Notes

The part of the In-patient Hospice along with Palliative Scientific Pharmacologist inside the Interdisciplinary Crew.
Of 82 patients, 48 were excluded from the analysis and the remaining 34 patients were included in the analysis. A total of 26 participants (73.5%) achieved successful extubation. Their average age was 39.72±16.43years. None of the variables that were compared in relation to success or failure of extubation showed statistical significance, except for age (Z=-2.014, P<0.044 with a Wide confidence interval; Spearman's ρ r=0.351, P<0.042).

In this study, the only predictive factor for successful extubation in neurocritical care patients was an age of <42.5years.
In this study, the only predictive factor for successful extubation in neurocritical care patients was an age of less then 42.5 years.
Decompressive craniectomy (DC) may reduce mortality but might increase the number of survivors in a vegetative state. In this study, we assessed the long-term functional outcome of patients undergoing DC in a middle-income country.

This was a prospective observational study of patients undergoing DC at a single tertiary hospital in southern Brazil between January 2015 and December 2018.

Of the 125 patients who were included in this study, 57.6% (72/125) had a traumatic brain injury (TBI), 21.6% (27/125) had a stroke, 19.2% (24/125) had a cerebral hemorrhage (intracerebral or subarachnoid hemorrhage), and 0.8% (1/125) had a cerebral abscess. The mean age was 45.18±19.6years, and 71% of the patients were men. The mean initial Glasgow Coma Scale (GCS) score was 7.8±3.6. The in-hospital mortality rate was 44.8% (56/125). Of the survivors, 50.7% (35/69) had a favorable outcome 6months after DC. After multivariate analysis, a lower initial GCS score (7.5±3.6 versus 8.8±3.5, P=0.007) and older age (49.7±18.9 versus 33.3±16.2years, P=0.0001) were associated with an unfavorable outcome.

Six months after DC, almost half of the patients who survive have a favorable outcome.
Six months after DC, almost half of the patients who survive have a favorable outcome.
Advanced multimodal monitoring (MMM) of the brain is recommended as a tool to manage severe acute brain injury in intensive care units (ICUs) and prevent secondary lesions. Nirogacestat The aim of this study was to determine if MMM has implications for patient outcome and mortality.

We analyzed data on 389 patients admitted with a subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI) to two general ICUs and one neurocritical care ICU (NCCU) between March 2014 and October 2016, and their subsequent outcomes.

The study population consisted of 259 males and 130 females. Group 1, which comprised 69 patients with MMM admitted to the NCCU, was compared with group 2, which comprised patients managed without MMM. With the exceptions of the Simplified Acute Physiology Score (SAPS II) and Glasgow Coma Scale (GCS) scores, there were no differences between the two groups. Group 1 had significantly better outcomes at ICU discharge, at 28days, and at 3months, and also had a lower mortality rate (P<0.05). When outcomes were adjusted for SAPS II scores, patients who had MMM had better outcomes (odds ratios 0.215 at ICU discharge, 0.234 at 28days, 0.338 at 3months, and 0.474 at 6months) but no difference in mortality.

Use of MMM in patients with SAH or TBI is associated with better outcomes and should be considered in the management of these patients.
Use of MMM in patients with SAH or TBI is associated with better outcomes and should be considered in the management of these patients.After decompressive craniectomy (DC), cranioplasty (CP) can help to normalize vascular and cerebrospinal fluid circulation besides improving the patient's neurological status. The aim of this study was to investigate the effects of CP on cerebral hemodynamics and on cognitive and functional outcomes in patients with and without a traumatic brain injury (TBI). Over a period of 3 years, 51 patients were included in the study 37 TBI patients and 14 non-TBI patients. The TBI group was younger (28.86 ± 9.71 versus 45.64 ± 9.55 years, P = 0.0001), with a greater proportion of men than the non-TBI group (31 versus 6, P = 0.011). Both groups had improved cognitive outcomes (as assessed by the Mini-Mental State Examination) and functional outcomes (as assessed by the Barthel Index and Modified Rankin Scale) 90 days after CP. In the TBI group, the mean velocity of blood flow in the middle cerebral artery ipsilateral to the cranial defect increased between the time point before CP and 90 days after CP (34.24 ± 11.02 versus 42.14 ± 10.19 cm/s, P = 0.0001). In conclusion, CP improved the neurological status in TBI and non-TBI patients, but an increment in cerebral blood flow velocity after CP occurred only in TBI patients.Cranioplasty (CP) after decompressive craniectomy (DC) is associated with neurological improvement. We evaluated neurological recovery in patients who underwent late CP (more than 6 months after DC) in comparison with early CP. This prospective study of 51 patients investigated neurological function using the Addenbrooke's Cognitive Examination Revised (ACE-R), Mini-Mental State Examination (MMSE), Barthel Index (BI), and Modified Rankin Scale (mRS) prior to and after CP. Most patients with traumatic brain injury (74%) were young (mean age 33.4 ± 12.2 years) and male (33/51; 66%). There were general improvements in the patients' cognition and functional status, especially in the late-CP group. The ACE-R score increased from the time point before CP to 3 days after CP (51 ± 28.94 versus 53.1 ± 30.39, P = 0.016) and 90 days after CP (51 ± 28.94 versus 58.10 ± 30.43, P = 0.0001). In the late-CP group, increments also occurred from the time point before CP to 90 days after CP in terms of the MMSE score (18.54 ± 1.51 versus 20.34 ± 1.50, P = 0.003), BI score (79.84 ± 4.66 versus 85.62 ± 4.10, P = 0.028), and mRS score (2.07 ± 0.22 versus 1.74 ± 0.20, P = 0.015). CP is able to improve neurological outcomes even more than 6 months after DC.Hyperthermia is a common detrimental condition in patients with an acute brain injury (ABI), which can worsen their prognosis and outcome. The aim of this study was to evaluate the effects of hyperthermia on intracranial pressure (ICP) and cerebral autoregulation (CA).Eight patients with ABI were studied. CA was assessed on the basis of the pressure reactivity index (PRx) coefficient. The ICP, cerebral perfusion pressure (CPP), and PRx were compared before and during development of hyperthermia. Hyperthermia was defined as an increase in cerebral temperature above 38.3 °C.Thirty-three episodes of hyperthermia were analyzed 25 of these occurred on a background of initially normal ICP whereas 8 occurred on a background of initially elevated ICP, and 17 of the 33 episodes occurred on a background of initially intact autoregulation whereas 16 occurred on a background of initially impaired autoregulation.During hyperthermia, elevated ICP was found in 52% of instances where it was initially normal, and further progression of intracranial hypertension occurred in 100% of instances where ICP was initially elevated.
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