344 research outputs found
Editorial: Crucial Decisions in Severe Traumatic Brain Injury Management: Criteria for Treatment Escalation
No full textAcute ischaemic stroke and its challenges for the intensivist
No full textAcute ischaemic stroke (AIS) is responsible for almost 90% of all strokes and is one of the leading causes of death and disability. Acute ischaemic stroke is caused by a critical alteration in focal cerebral blood flow (ischaemia) from a variety of causes, resulting in infarction. The primary cerebral injury due to AIS occurs in the first hours, therefore early reperfusion importantly impacts on patient outcome ('Time is brain' concept). Secondary cerebral damage progressively evolves over the following hours and days due to cerebral oedema, haemorrhagic transformation, and cerebral inflammation. Systemic complications, such as pneumonia, sepsis, and deep venous thrombosis, could also affect outcome. The risk of a recurrent ischaemic stroke is in particular high in the first days, which necessitate particular attention. The role of intensive care unit physicians is therefore to avoid or reduce the risk of secondary damage, especially in the areas where the brain is functionally impaired and 'at risk' of further injury. Therapeutic strategies therefore consist of restoration of blood flow and a bundle of medical, endovascular, and surgical strategies, which-when applied in a timely and consistent manner-can prevent secondary deterioration due to cerebral and systemic complications and recurrent stroke and improve short- and long-term outcomes. A multidisciplinary collaboration between neurosurgeons, interventional radiologists, neurologists, and intensivists is necessary to elaborate the best strategy for the treatment of these patients
Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment
No full textComputerized tomography angiography (CTA) can be
performed quicker, safer and cheaper than digital subtraction angiography
(DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However,
DSA is still regarded as the gold standard in the diagnosis of
intracranial ruptured aneurysms. No studies have specifically addressed
the value of CTA in planning of endovascular treatment of ruptured
aneurysms. Mathieu van der Jagt investigates the diagnostic value of CTA
for endovascular treatment compared with DSA, in cooperation with
Radiology. He hypothesizes is that, at least in a subset of patients, CTA
suffices and DSA can be omitted in the planning of endovascular treatment.
Another project concerns a systematic review on rupture rate of unruptured
intracranial aneurysms (UIAs), estimating the rupture rate of UIAs based
on the available observational studies. The statistical method used will
allow for correction for methodological quality per study, lea!
ding to an estimate of rupture rate that is based on less biased data.
The PhD project also evaluates the localizing value of blood distribution
on CTA for the location of ruptured intracranial aneurysm; it includes a
cohort study on the impact of early surgery on overall outcome after
aneurysmal SAH
Intensive Care Admission and Management of Patients With Acute Ischemic Stroke: A Cross-sectional Survey of the European Society of Intensive Care Medicine
No full textBACKGROUND: No specific recommendations are available regarding the intensive care management of critically ill acute ischemic stroke (AIS) patients, and questions remain regarding optimal ventilatory, hemodynamic, and general intensive care unit (ICU) therapeutic targets in this population. We performed an international survey to investigate ICU admission criteria and management of AIS patients. METHODS: An electronic questionnaire including 25 items divided into 3 sections was available on the European Society of Intensive Care Medicine Web site between November 1, 2019 and March 30, 2020 and advertised through the neurointensive care (NIC) section newsletter. This survey was emailed directly to the NIC members and was endorsed by the European Society of Intensive Care Medicine. RESULTS: There were 214 respondents from 198 centers, with response rate of 16.5% of total membership (214/1296). In most centers (67%), the number of AIS patients admitted to respondents' hospitals in 2019 was between 100 and 300, and, among them, fewer than 50 required ICU admission per hospital. The most widely accepted indication for ICU admission criteria was a requirement for intubation and mechanical ventilation. A standard protocol for arterial blood pressure (ABP) management was utilized by 88 (58%) of the respondents. For patients eligible for intravenous thrombolysis, the most common ABP target was 95% (n=80 [53%]), and tidal volume 6 to 8 mL/kg of predicted body weight (n=135 [89%]). CONCLUSIONS: The ICU management of AIS, including therapeutic targets and clinical practice strategies, importantly varies between centers. Our findings may be helpful to define future studies and create a research agenda regarding the ICU therapeutic targets for AIS patients.sponsorship: The authors would like to thank the many colleagues who completed this survey; a full list of collaborators is available in the supplementary material (List of collaborators, SDC 13, http://links.lww.com/JNA/A357).The authors would also like to thank Mrs Sherihane Bensemmane and the ESICM for their support in the development of the study. (ESICM)status: Publishe
Supplemental Material, 2017.08.01.JICM_Additional_files_B-H_(1) - High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction
No full text Supplemental Material, 2017.08.01.JICM_Additional_files_B-H_(1) for High Early Fluid
Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With
Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction by
Leonie J. M. Vergouw, Mohamud Egal, Bas Bergmans, Diederik W. J. Dippel, Hester F.
Lingsma, Mervyn D. I. Vergouwen, Peter W. A. Willems, Annemarie W. Oldenbeuving, Jan
Bakker and Mathieu van der Jagt in Journal of Intensive Care Medicine </p
Supplemental Material, Additional_file_A_(1) - High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction
No full text Supplemental Material, Additional_file_A_(1) for High Early Fluid Input After Aneurysmal
Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and
Feasibility of Cardiac Output–Guided Fluid Restriction by Leonie J. M. Vergouw, Mohamud
Egal, Bas Bergmans, Diederik W. J. Dippel, Hester F. Lingsma, Mervyn D. I. Vergouwen,
Peter W. A. Willems, Annemarie W. Oldenbeuving, Jan Bakker and Mathieu van der Jagt in
Journal of Intensive Care Medicine </p
Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study
No full textBrain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study
Ernest van Veen1,2,3, Mathieu van der Jagt1, Maryse C. Cnossen2, Andrew I. R. Maas4, Inez D. de
Beaufort3, David K. Menon5, Giuseppe Citerio6,7, Nino Stocchetti8,9, Wim J. R. Rietdijk1, Jeroen T.
J. M. van Dijck10, Erwin J. O. Kompanje1,3* and CENTER-TBI investigators and participants
Abstract
Background: We aimed to investigate the extent of the agreement on practices around brain death and
postmortem organ donation.
Methods: Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in
Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate:
99%).
Results: Regarding practices around brain death, we found agreement on the clinical evaluation
(prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the
centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor
patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures
(LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory
arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of
centers the patients with a ventricular drain in situ had this removed, either sometimes or all of
the time.
Conclusions: This study showed both agreement and some regional differences regarding practices
around brain death and postmortem organ donation. We hope our results help quantify and understand
potential differences, and provide impetus for current dialogs toward further harmonization of
practices around brain death and postmortem organ donation.
Keywords: Traumatic brain injury, Brain death, Ethics, Postmortem organ donation, Withdrawing
life-sustaining
measures, Ventricular drainag
Letter by van der Jagt and Suarez Regarding Article, "Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled Trial"
No full textFluid management of the neurological patient: A concise review
No full textMaintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes
- …
