Intracranial Hypertension with Patent Basal Cisterns: Controlled Lumbar Drainage as a Therapeutic Option. Selected Case Series.

Background: There are pathological conditions in which intracranial hypertension and patent basal cisterns in computed tomography coexist. These situations are not well recognized, which could lead to diagnostic errors and improper management.

Methods: We present a retrospective case series of patients with traumatic brain injury, subarachnoid hemorrhage, and cryptococcal meningitis who were treated at our intensive care unit.

Ultrasonographic measurement of the optic nerve sheath diameter to detect intracranial hypertension: an observational study.

Objectives: To evaluate the ultrasonographic measurement of optic nerve sheath diameter (ONSD) as a predictor of intracranial hypertension as compared to the invasive measurement of intracranial pressure (ICP).

Design: Cross-sectional observational study.

Setting: Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay.

Individual variation of tentorial notch morphometry in a series of neurocritical patients.

Background: Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients.

Objectives: 1) To investigate the morphometric characteristics of the tentorial notch in neurocritical patients using computed tomography (CT); 2) To investigate the correlation between tentorial notch measurements by CT and by magnetic resonance imaging (MRI); and 3) To analyze the individual variability of the tentorial notch anatomy seen in neurocritical patients.

Effect of half-molar sodium lactate infusion on biochemical parameters in critically ill patients.

Objective: To evaluate the impact of the infusion of sodium lactate 500ml upon different biochemical variables and intracranial pressure in patients admitted to the intensive care unit.

Design: A prospective experimental single cohort study was carried out.

Scope: Polyvalent intensive care unit of a university hospital.

Transcranial Doppler Plateau Wave in a Patient with Pseudo-Chiari Malformation.

A 26-year-old woman presented a superior sagittal and transverse sinus thrombosis with venous infarction. Anticoagulation was started. Six months later headache and visual impairment developed, and intracranial hypertension was diagnosed-secondary pseudotumor cerebri.

Impacts of a Pressure Challenge on Cerebral Critical Closing Pressure and Effective Cerebral Perfusion Pressure in Patients with Traumatic Brain Injury.

Introduction: Cerebral critical closing pressure (CrCP) comprises intracranial pressure (ICP) and arteriolar wall tension (WT). It is the arterial blood pressure (ABP) at which small vessels close and circulation stops. We hypothesized that the increase in WT secondary to a systemic hypertensive challenge would lead to an increase in CrCP and that the "effective" cerebral perfusion pressure (CPPeff; calculated as ABP - CrCP) would give more complete information than the "conventional" cerebral perfusion pressure (CPP; calculated as ABP - ICP).

Comparison of ultrasonographic versus infrared pupillary assessment.

Objectives: To evaluate the correlation between ultrasonographic and infrared pupillary assessments in critically ill patients, including neurocritically ill patients.

Design: Prospective, observational study.

Setting: Tertiary teaching hospital intensive care unit (ICU) in Montevideo, Uruguay.

TH17/Treg imbalance and IL-17A increase after severe aneurysmal subarachnoid hemorrhage.

To evaluate cerebrospinal fluid (CSF) and peripheral blood (PB) Treg, TH17 cells, TH1, TH2 and related cytokines in the acute phase of aSAH we assessed TH17, TH1, TH2, T regulatory cells and neutrophils in 39 aneurysmal subarachnoid hemorrhage (aSAH) patients and 56 controls. PB TH17 cells and TH17/Treg ratio were higher in CSF and PB of aSAH patients. Serum and CSF IL-17A levels were increased in aSAH.

Diagnosis of ventriculostomy-related infection: Is cerebrospinal fluid lactate measurement a useful tool?

Objective: To evaluate the value of CSF lactate (L) for the diagnosis of ventriculostomy related infections (VRI), and compare it with other CSF markers.

Methods: Prospective study of neurocritical patients admitted to Maciel Hospital and Clinicas Hospital ICUs in which an external ventricular drain (EVD) was inserted. In patients with clinical suspicion of VRI, a CSF sample was obtained through the EVD for CSF culture and markers analysis (glucose, protein, lactate and leukocytes).

Cerebral Critical Closing Pressure: Is the Multiparameter Model Better Suited to Estimate Physiology of Cerebral Hemodynamics?

Background: Cerebral critical closing pressure (CrCP) is the level of arterial blood pressure (ABP) at which small brain vessels close and blood flow stops. This value is always greater than intracranial pressure (ICP). The difference between CrCP and ICP is explained by the tone of the small cerebral vessels (wall tension).

[Half-molar sodium-lactate: The osmotic agent we are looking for?].

Intracranial hypertension (ICH) is the most important modifiable factor with predictive negative value in brain injury patients. Osmotherapy is the most important first level specific measure in the treatment of ICH. Mannitol 20%, and 3, 7.

Immune cells subpopulations in cerebrospinal fluid and peripheral blood of patients with Aneurysmal Subarachnoid Hemorrhage.

Background: There is growing evidence supporting the role of inflammation in aneurysmal subarachnoid hemorrhage (aSAH) pathophysiology and it is of great interest to elucidate which immune mechanisms are involved.

Methods: 12 aSAH patients and 28 healthy controls were enrolled prospectively. We assessed leukocytes subpopulations and their activation status by flow cytometry in cerebrospinal fluid (CSF) and peripheral blood (PB) of SAH patients at the same time and in PB of controls.

Hyponatremia in the neurocritical care patient: An approach based on current evidence.

In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution.

Effects of indomethacin test on intracranial pressure and cerebral hemodynamics in patients with refractory intracranial hypertension: a feasibility study.

Background: Intracranial hypertension is the final pathway of many neurocritical entities, such as spontaneous intracerebral hemorrhage (sICH) and severe traumatic brain injury (sTBI).

Objective: This study aimed to (1) determine alterations in intracranial pressure (ICP) and cerebral hemodynamics after an indomethacin (INDO) infusion test and the related association with survival in patients with refractory intracranial hypertension (RICH) secondary to sICH or sTBI and (2) assess the safety profile after INDO.

Methods: INDO was administered in a loading dose (0.

Bedside study of cerebral critical closing pressure in patients with severe traumatic brain injury: a transcranial Doppler study.

Objective: Cerebral critical closing pressure (CrCP) is the arterial pressure (AP) below which small arterial cerebral vessels collapse. Our objective was to estimate cerebral CrCP in 12 severe TBI patients, relating transcranial Doppler flow velocity (FV) and AP data.

Methods: FV, intracranial pressure (ICP) and invasive AP were prospectively acquired at 50 Hz.

Perioperative glucose control in neurosurgical patients.

Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery.

ABDOPRE: an external device for the reduction of intra-abdominal pressure.

This article describes a device for the reduction of intra-abdominal pressure. The device (ABDOPRE) includes a unique external servo-control mechanism, based on urinary bladder pressure measurement. The results of ABDOPRE use in the first four intra-abdominal hypertension patients are reported; the device resulted in a reduction of intra-abdominal pressure between 16% and 35% in 3 cases and in a paradoxical increase of the intra-abdominal pressure in an obese woman, likely due to inappropriate chamber size for the patient's anatomy.

High-dose selenium reduces ventilator-associated pneumonia and illness severity in critically ill patients with systemic inflammation.

Purpose: To confirm the pharmacodynamics and evaluate the efficacy of high-dose selenium (Se) administered by continuous infusion, following an initial loading bolus of selenite, on clinical outcome in critically ill patients with systemic inflammatory response syndrome (SIRS).

Methods: Prospective, placebo-controlled, randomized, single-blinded phase II study in a multidisciplinary university hospital intensive care unit (ICU). Two groups of patients with SIRS, age >18 years, and Acute Physiology and Chronic Health Evaluation (APACHE) II ≥15 (n = 35) were randomized to receive either placebo or intravenous selenite as a bolus-loading dose of 2,000 μg Se followed by continuous infusion of 1,600 μg Se per day for 10 days.

Development of a multimodal monitoring platform for medical research.

A low cost multimodal monitoring and signal processing platform is presented. A modular and flexible system was developed, aimed to continuous acquisition of several biological variables at patient bed-head and further processing with application specific algorithms. System hardware is made of a six-channel isolation and signal conditioning front-end along with a high resolution analog-to-digital converter board connected to a standard laptop.

High-dose selenium for critically ill patients with systemic inflammation: pharmacokinetics and pharmacodynamics of selenious acid: a pilot study.

Objective: Systemic inflammatory response syndrome is characterized by increased urinary excretion of selenium and low serum concentration. Repletion by parenteral selenite is the most efficacious form of supplementation. However, the optimum safe dose and mode of administration remain controversial.

Serum selenium and glutathione peroxidase-3 activity: biomarkers of systemic inflammation in the critically ill?

Objectives: To confirm the influence of systemic inflammatory response syndrome (SIRS) on selenium (Se) levels and prospectively evaluate the relationship between serum Se concentration [Se], glutathione peroxidase activity [GPx-3] and injury severity in patients at the time of intensive care unit (ICU) admission.

Design: Prospective, observational study.

Setting: Multidisciplinary University Hospital ICU.

Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool).

Objectives: To evaluate the feasibility, safety and effectiveness of a new method of intravascular temperature management for inducing moderate hypothermia (MHT).

Design And Settings: Prospective, international-multicenter clinical trial conducted in four university hospitals.

Patients: In a 2-year period 24 patients with severe head injury and refractory high ICP were treated with MHT (32.