filippo AU - Schuind, Sophie AU - Taccone, Fabio Silvio TI - The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis JF - NEUROCRITICAL CARE J2 - NEUROCRIT CARE VL - 37 PY - 2022 IS - 3 SP - 779 EP - 789 PG - 11 SN - 1541-6933 DO - 10.1007/s12028-022-01613-0 UR - https://m2.mtmt.hu/api/publication/33435309 ID - 33435309 N1 - Export Date: 20 January 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Hawryluk, Gregory W. J. AU - Citerio, Giuseppe AU - Hutchinson, Peter AU - Kolias, Angelos AU - Meyfroidt, Geert AU - Robba, Chiara AU - Stocchetti, Nino AU - Chesnut, Randall TI - Intracranial pressure: current perspectives on physiology and monitoring JF - INTENSIVE CARE MEDICINE J2 - INTENS CARE MED VL - 48 PY - 2022 IS - 10 SP - 1471 EP - 1481 PG - 11 SN - 0342-4642 DO - 10.1007/s00134-022-06786-y UR - https://m2.mtmt.hu/api/publication/33435324 ID - 33435324 N1 - Export Date: 21 January 2023 CODEN: ICMED AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Hawryluk, Gregory W. J. AU - Selph, Shelley AU - Lumba-Brown, Angela AU - Totten, Annette M. AU - Ghajar, Jamshid AU - Aarabi, Bizhan AU - Ecklund, James AU - Shackelford, Stacy AU - Adams, Britton AU - Adelson, David AU - Armonda, Rocco A. AU - Benjamin, John AU - Boone, Darrell AU - Brody, David AU - Dengler, Bradley AU - Figaji, Anthony AU - Grant, Gerald AU - Harris, Odette AU - Hoffer, Alan AU - Kitigawa, Ryan AU - Latham, Kerry AU - Neal, Christopher AU - Okonkwo, David O. AU - Pannell, Dylan AU - Rosenfeld, Jeffrey V AU - Rosenthal, Guy AU - Rubiano, Andres AU - Stein, Deborah M. AU - Stippler, Martina AU - Talbot, Max AU - Valadka, Alex AU - Wright, David W. AU - Davis, Shelton AU - Bell, Randy TI - Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury JF - NEUROTRAUMA REPORTS J2 - NEUROTRAUMA REP VL - 3 PY - 2022 IS - 1 SP - 240 EP - 247 PG - 8 SN - 2689-288X DO - 10.1089/neur.2022.0008 UR - https://m2.mtmt.hu/api/publication/33435328 ID - 33435328 N1 - Export Date: 28 November 2023 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Kirschen, Matthew P. AU - Majmudar, Tanmay AU - Diaz-Arrastia, Ramon AU - Berg, Robert AU - Abella, Benjamin S. AU - Topjian, Alexis AU - Balu, Ramani TI - Deviations from PRx-derived optimal blood pressure are associated with mortality after cardiac arrest JF - RESUSCITATION J2 - RESUSCITATION VL - 175 PY - 2022 SP - 81 EP - 87 PG - 7 SN - 0300-9572 DO - 10.1016/j.resuscitation.2022.03.003 UR - https://m2.mtmt.hu/api/publication/33450352 ID - 33450352 N1 - Export Date: 21 January 2023 CODEN: RSUSB AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Komurcu, Ozgur AU - Dost, Burhan AU - Akdemir, Neslihan Unal AU - Ulger, Fatma TI - The Effect of Fluid Challenge Test on Optic Nerve Sheath Diameter JF - JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN J2 - JCPSP-J COLL PHYSICI VL - 32 PY - 2022 IS - 9 SP - 1116 EP - 1121 PG - 6 SN - 1022-386X DO - 10.29271/jcpsp.2022.09.1116 UR - https://m2.mtmt.hu/api/publication/33450356 ID - 33450356 N1 - Export Date: 21 January 2023 CODEN: JSPJE AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Lavinio, Andrea TI - Cerebral circulation II: pathophysiology and monitoring JF - BJA EDUCATION J2 - BJA EDUCATION VL - 22 PY - 2022 IS - 7 SP - 282 EP - 288 PG - 7 SN - 2058-5349 DO - 10.1016/j.bjae.2022.02.005 UR - https://m2.mtmt.hu/api/publication/33450363 ID - 33450363 N1 - Export Date: 21 January 2023 LA - English DB - MTMT ER -