Topic Editors

Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
Dr. Guangzhi Shi
Department of Intensive Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China

Advances in Neurocritical Care

Abstract submission deadline
closed (31 March 2023)
Manuscript submission deadline
closed (31 October 2023)
Viewed by
34530

Topic Information

Dear Colleagues,

It is an enormous honor to be topic editors for this special collection of advances in neurocritical care. This topic is dedicated to publishing outstanding study results in a bundle of high-quality academic journals, including JCM, Biomedicines, Brain Sciences, Medicina, and JVD. We welcome basic and translational science reports, clinical trials, systematic reviews, predictive modeling studies, advances in therapies and monitoring, analytic and methodologic advances, and all kinds of health services research related to neurocritical illness. This special collection is directed toward neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with acute neurologic disorders. Hopefully, this special collection will provide a comprehensive overview of current developments in neurology, neurosurgery, and neuroanesthesia and includes information about new therapeutic avenues and technological innovations in neurocritical diseases.

Prof. Dr. Guoyi Gao
Dr. Guangzhi Shi
Prof. Dr. Zhixiong Liu
Topic Editors

Keywords

  • neurocritical care
  • monitoring
  • treatment
  • pharmaceutics
  • data processing
  • artificial intelligence
  • preclinical study
  • clinical study

Participating Journals

Journal Name Impact Factor CiteScore Launched Year First Decision (median) APC
Biomedicines
biomedicines
4.7 3.7 2013 15.4 Days CHF 2600
Brain Sciences
brainsci
3.3 3.9 2011 15.6 Days CHF 2200
Journal of Clinical Medicine
jcm
3.9 5.4 2012 17.9 Days CHF 2600
Journal of Vascular Diseases
jvd
- - 2022 25 Days CHF 1000
Medicina
medicina
2.6 3.6 1920 19.6 Days CHF 1800

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Published Papers (20 papers)

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12 pages, 1736 KiB  
Article
Evaluation of the Efficacy and Safety of Quetiapine in the Treatment of Delirium in Adult ICU Patients: A Retrospective Comparative Study
by Sultan Alghadeer, Rahaf S. Almesned, Emad A. Alshehri and Abdulrahman Alwhaibi
J. Clin. Med. 2024, 13(3), 802; https://doi.org/10.3390/jcm13030802 - 30 Jan 2024
Viewed by 893
Abstract
Background: Quetiapine is commonly prescribed off-label to manage delirium in intensive care unit (ICU) patients. However, limited studies comparing its efficacy and safety to those of other antipsychotics exist in the literature. Method: A retrospective, single-center chart review study was conducted on adults [...] Read more.
Background: Quetiapine is commonly prescribed off-label to manage delirium in intensive care unit (ICU) patients. However, limited studies comparing its efficacy and safety to those of other antipsychotics exist in the literature. Method: A retrospective, single-center chart review study was conducted on adults admitted to the ICU between January 2017 and August 2022, who were diagnosed with delirium and treated with a single antipsychotic and had no neurological medical conditions, active alcohol withdrawal, or prior use of antipsychotics. Data were analyzed using SPSS software version 28, with p-values of <0.05 indicating statistical significance. Results: In total, 47 patients were included, of whom 22 (46.8%), 19 (40.4%), 4 (8.5%), and 2 (4.3%) were on quetiapine, haloperidol, risperidone, and olanzapine, respectively. The median number of hours needed to resolve delirium were 12 (21.5), 23 (28), 13 (13.75), and 36 (10) (p = 0.115) for quetiapine, haloperidol, risperidone, and olanzapine, respectively, with haloperidol being used for a significantly shorter median number of days than quetiapine (3 (2.5) days vs. 7.5 (11.5) days; p = 0.007). Of the medication groups, only quetiapine-treated patients received a significantly higher median maintenance compared to the initiation dose (50 (50) mg vs. 50 (43.75) mg; p = 0.039). For the length of stay in the ICU and hospital, delirium-free days, % of ICU time spent in delirium, ventilator-free days, the difference between the highest and baseline QTc intervals, and ICU and hospital mortalities, no significant difference was observed between the groups. Conclusions: Overall, the use of quetiapine in our retrospective study seems to not be advantageous over the other drugs in terms of efficacy and safety outcomes. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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12 pages, 1101 KiB  
Systematic Review
The Effects of Acetazolamide on Cerebral Hemodynamics in Adult Patients with an Acute Brain Injury: A Systematic Review
by Claudia Stella, Anas Hachlouf, Lorenzo Calabrò, Irene Cavalli, Sophie Schuind, Elisa Gouvea Bogossian and Fabio Silvio Taccone
Brain Sci. 2023, 13(12), 1678; https://doi.org/10.3390/brainsci13121678 - 06 Dec 2023
Viewed by 1359
Abstract
Background: Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the regulation of cerebral blood flow (CBF). The aim of this review was to understand the effects of acetazolamide [...] Read more.
Background: Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme expressed in different cells of the central nervous system (CNS) and involved in the regulation of cerebral blood flow (CBF). The aim of this review was to understand the effects of acetazolamide on CBF, intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) after an acute brain injury (ABI). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), we performed a comprehensive, computer-based, literature research on the PubMed platform to identify studies that have reported the effects on CBF, ICP, or PbtO2 of acetazolamide administered either for therapeutic or diagnostic purposes in patients with subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, and hypoxic-ischemic encephalopathy. Results: From the initial search, 3430 records were identified and, through data selection, 11 of them were included for the qualitative analysis. No data on the effect of acetazolamide on ICP or PbtO2 were found. Cerebral vasomotor reactivity (VMR—i.e., the changing in vascular tone due to a vasoactive substance) to acetazolamide tends to change during the evolution of ABI, with the nadir occurring during the subacute stage. Moreover, VMR reduction was correlated with clinical outcome. Conclusions: This systematic review showed that the available studies on the effects of acetazolamide on brain hemodynamics in patients with ABI are scarce. Further research is required to better understand the potential role of this drug in ABI patients. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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15 pages, 4656 KiB  
Article
MicroRNA-323-5p Involved in Dexmedetomidine Preconditioning Impart Neuroprotection
by Hyunyoung Seong, Daun Jeong, Eung Hwi Kim, Kyung Seob Yoon, Donghyun Na, Seung Zhoo Yoon and Jang Eun Cho
Medicina 2023, 59(9), 1518; https://doi.org/10.3390/medicina59091518 - 23 Aug 2023
Viewed by 903
Abstract
Background and Objectives: Cerebral ischemia is one of the major preoperative complications. Dexmedetomidine is a well-known sedative–hypnotic agent that has potential organ-protective effects. We examine the miRNAs associated with preconditioning effects of dexmedetomidine in cerebral ischemia. Materials and Methods: Transient infarcts [...] Read more.
Background and Objectives: Cerebral ischemia is one of the major preoperative complications. Dexmedetomidine is a well-known sedative–hypnotic agent that has potential organ-protective effects. We examine the miRNAs associated with preconditioning effects of dexmedetomidine in cerebral ischemia. Materials and Methods: Transient infarcts were induced in mice via reperfusion after temporary occlusion of one side of the middle cerebral artery. A subset of these mice was exposed to dexmedetomidine prior to cerebral infarction and miRNA profiling of the whole brain was performed. We administered dexmedetomidine and miRNA-323-5p mimic/inhibitor to oxygen–glucose deprivation/reoxygenation astrocytes. Additionally, we administered miR-323-5p mimic and inhibitor to mice via intracerebroventricular injection 2 h prior to induction of middle cerebral artery occlusion. Results: The infarct volume was significantly lower in the dexmedetomidine-preconditioned mice. Analysis of brain samples revealed an increased expression of five miRNAs and decreased expression of three miRNAs in the dexmedetomidine-pretreated group. The viability of cells significantly increased and expression of miR-323-5p was attenuated in the dexmedetomidine-treated oxygen–glucose deprivation/reoxygenation groups. Transfection with anti-miR-323-5p contributed to increased astrocyte viability. When miRNA-323-5p was injected intraventricularly, infarct volume was significantly reduced when preconditioned with the miR-323-5p inhibitor compared with mimic and negative control. Conclusions: Dexmedetomidine has a protective effect against transient neuronal ischemia–reperfusion injury and eight specific miRNAs were profiled. Also, miRNA-323-5p downregulation has a cell protective effect under ischemic conditions both in vivo and in vitro. Our findings suggest the potential of the miR-323-5p inhibitor as a therapeutic agent against cerebral infarction. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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17 pages, 2150 KiB  
Review
Subtypes and Mechanistic Advances of Extracorporeal Membrane Oxygenation-Related Acute Brain Injury
by Bixin Deng, Junjie Ying and Dezhi Mu
Brain Sci. 2023, 13(8), 1165; https://doi.org/10.3390/brainsci13081165 - 04 Aug 2023
Viewed by 1191
Abstract
Extracorporeal membrane oxygenation (ECMO) is a frequently used mechanical cardiopulmonary support for rescuing critically ill patients for whom conventional medical therapies have failed. However, ECMO is associated with several complications, such as acute kidney injury, hemorrhage, thromboembolism, and acute brain injury (ABI). Among [...] Read more.
Extracorporeal membrane oxygenation (ECMO) is a frequently used mechanical cardiopulmonary support for rescuing critically ill patients for whom conventional medical therapies have failed. However, ECMO is associated with several complications, such as acute kidney injury, hemorrhage, thromboembolism, and acute brain injury (ABI). Among these, ABI, particularly intracranial hemorrhage (ICH) and infarction, is recognized as the primary cause of mortality during ECMO support. Furthermore, survivors often suffer significant long-term morbidities, including neurocognitive impairments, motor disturbances, and behavioral problems. This review provides a comprehensive overview of the different subtypes of ECMO-related ABI and the updated advance mechanisms, which could be helpful for the early diagnosis and potential neuromonitoring of ECMO-related ABI. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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23 pages, 2057 KiB  
Review
Neurointerventional Treatment of Vein of Galen Malformation (VGM): A Structured Review with a Proposal for the Comparison of Outcome Quality
by Friedhelm Brassel, Martin Schlunz-Hendann, Martin Scholz, Robert Lucaciu, Chunfu Fan, Vitali Koch, Dominik Grieb, Francisco Brevis Nunez, Simone Schwarz and Christof M. Sommer
J. Vasc. Dis. 2023, 2(2), 236-258; https://doi.org/10.3390/jvd2020018 - 01 Jun 2023
Viewed by 1933
Abstract
Background: Vein of Galen malformation (VGM) is a congenital intracranial vascular anomaly consisting of arteriovenous fistulas and/or malformations between various arterial feeders and the median prosencephalic vein of Markowski (MPV). Despite its rare occurrence, VGM is of particular clinical relevance, as the excessive [...] Read more.
Background: Vein of Galen malformation (VGM) is a congenital intracranial vascular anomaly consisting of arteriovenous fistulas and/or malformations between various arterial feeders and the median prosencephalic vein of Markowski (MPV). Despite its rare occurrence, VGM is of particular clinical relevance, as the excessive intracranial shunt volume leads to high mortality without appropriate treatment. Methods: The objective of this article is to review the published data on neurointerventional treatment and compare outcome quality in the included studies. Eight studies were included and synthesized. One study was multicentric and the rest were retrospective monocentric (level 4 evidence studies according to the Oxford Centre for Evidence-based Medicine). Results: The total number of included patients was 480 and patient age ranged from 1 day to 18 years. Mild or severe heart failure, hydrocephalus, and other reasons led to the indication for neurointerventional treatment, which was performed in all studies in the form of embolization. Under consideration of the introduced semiquantitative multidimensional scoring system, the highest total score, i.e., the best outcome quality, was found for the study “Houston” 2002–2018 (19 points) and the study “Duisburg” 2001–2010 (19 points). Conclusions: Neurointerventional treatment represents the essential pillar in the interdisciplinary management of patients with VGM, although standardization is lacking—based on the results of the structured review. As complementary treatments, pediatric critical care is mandatory and includes medical hemodynamic stabilization. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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9 pages, 238 KiB  
Article
Magnetic Resonance-Based Assessment of Optic Nerve Sheath Diameter: A Prospective Observational Cohort Study on Inter- and Intra-Rater Agreement
by Raffaele Aspide, Giacomo Bertolini, Laura Maria Beatrice Belotti, Luca Albini Riccioli, Francesco Toni, Diego Mazzatenta, Giorgio Palandri, Luigi Vetrugno and Daniele Guerino Biasucci
J. Clin. Med. 2023, 12(7), 2713; https://doi.org/10.3390/jcm12072713 - 05 Apr 2023
Cited by 2 | Viewed by 1207
Abstract
Background: The measurement of optic nerve sheath diameter (ONSD) as a non-invasive method of estimating intracranial pressure has been widely reported in the literature. However, few studies have evaluated the accuracy of magnetic resonance imaging (MRI) in assessing ONSD measurements, although it is [...] Read more.
Background: The measurement of optic nerve sheath diameter (ONSD) as a non-invasive method of estimating intracranial pressure has been widely reported in the literature. However, few studies have evaluated the accuracy of magnetic resonance imaging (MRI) in assessing ONSD measurements, although it is considered a very reliable method, it is not easily repeatable, expensive and is not readily available bedside. Herein, an assessment of the intra- and inter-rater reliability of ONSD assessment using MRI was conducted. Methods: A consecutive, prospective cohort of patients with suspected idiopathic normal-pressure hydrocephalus was analyzed. ONSD MRI measurements of the transverse and sagittal diameters at a distance of 3 mm behind the papilla were evaluated twice each by two expert neuroradiologists. The correlations between MRI examiners were calculated using the concordance correlation coefficient (CCC). Results: Fifty patients were included in the study. ONSD MRI average measurements were substantially higher than clinically expected (>5 mm). Considering intra-rater concordance, only one of the two neuroradiologists achieved an excellent score at CCC. Only a moderate inter-observer CCC for MRI assessment was found at all diameters. Conclusions: The use of a widespread MRI sequence (3D T1) to measure ONSD is not an accurate method since it may overestimate measurements and is dependent upon an operator. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
7 pages, 295 KiB  
Article
The Effect of Prognostic Nutritional Index on Infection in Acute Ischemic Stroke Patients
by Sebnem Nergiz and Unal Ozturk
Medicina 2023, 59(4), 679; https://doi.org/10.3390/medicina59040679 - 29 Mar 2023
Cited by 3 | Viewed by 1372
Abstract
Objectives: Malnutrition is frequently seen in stroke patients. Malnutrition worsens the prognosis and increases the mortality rate in acute ischemic stroke patients. Malnutrition is a significant factor not only in the initiation of infection but also in its progression. The prognostic nutritional [...] Read more.
Objectives: Malnutrition is frequently seen in stroke patients. Malnutrition worsens the prognosis and increases the mortality rate in acute ischemic stroke patients. Malnutrition is a significant factor not only in the initiation of infection but also in its progression. The prognostic nutritional index (PNI) is a new index that evaluates the nutrition and inflammatory status. This study aims to investigate the relationship between PNI and stroke-related infection (SRI) development during hospitalization in patients with acute ischemic stroke. Materials and Methods: Acute ischemic stroke was the primary diagnosis for 158 patients who were admitted to the neurology intensive care unit. Patients’ demographic, clinical, and laboratory parameters were recorded. PNI was calculated according to the formula given below. PNI: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm3). PNI > 380 normal, PNI: 350–380 moderate malnutrition risk, PNI < 350 severe malnutrition risk. Results: A total of 158 patients with acute ischemic stroke were included in the study. There were 70 male and 88 female patients, whereas the mean age of the patients was 67.79 ± 14.0 years. Nosocomial infection developed in 34 (21%) of the patients. Compared to high PNI scores, patients with low PNI scores were generally older, and the National Institutes of Health Stroke Scale (NIHSS) score, atrial fibrillation, infection, mortality rate, and hospitalization rates were all significantly higher. Conclusions: In this study, we discovered that patients with poor PNI had a considerably increased rate of infection development. It is vital to evaluate the nutritional status of patients with acute ischemic stroke during hospitalization. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
15 pages, 1002 KiB  
Article
Effects of Tele-Pilates and Tele-Yoga on Biochemicals, Physical, and Psychological Parameters of Females with Multiple Sclerosis
by Parisa Najafi, Maryam Hadizadeh, Jadeera Phaik Geok Cheong, Hamidreza Mohafez, Suhailah Abdullah and Maryam Poursadeghfard
J. Clin. Med. 2023, 12(4), 1585; https://doi.org/10.3390/jcm12041585 - 16 Feb 2023
Cited by 4 | Viewed by 2229
Abstract
Background: People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the [...] Read more.
Background: People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the serum levels of prolactin and cortisol and selected physical and psychological factors. Methods: Forty-five females with relapsing remitting multiple sclerosis, based on age (18–65), expanded disability status scale (0–5.5), and body mass index (20–32), were randomly assigned to tele-Pilates, tele-yoga, or control groups (n = 15). Serum blood samples and validated questionnaires were collected before and after interventions. Results: Following online interventions, there was a significant increase in the serum levels of prolactin (p = 0.004) and a significant decrease in cortisol (p = 0.04) in the time × group interaction factors. In addition, significant improvements were observed in depression (p = 0.001), physical activity levels (p < 0.001), QoL (p ≤ 0.001), and the speed of walking (p < 0.001). Conclusion: Our findings suggest that tele-yoga and tele-Pilates training could be introduced as patient-friendly, non-pharmacological, add-on therapeutic methods for increasing prolactin and decreasing cortisol serum levels and achieving clinically relevant improvements in depression, walking speed, physical activity level, and QoL in female MS patients. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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11 pages, 660 KiB  
Article
Corticosteroid-Dependent Leukocytosis Masks the Predictive Potential of White Blood Cells for Delayed Cerebral Ischemia and Ventriculoperitoneal Shunt Dependency in Aneurysmatic Subarachnoid Hemorrhage
by Andras Piffko, Franz L. Ricklefs, Nils Schweingruber, Thomas Sauvigny, Marius Marc-Daniel Mader, Malte Mohme, Lasse Dührsen, Manfred Westphal, Jan Regelsberger, Nils Ole Schmidt and Patrick Czorlich
J. Clin. Med. 2023, 12(3), 1006; https://doi.org/10.3390/jcm12031006 - 28 Jan 2023
Viewed by 1227
Abstract
A multitude of pathological and inflammatory processes determine the clinical course after aneurysmal subarachnoid hemorrhage (aSAH). However, our understanding of predictive factors and therapeutic consequences is limited. We evaluated the predictive value of clinically relevant factors readily available in the ICU setting, such [...] Read more.
A multitude of pathological and inflammatory processes determine the clinical course after aneurysmal subarachnoid hemorrhage (aSAH). However, our understanding of predictive factors and therapeutic consequences is limited. We evaluated the predictive value of clinically relevant factors readily available in the ICU setting, such as white blood cell (WBC) count and CRP, for two of the leading comorbidities, delayed cerebral ischemia (DCI) and ventriculoperitoneal (VP) shunt dependency in aSAH patients with and without corticosteroid treatment. We conducted a retrospective analysis of 484 aSAH patients admitted to our institution over an eight-year period. Relevant clinical factors affecting the risk of DCI and VP shunt dependency were identified and included in a multivariate logistic regression model. Overall, 233/484 (48.1%) patients were treated with corticosteroids. Intriguingly, predictive factors associated with the occurrence of DCI differed significantly depending on the corticosteroid treatment status (dexamethasone group: Hunt and Hess grade (p = 0.002), endovascular treatment (p = 0.016); no-dexamethasone group: acute hydrocephalus (p = 0.018), peripheral leukocyte count 7 days post SAH (WBC at day 7) (p = 0.009)). Similar disparities were found for VP shunt dependency (dexamethasone group: acute hydrocephalus (p = 0.002); no-dexamethasone group: WBC d7 (p = 0.036), CRP peak within 72 h (p = 0.015)). Our study shows that corticosteroid-induced leukocytosis negates the predictive prognostic potential of systemic inflammatory markers for DCI and VP shunt dependency, which has previously been neglected and should be accounted for in future studies. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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9 pages, 444 KiB  
Article
Non-Convulsive Status Epilepticus in Aneurysmal Subarachnoid Hemorrhage: A Prognostic Parameter
by Martin Vychopen, Tim Lampmann, Harun Asoglu, Agi Güresir, Hartmut Vatter, Johannes Wach and Erdem Güresir
Brain Sci. 2023, 13(2), 184; https://doi.org/10.3390/brainsci13020184 - 22 Jan 2023
Cited by 1 | Viewed by 1639
Abstract
A non-convulsive status epilepticus (ncSE) is a potentially fatal complication for patients in neurointensive care. In patients with aneurysmal subarachnoid hemorrhage (SAH), ncSE remains scarcely investigated. In this study, we aim to investigate the frequency and influence of non-convulsive status epilepticus on outcome [...] Read more.
A non-convulsive status epilepticus (ncSE) is a potentially fatal complication for patients in neurointensive care. In patients with aneurysmal subarachnoid hemorrhage (SAH), ncSE remains scarcely investigated. In this study, we aim to investigate the frequency and influence of non-convulsive status epilepticus on outcome in patients with SAH. We retrospectively analyzed data of consecutive patients with aneurysmal subarachnoid hemorrhage and evaluated clinical, radiological, demographical and electroencephalogram (EEG) data. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favorable (mRS 0-2) vs. unfavorable (mRS 3-6). We identified 171 patients with SAH, who received EEG between 01/2012 and 12/2020. ncSE was diagnosed in 19 patients (3.7%), only one of whom achieved favorable outcome. The multivariate regression analysis revealed four independent predictors of unfavorable outcome: presence of ncSE (p = 0.003; OR 24.1; 95 CI% 2.9–195.3), poor-grade SAH (p < 0.001; OR 14.0; 95 CI% 8.5–23.1), age (p < 0.001; OR 2.8; 95 CI% 1.6–4.6) and the presence of DIND (p < 0.003; OR 1.9; 95 CI% 1.2–3.1) as independent predictors for unfavorable outcome. According to our study, development of ncSE in patients suffering SAH might correlate with poor prognosis. Even when medical treatment is successful and no EEG abnormalities are detected, the long-term outcome remains poor. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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11 pages, 2944 KiB  
Article
Prediction of Acute Respiratory Distress Syndrome in Traumatic Brain Injury Patients Based on Machine Learning Algorithms
by Ruoran Wang, Linrui Cai, Jing Zhang, Min He and Jianguo Xu
Medicina 2023, 59(1), 171; https://doi.org/10.3390/medicina59010171 - 15 Jan 2023
Cited by 2 | Viewed by 2018
Abstract
Background: Acute respiratory distress syndrome (ARDS) commonly develops in traumatic brain injury (TBI) patients and is a risk factor for poor prognosis. We designed this study to evaluate the performance of several machine learning algorithms for predicting ARDS in TBI patients. Methods [...] Read more.
Background: Acute respiratory distress syndrome (ARDS) commonly develops in traumatic brain injury (TBI) patients and is a risk factor for poor prognosis. We designed this study to evaluate the performance of several machine learning algorithms for predicting ARDS in TBI patients. Methods: TBI patients from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were eligible for this study. ARDS was identified according to the Berlin definition. Included TBI patients were divided into the training cohort and the validation cohort with a ratio of 7:3. Several machine learning algorithms were utilized to develop predictive models with five-fold cross validation for ARDS including extreme gradient boosting, light gradient boosting machine, Random Forest, adaptive boosting, complement naïve Bayes, and support vector machine. The performance of machine learning algorithms were evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy and F score. Results: 649 TBI patients from the MIMIC-III database were included with an ARDS incidence of 49.5%. The random forest performed the best in predicting ARDS in the training cohort with an AUC of 1.000. The XGBoost and AdaBoost ranked the second and the third with an AUC of 0.989 and 0.815 in the training cohort. The random forest still performed the best in predicting ARDS in the validation cohort with an AUC of 0.652. AdaBoost and XGBoost ranked the second and the third with an AUC of 0.631 and 0.620 in the validation cohort. Several mutual top features in the random forest and AdaBoost were discovered including age, initial systolic blood pressure and heart rate, Abbreviated Injury Score chest, white blood cells, platelets, and international normalized ratio. Conclusions: The random forest and AdaBoost based models have stable and good performance for predicting ARDS in TBI patients. These models could help clinicians to evaluate the risk of ARDS in early stages after TBI and consequently adjust treatment decisions. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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13 pages, 2542 KiB  
Review
Assessing Cognitive Outcomes in Coma Survivors: A Literature Review
by Allison Frantz, Natalia Incio Serra, Aracely Lopez Almendariz, Catherine Duclos, Adrian M. Owen and Stefanie Blain-Moraes
Brain Sci. 2023, 13(1), 96; https://doi.org/10.3390/brainsci13010096 - 04 Jan 2023
Viewed by 1869
Abstract
(1) Background: Although cognitive impairments in coma survivors are common, methods of measuring long-term cognitive outcomes in this population are inconsistent, precluding the development of a strong evidence-base to support clinical decision making. In this literature review, we identify and characterize the measures [...] Read more.
(1) Background: Although cognitive impairments in coma survivors are common, methods of measuring long-term cognitive outcomes in this population are inconsistent, precluding the development of a strong evidence-base to support clinical decision making. In this literature review, we identify and characterize the measures used to track cognitive recovery in coma survivors to data. (2) Methods: We extracted the instrument used for cognitive assessment, the cognitive domains assessed, methods administration and scoring, and timing of assessment from 134 of 996 screened records. (3) Results: A total of 133 unique cognitive tests and cognitive testing batteries were identified, with 97 cognitive instruments used in less than three articles. The instruments assessed 20 different cognitive domains, with 73 articles also using tests that assess general “cognitive ability”. Cognitive instruments ranged from subjective assessments to comprehensive cognitive batteries. There were inconsistent points of reference for the timing of assessment across studies, with few studies repeating assessments at more than one time point, and arbitrary time intervals between tests. (4) Conclusions: Overall, this review illustrates the enormous disparity between studies that track cognitive outcome in coma survivors, and the need for a systematic, patient-accessible method of assessing cognitive functioning in future studies with this population. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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10 pages, 1436 KiB  
Case Report
Posterior Reversible Encephalopathy Syndrome after Lenvatinib Therapy in a Patient with Olfactory Neuroblastoma
by Yu-Ju Tseng, Chun-Nan Chen, Ruey-Long Hong, Woon-Man Kung and Abel Po-Hao Huang
Brain Sci. 2023, 13(1), 33; https://doi.org/10.3390/brainsci13010033 - 23 Dec 2022
Cited by 3 | Viewed by 1753
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe neurological syndrome that may stem from the use of some medications. Although its mechanism is not well-known, hypertension and endothelial dysfunction have been mentioned in previous literature as being related. Lenvatinib serves as [...] Read more.
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe neurological syndrome that may stem from the use of some medications. Although its mechanism is not well-known, hypertension and endothelial dysfunction have been mentioned in previous literature as being related. Lenvatinib serves as a neoplastic agent that inhibits the tyrosine kinase of vascular endothelial growth factor receptors (VEGFR). VEGFR inhibitors result in endothelial dysfunction and consequent hypertension by nitric oxide pathway suppression and endothelin (ET)-1 stimulation. We hypothesized that VEGFR inhibitors would cause PRES. Herein, we report the case of a 40-year-old man with olfactory neuroblastoma who developed PRES while undergoing treatment with lenvatinib, 7 months after initiation. The symptoms included loss of consciousness and seizures. Fortunately, the symptoms and presence of PRES in imaging resolved, 7 days and 1 month, respectively, after cessation of lenvatinib. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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8 pages, 472 KiB  
Article
Off-Hour Admission Is Associated with Poor Outcome in Patients with Intracerebral Hemorrhage
by Muhammad Junaid Akram, Xinni Lv, Lan Deng, Zuoqiao Li, Tiannan Yang, Hao Yin, Xiaofang Wu, Mingjun Pu, Chu Chen, Libo Zhao and Qi Li
J. Clin. Med. 2023, 12(1), 66; https://doi.org/10.3390/jcm12010066 - 21 Dec 2022
Cited by 1 | Viewed by 1502
Abstract
The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at [...] Read more.
The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1–53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4–9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35–3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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14 pages, 1308 KiB  
Article
Nomogram for Early Prediction of Outcome in Coma Patients with Severe Traumatic Brain Injury Receiving Right Median Nerve Electrical Stimulation Treatment
by Chao Zhang, Wen-Dong You, Xu-Xu Xu, Qian Zhou and Xiao-Feng Yang
J. Clin. Med. 2022, 11(24), 7529; https://doi.org/10.3390/jcm11247529 - 19 Dec 2022
Cited by 1 | Viewed by 1710
Abstract
Background: Accurate outcome prediction can serve to approach, quantify and categorize severe traumatic brain injury (TBI) coma patients for right median electrical stimulation (RMNS) treatment, which can support rehabilitation plans. As a proof of concept for individual risk prediction, we created a novel [...] Read more.
Background: Accurate outcome prediction can serve to approach, quantify and categorize severe traumatic brain injury (TBI) coma patients for right median electrical stimulation (RMNS) treatment, which can support rehabilitation plans. As a proof of concept for individual risk prediction, we created a novel nomogram model combining amplitude-integrated electroencephalography (AEEG) and clinically relevant parameters. Methods: This study retrospective collected and analyzed a total of 228 coma patients after severe TBI in two medical centers. According to the extended Glasgow Outcome Scale (GOSE), patients were divided into a good outcome (GOSE 3–8) or a poor outcome (GOSE 1–2) group. Their clinical and biochemical indicators, together with EEG features, were explored retrospectively. The risk factors connected to the outcome of coma patients receiving RMNS treatment were identified using Cox proportional hazards regression. The discriminative capability and calibration of the model to forecast outcome were assessed by C statistics, calibration plots, and Kaplan-Meier curves on a personalized nomogram forecasting model. Results: The study included 228 patients who received RMNS treatment for long-term coma after a severe TBI. The median age was 40 years, and 57.8% (132 of 228) of the patients were male. 67.0% (77 of 115) of coma patients in the high-risk group experienced a poor outcome after one year and the comparative data merely was 30.1% (34 of 113) in low-risk group patients. The following variables were integrated into the forecasting of outcome using the backward stepwise selection of Akaike information criterion: age, Glasgow Coma Scale (GCS) at admission, EEG reactivity (normal, absence, or the stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs)), and AEEG background pattern (A mode, B mode, or C mode). The C statistics revealed that the nomograms’ discriminative potential and calibration demonstrated good predictive ability (0.71). Conclusion: Our findings show that the nomogram model using AEEG parameters has the potential to predict outcomes in severe TBI coma patients receiving RMNS treatment. The model could classify patients into prognostic groups and worked well in internal validation. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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12 pages, 1343 KiB  
Article
Effect of Folic Acid Treatment for Patients with Traumatic Brain Injury (TBI)-Related Hospital Acquired Pneumonia (HAP): A Retrospective Cohort Study
by Hao Wu, Xin Geng, Chenan Liu, Augustine K. Ballah, Feixiang Li, Tangrui Han, Shuai Gao, Chunhong Wang, Hongming Ji, Xiaoqi Nie, Gang Cheng, Xiangyu Wang, Rui Cheng and Yonghong Wang
J. Clin. Med. 2022, 11(24), 7403; https://doi.org/10.3390/jcm11247403 - 14 Dec 2022
Cited by 2 | Viewed by 1606
Abstract
Hospital Acquired Pneumonia (HAP) is one of the most common complications and late causes of death in TBI patients. Targeted prevention and treatment of HAP are of great significance for improving the prognosis of TBI patients. In the previous clinical observation, we found [...] Read more.
Hospital Acquired Pneumonia (HAP) is one of the most common complications and late causes of death in TBI patients. Targeted prevention and treatment of HAP are of great significance for improving the prognosis of TBI patients. In the previous clinical observation, we found that folic acid treatment for TBI patients has a good effect on preventing and treating HAP. We conducted this retrospective cohort study to demonstrate what we observed by selecting 293 TBI patients from two medical centers and analyzing their hospitalization data. The result showed that the incidence of HAP was significantly lower in TBI patients who received folic acid treatment (44.1% vs. 63.0%, p = 0.012). Multivariate logistic regression analysis showed that folic acid treatment was an independent protective factor for the occurrence of HAP in TBI patients (OR = 0.418, p = 0.031), especially in high-risk groups of HAP, such as the old (OR: 1.356 vs. 2.889), ICU (OR: 1.775 vs. 5.996) and severe TBI (OR: 0.975 vs. 5.424) patients. At the same time, cohort studies of HAP patients showed that folic acid also had a good effect on delaying the progression of HAP, such as reducing the chance of tracheotomy (26.1% vs. 50.8%, p = 0.041), and reduced the length of hospital stay (15 d vs. 19 d, p = 0.029) and ICU stay (5 d vs. 8 d, p = 0.046). Therefore, we believe that folic acid treatment in TBI patients has the potential for preventing and treating HAP, and it is worthy of further clinical research. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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14 pages, 1762 KiB  
Article
Relationship between the Blood Urea Nitrogen to Creatinine Ratio and In-Hospital Mortality in Non-Traumatic Subarachnoid Hemorrhage Patients: Based on Propensity Score Matching Method
by Zirong Chen, Junhong Wang, Hongkuan Yang, Hua Li, Rudong Chen and Jiasheng Yu
J. Clin. Med. 2022, 11(23), 7031; https://doi.org/10.3390/jcm11237031 - 28 Nov 2022
Cited by 2 | Viewed by 2057
Abstract
(1) Background: To explore the correlation between the blood urea nitrogen to creatinine ratio (UCR) and in-hospital mortality in non-traumatic subarachnoid hemorrhage patients. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive Ⅳ (MIMIC-Ⅳ) database. The optimal cut-off [...] Read more.
(1) Background: To explore the correlation between the blood urea nitrogen to creatinine ratio (UCR) and in-hospital mortality in non-traumatic subarachnoid hemorrhage patients. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive Ⅳ (MIMIC-Ⅳ) database. The optimal cut-off value of the UCR was calculated with ROC curve analysis conducted using the maximum Youden index for the prediction of survival status. Univariable and multivariable logistic regression analyses were also carried out to assess the prognostic significance of UCR, and the Kaplan–Meier (K–M) analysis was conducted to draw the survival curves. Then, the 1:1 propensity score matching (PSM) method was applied to improve the reliability of the research results while balancing the unintended influence of underlying confounders. (3) Results: This retrospective cohort study included 961 patients. The optimal cut-off value of the UCR for in-hospital mortality was 27.208. The PSM was performed to identify 92 pairs of score-matched patients, with balanced differences exhibited for nearly all variables. According to the K–M analysis, those patients with a UCR of more than 27.208 showed a significantly higher level of in-hospital mortality compared to the patients with a UCR of less than 27.208 (p < 0.05). After the adjustment for possible confounders, those patients whose UCR was more than 27.208 still had a significantly higher level of in-hospital mortality than the patients whose UCR was less than 27.208, as revealed by the multivariable logistic regression analysis (OR = 3.783, 95% CI: 1.959~7.305, p < 0.001). Similarly, the in-hospital mortality remained substantially higher for those patients in the higher UCR group than for the patients in the lower UCR group after PSM. (4) Conclusion: A higher level of the UCR was evidently associated with an increased risk of in-hospital mortality, which made the ratio useful as a prognostic predictor of clinical outcomes for those patients with non-traumatic subarachnoid hemorrhage. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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8 pages, 413 KiB  
Article
Impact of Subsyndromal Delirium Occurrence and Its Trajectory during ICU Stay
by Rodrigo B. Serafim, Felipe Dal-Pizzol, Vicente Souza-Dantas, Marcio Soares, Fernando A. Bozza, Pedro Póvoa, Ronir Raggio Luiz, José R. Lapa e Silva and Jorge I. F. Salluh
J. Clin. Med. 2022, 11(22), 6797; https://doi.org/10.3390/jcm11226797 - 17 Nov 2022
Cited by 3 | Viewed by 1690
Abstract
Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 [...] Read more.
Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 patients included, SSD occurred in 22.7%. Considering the worst cognitive assessment during the first 72 h, 233 (34%) patients had normal mental status, 124 (18%) patients had SSD and 324 (48%) patients had delirium or coma. SSD was not independently associated with an increased risk of death when compared with normal mental status (OR 95%IC 1.0 vs. 1.35 [0.73–1.49], p = 0.340), but was associated with a longer ICU LOS (7.0 (4–12) vs. 4 (3–8) days, p < 0.001). SSD patients who deteriorated to delirium or coma (21%) had a longer ICU LOS in comparison with those who improved or maintained mental status (8 (5–11) vs. 6 (4–8) days, p = 0.025), but did not have an increase in mortality. The main factors associated with the progression from SSD to delirium or coma were the use of mechanical ventilation, the use of intravenous benzodiazepines and a baseline APACHE II score > 23 points. Our findings support the association of SSD with increased ICU LOS, but not with ICU mortality. Monitoring the trajectory of SSD early at ICU admission can help to identify patients with increased risk of conversion from SSD to delirium or coma. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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14 pages, 1625 KiB  
Review
Prevalence of Venous Thromboembolism in Intensive Care Units: A Meta-Analysis
by Xiaoyu Gao, Liangnan Zeng, Haorun Wang, Shan Zeng, Junjie Tian, Ligang Chen and Tangming Peng
J. Clin. Med. 2022, 11(22), 6691; https://doi.org/10.3390/jcm11226691 - 11 Nov 2022
Cited by 4 | Viewed by 2048
Abstract
Objective: Venous thromboembolism (VTE) is a life threating complication in intensive care units (ICUs). This study aimed to pool the prevalence of VTE and examined the risk factors of VTE in intensive care patients worldwide. Methods: A systematic search in PubMed, EMBASE and [...] Read more.
Objective: Venous thromboembolism (VTE) is a life threating complication in intensive care units (ICUs). This study aimed to pool the prevalence of VTE and examined the risk factors of VTE in intensive care patients worldwide. Methods: A systematic search in PubMed, EMBASE and Web of Science databases was performed. Studies reported that the data on the prevalence of VTE or relevant information were synthesized using a random-effects model. Results: A total of 42 studies reporting on 27,344 patients were included. The pooled prevalence of VTE was 10.0% (95% CI: 7.0–14.0%). Subgroup and metaregression analyses found that thromboprophylaxis strategy, simplified acute physiology score (SAPS II), age, study quality, sample size, malignancy, sex, spinal cord injury and injury severity score (ISS) moderated the prevalence of VTE in intensive care patients. Conclusions: The present meta-analysis revealed a high prevalence of VTE in critically ill patients. The risk factors of VTE included thromboprophylaxis strategy, SAPS II, age, malignancy, sex, spinal cord injury and ISS. Therefore, we need to pay more attention to high-risk populations of VTE in intensive care patients. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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12 pages, 1673 KiB  
Article
Intracranial-Pressure-Monitoring-Assisted Management Associated with Favorable Outcomes in Moderate Traumatic Brain Injury Patients with a GCS of 9–11
by Mingsheng Chen, Haiyang Wu, Zhihong Li, Shunnan Ge, Lanfu Zhao, Xingye Zhang and Yan Qu
J. Clin. Med. 2022, 11(22), 6661; https://doi.org/10.3390/jcm11226661 - 10 Nov 2022
Viewed by 1772
Abstract
Objective: With a mortality rate of 10–30%, a moderate traumatic brain injury (mTBI) is one of the most variable traumas. The indications for intracranial pressure (ICP) monitoring in patients with mTBI and the effects of ICP on patients’ outcomes are uncertain. The purpose [...] Read more.
Objective: With a mortality rate of 10–30%, a moderate traumatic brain injury (mTBI) is one of the most variable traumas. The indications for intracranial pressure (ICP) monitoring in patients with mTBI and the effects of ICP on patients’ outcomes are uncertain. The purpose of this study was to examine the indications of ICP monitoring (ICPm) and its effects on the long-term functional outcomes of mTBI patients. Methods: Patients with Glasgow Coma Scale (GCS) scores of 9–11 at Tangdu hospital, between January 2015 and December 2021, were enrolled and treated in this retrospective cohort study. We assessed practice variations in ICP interventions using the therapy intensity level (TIL). Six-month mortality and a Glasgow Outcome Scale Extended (GOS-E) score were the main outcomes. The secondary outcome was neurological deterioration (ND) events. The indication and the estimated impact of ICPm on the functional outcome were investigated by using binary regression analyses. Results: Of the 350 patients, 145 underwent ICP monitoring-assisted management, and the other 205 patients received a standard control based on imaging or clinical examinations. A GCS ≤ 10 (OR 1.751 (95% CI 1.216–3.023), p = 0.003), midline shift (mm) ≥ 2.5 (OR 3.916 (95% CI 2.076–7.386) p < 0.001), and SDH (OR 1.772 (95% CI 1.065–2.949) p = 0.028) were predictors of ICP. Patients who had ICPm (14/145 (9.7%)) had a decreased 6-month mortality rate compared to those who were not monitored (40/205 (19.5%), p = 0.011). ICPm was linked to both improved neurological outcomes at 6 months (OR 0.815 (95% CI 0.712–0.933), p = 0.003) and a lower ND rate (2 = 11.375, p = 0.010). A higher mean ICP (17.32 ± 3.52, t = −6.047, p < 0.001) and a more significant number of ICP > 15 mmHg (27 (9–45.5), Z = −5.406, p < 0.001) or ICP > 20 mmHg (5 (0–23), Z = −4.635, p < 0.001) 72 h after injury were associated with unfavorable outcomes. The best unfavorable GOS-E cutoff value of different ICP characteristics showed that the mean ICP was >15.8 mmHg (AUC 0.698; 95% CI, 0.606–0.789, p < 0.001), the number of ICP > 15 mmHg was >25.5 (AUC 0.681; 95% CI, 0.587–0.774, p < 0.001), and the number of ICP > 20 mmHg was >6 (AUC 0.660; 95% CI, 0.561–0.759, p < 0.001). The total TIL score during the first 72 h post-injury in the non-ICP group (9 (8, 11)) was lower than that of the ICP group (13 (9, 17), Z = −8.388, p < 0.001), and was associated with unfavorable outcomes. Conclusion: ICPm-assisted management was associated with better clinical outcomes six months after discharge and lower incidences of ND for seven days post-injury. A mean ICP > 15.8 mmHg, the number of ICP > 15 mmHg > 25.5, or the number of ICP > 20 mmHg > 6 implicate an unfavorable long-term prognosis after 72 h of an mTBI. Full article
(This article belongs to the Topic Advances in Neurocritical Care)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Retrospective analysis on long-time external drainage through ventricular abdominal subcutaneous tunnel in treatment of infectious hydrocephalus
Authors: PAN Dong-chao; LIU Dong-sheng; FU Ji-di
Affiliation: Department of Neurosurgery, Plastic Surgery Hospital(Institute),CAMS,PUMC,Beijing 100012,China
Abstract: Objective: To explore the advantages and disadvantages of lateral ventricular abdominal-wall subcutaneous tunnel drainage in the treatment of infectious hydrocephalus. Methods: 384 patients with hydrocephalus secondary to intracranial infection were included. After ventricular and lumbar cistern external drainage and routine anti infection treatment,ventricular abdominal wall external drainage was performed when the bacterial culture in cerebrospinal fluid was negative three times in two weeks as a transitional treatment before shunting.After waiting for the physical and chemical indexes of cerebrospinal fluid to return to normal,the indexes of cerebrospinal luid were still stable after drug withdrawal for more than 2 weeks,and ventriculoperitoneal shunt was performed.The advantages and existing problems of this treatment in reducing the shunt failure rate were explored. Results Of 384 patients,244(63.54%) were positive for bacteria in cerebrospinal fluid. For all 384 cases,lateral ventricular abdominal-wall subcutaneous tunnel drainage were performed,including 37 of isolated ventricle,7 of infection during drainage(4 were cured) and 6 died(3 of infection,1 of hypertensive cerebral hemorrhage,1 of giving up,1 of brain stem failure). Finally,for 378 of the 384 cases,ventriculoperitoneal shunt were performed. The shortest drainage time was 14 days and the longest was 387 days,with an average of 95.7 days. One-year follow-up showed that 369 cases(97.62%) were successful,9 failed(5 of infection after shunt, 4 of shunt simple mechanical blockage),and the failure rate was 2.38%. Of the 9 failed cases,6 died(2of infection, 1 died of epilepsy 4 months after discharge, 1 died of unknown cause 7 months after discharge,1 died of hypertensive cerebral hemorrhage,1 died of shunt blockage). Compared with traditional short-term extracorporeal drainage(median 13 days),long-lerm extracorporeal drainage( median 69 days) had definite help in improving the cure rate of intracranial infection and infectious hydrocephalus. Conclusion: Lateral ventricular abdominal-wall subcutaneous tunnel drainage can effectively reduce the failure rate of infectious hydrocephalus shunt. Key words: infectious hydrocephalus; ventriculitis; ventricular peritoneal drainage; ventriculoperitoneal shunt

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