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Periprocedural management of patients with subarachnoid hemorrhage
No full textPeriprocedural management of patients with
subarachnoid hemorrhage
Paolo Grittia, Ferdinando L. Lorinia, Luigi A. Lanternab, and Federico Bilottac
Purpose of review
Anesthesiologists and intensivists may be involved in the management of aneurysmal subarachnoid
hemorrhage (aSAH) patients at various stages of care. This article will review the recent advances
in the periprocedural management of aSAH patients.
Recent findings
New scoring systems to assess gravity and prognosis of aSAH patients have been evaluated and
proposed. Rebleeding still remains, with early aneurysmal treatment, a major challenge in the
first hours of aSAH management. In the last decades, the treatment of the aSAH has shifted from
clipping to coiling and more recently, the use of flow diversion technique has been introduced in
selected patients. Although these improvements allow treatment of more complex aneurysms, they
have implications for the anesthesiologist, including requiring the management of anticoagulation
with its inherent risks. Even though knowledge, monitoring, and management of postprocedural
phase of aSAH patients has improved, vasospasm and cerebral-delayed ischemia still remain the
major and devastating complications in the postoperative course of aSAH patients.
Summary
Despite recent progress in the scoring, diagnosis, and treatment of aSAH patients, the
periprocedural management of these patients is still a major challenge for anesthesiologists and
intensivists, who are involved from the first phase of the aneurysm rupture through the
postoperative phases and vasospasm period.
Keywords
aneurysm management, aneurysmal subarachnoid hemorrhage, cerebral aneurysm, periprocedural
management, subarachnoid hemorrhag
Hypocortisolism in Noncomatose Patients during the Acute Phase of Subarachnoid Hemorrhage.
No full textBACKGROUND: Hypopituitarism represents a common long-term complication of subarachnoid hemorrhage (SAH). The incidence of hypocortisolism may be higher during the acute phase of SAH. Although hypocortisolism may be harmful in critically ill SAH patients, data are still lacking. The primary objective of this study was to investigate the incidence of hypocortisolism during the acute phase of SAH (15 days). Secondary objectives included an analysis of the relationship between hypocortisolism and outcome and the computation of the cortisol-time secretion curve.
METHODS:
Clinical data of a consecutive series of 26 noncomatose patients with aneurysmal SAH were collected prospectively. The sample size was calculated considering an expected proportion of hypocortisolism of 30%, a confidence level of 95%, and a total width of confidence interval of 0.35. The definition of hypocortisolism (as taken from a statement from the critical care medicine task forces) includes random total cortisol <10 μg/dL or a Δtotal serum cortisol <9 μg/dL after 1 μg of corticotrophin hormone.
RESULTS:
Hypocortisolism was diagnosed in 11 patients (42.3%). Cortisol increment after stimulation test was always >9 μg/dl, suggesting a hypothalamic-pituitary impairment. Hypocortisolism was independently associated with a higher risk of poor outcome (P = .046) even after adjusting for age and Hunt and Hess grade. The cortisol-time secretion curve showed a peak at day 5 and a minimum at day 8. The peak at day 5 correlated with the risk of delayed cerebral ischemia (P = .001), and the cortisol concentration slope between days 1 and 8 correlated with the risk of poor outcome (P = .033).
CONCLUSIONS:
Patients with SAH are at high risk of secondary hypocortisolism during the first 15 days after bleeding. Hypocortisolism independently increases the risk of poor outcome. The acute phase of hypothalamo-pituitary dysfunction, as reflected by an abnormal day-by-day cortisol secretion pattern, may affect the risk of delayed cerebral ischemia
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A Narrative Review of Adherence to Subarachnoid Hemorrhage Guidelines
No full textA Narrative Review of Adherence to Subarachnoid Hemorrhage Guidelines
Paolo Gritti, MD,* Oluwaseun Akeju, MD, MMSc,† Ferdinando L. Lorini, MD,* Luigi A. Lanterna, MD,‡
Carlo Brembilla, MD,‡ and Federico Bilotta, MD, PhD§
Abstract: Over the past 2 decades, a large number of guidelines for aneurysmal subarachnoid
hemorrhage (aSAH) management have been proposed. The primary aim of these “evidence-based”
guidelines is to improve the care of aSAH patients by summa- rizing and making current knowledge
readily available to clini- cians. However, an investigation into aSAH guidelines, their
changes along time and their successful translation into clinical practice is still lacking.
We performed a literature search of historical events and subarachnoid hemorrhage
guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to
November of 2016. Data were summarized for guidelines on aSAH management and cross-sectional
studies of their applica- tion. A total of 11 guidelines and 10 cross-sectional studies on aSAH
management were analyzed. The use of nimodipine for the treatment of SAH is the only
recommendation that remained consistent across guidelines over time (r = 0.82; P < 0.05). A shift
in the definitive treatment for aneurysms from open surgical clipping to endovascular
coiling was also noted (r = −0.91; r = 0.96; P < 0.005). In addition, definitive treatment for
aneur- ysm is being performed earlier. The use of triple-H therapy and the long-term administration
of anticonvulsive therapy has de- creased. Finally, written protocols for aSAH management were not
consistently used across tertiary care institutions (r = −0.46; P = 0.43; confidence interval, −0.95
to −0.70).
We conclude that guidelines related to the management of patients with SAH have evolved
from a consensus-based ap- proach into an evidence-based approach. Nevertheless, the
translation into clinical practice is limited, suggesting that per- sonalized approaches to care is
inherent, and perhaps necessary
for aSAH management
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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