Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus.

Background: Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.

Methods: An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024.

Defining Death: Toward a Biological and Ethical Synthesis.

Much of the debate over the definition and criteria for determining our death has focused on disagreement over the correct biological account of death, i.e., what it means for any organism to die.

Brain death: Controversies and reappraisals.

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Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series.

There is limited evidence of N-butyl cyanoacrylate (n-BCA) use in endovascular embolization of traumatic face and neck vessel injuries. We investigated the safety and effectiveness of n-BCA for this purpose. We retrospectively analyzed consecutive patients presenting to a Level 1 trauma center between April 2021 and July 2022.

Evaluation and Management of Disorders of Consciousness in the Acute Care Setting.

Acute disorders of consciousness (DOC) are impairments in arousal and awareness that occur within 28 days of an initial injury and can result from a variety of insults. These states range from coma, unresponsive wakefulness, covert consciousness, minimal consciousness, to confusional state. It is important to perform thorough, serial examinations with particular emphasis on the level of consciousness, brainstem reflexes, and motor responses.

Conceptualizing Consciousness: a Change in Perspective: The Elephant Still Surprises Those only Touching Its Trunk.

Providers of patients with disorders of consciousness (DoC) face clinical and ethical challenges that could be lessened by becoming acquainted with the subjective and objective aspects of consciousness. A first step to improving DoC taxonomies, management, and outcomes might be to recognize the shortcomings of the medical concept of consciousness and to improve the terminology used for the clinical parameters assessed. The authors critically review the medical perspective of consciousness represented by three sub-concepts that do not necessarily correlate with one another and discuss how none of them reflects fully the personal subjective nature of consciousness.

Comparative Effectiveness of Early Neurosurgical Intervention in Civilian Penetrating Brain Injury Management.

Background And Objectives: To compare the outcomes of early vs no-neurosurgical intervention in civilians with penetrating brain injury (PBI).

Methods: We collected data from the National Trauma Data Bank for PBI between 2017 and 2019. A total of 10 607 cases were identified; 1276 cases met the following criteria: age 16-60 years, an intensive care unit (ICU) length of stay (LOS) of >2 days, a Glasgow Coma Scale of 3-12, and at least one reactive pupil on presentation.

Curriculum Innovations: A Social Media-Based Educational Curriculum Improves Knowledge for Trainees in Neurocritical Care: Results of a Stratified Randomized Study.

Introduction And Problem Statement: The Neurocritical Care (NCC) Society Resident and Fellow Task Force's NEURON study concluded that learners had significant concerns regarding the need for educational improvement in NCC. To address these shortcomings, we identified the lack of an educational curriculum for trainees in NCC and developed a Twitter-based educational curriculum for trainees to improve knowledge in NCC.

Objectives: The objectives of this study were to describe the pathophysiology, delineate a systematic diagnostic approach, and apply evidence-based strategies in the management of diseases in NCC.

Management Strategies Based on Multi-Modality Neuromonitoring in Severe Traumatic Brain Injury.

Secondary brain injury after neurotrauma is comprised of a host of distinct, potentially concurrent and interacting mechanisms that may exacerbate primary brain insult. Multimodality neuromonitoring is a method of measuring multiple aspects of the brain in order to understand the signatures of these different pathomechanisms and to detect, treat, or prevent potentially reversible secondary brain injuries. The most studied invasive parameters include intracranial pressure (ICP), cerebral perfusion pressure (CPP), autoregulatory indices, brain tissue partial oxygen tension, and tissue energy and metabolism measures such as the lactate pyruvate ratio.

Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management.

Importance: Civilian penetrating brain injury (PBI) is associated with high mortality. However, scant literature is available to guide neurocritical care monitoring and management of PBI.

Objective: To examine the association of intracranial pressure (ICP) monitoring with mortality, intensive care unit (ICU) length of stay (LOS), and dispositional outcomes in patients with severe PBI.

Coding the Dead: Cardiopulmonary Resuscitation for Organ Preservation.

Background: There is lack of consensus in the bioethics literature regarding the use of cardiopulmonary resuscitation (CPR) for organ-preserving purposes. In this study, we assessed the perspectives of clinicians in critical care settings to better inform donor management policy and practice.

Methods: An online anonymous survey of members of the Society of Critical Care Medicine that presented various scenarios about CPR for organ preservation.

Avoiding brain hypoxia in severe traumatic brain injury in settings with limited resources - A pathophysiological guide.

Cerebral oxygenation represents the balance between oxygen delivery, consumption and utilization by the brain, and therefore reflects the adequacy of cerebral perfusion. Different factors can influence the amount of oxygen to the brain including arterial blood pressure, hemoglobin levels, systemic oxygenation, and transfer of oxygen from blood to the cerebral microcirculation. A mismatch between cerebral oxygen supply and demand results in cerebral hypoxia/ischemia, and is associated with secondary brain damage and worsened outcome after acute brain injury.

Managing Severe Traumatic Brain Injury Across Resource Settings: Latin American Perspectives.

Severe traumatic brain injury (sTBI) is a condition of increasing epidemiologic concern worldwide. Outcomes are worse as observed in low- and middle-income countries (LMICs) versus high-income countries. Global targets are in place to address the surgical burden of disease.

Prediction of Intracranial Hypertension and Brain Tissue Hypoxia Utilizing High-Resolution Data from the BOOST-II Clinical Trial.

The current approach to intracranial hypertension and brain tissue hypoxia is reactive, based on fixed thresholds. We used statistical machine learning on high-frequency intracranial pressure (ICP) and partial brain tissue oxygen tension (PbtO) data obtained from the BOOST-II trial with the goal of constructing robust quantitative models to predict ICP/PbtO crises. We derived the following machine learning models: logistic regression (LR), elastic net, and random forest.