Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient.

Rationale: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI).

Objectives: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI.

Design: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress.

Elevated Cerebrospinal Fluid Protein Is Associated with Unfavorable Functional Outcome in Spontaneous Subarachnoid Hemorrhage.

Background/objective: Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. We sought to determine if CSF protein level is associated with functional outcome after SAH.

Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage.

Background: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH.

Medication History versus Point-of-Care Platelet Activity Testing in Patients with Intracerebral Hemorrhage.

Objective: We evaluated whether reduced platelet activity detected by point-of-care (POC) testing is a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure.

Methods: Patients presenting with spontaneous ICH were enrolled in a prospective observational cohort study that collected demographic, clinical, laboratory, and radiographic data. We measured platelet activity using the PFA-100 (Siemens AG, Germany) and VerifyNow-ASA (Accumetrics, CA) systems on admission.

Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage.

Objective: We tested the hypothesis that admission serum magnesium levels are associated with hematoma volume, hematoma growth, and functional outcomes in patients with intracerebral hemorrhage (ICH).

Methods: Patients presenting with spontaneous ICH were enrolled in an observational cohort study that prospectively collected demographic, clinical, laboratory, radiographic, and outcome data. We performed univariate and adjusted multivariate analyses to assess for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, and in-hospital hematoma growth as radiographic measures of hemostasis, and functional outcome measured by the modified Rankin Scale (mRS) at 3 months.

A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing".

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.

Treatment of malignant brain edema and increased intracranial pressure after stroke.

The management of patients with large territory ischemic strokes and the subsequent development of malignant brain edema and increased intracranial pressure is a significant challenge in modern neurology and neurocritical care. These patients are at high risk of subsequent neurologic decline and are best cared for in an intensive care unit or a comprehensive stroke center with access to neurosurgical support. Risks include hemorrhagic conversion, herniation, poor functional outcome, and death.

Neurotoxicity of commonly used hepatic drugs.

Neurologic complications are common side-effects of immunosuppressive medications used in the prevention of graft rejection after organ transplantation. The medications most commonly encountered include the calcineurin inhibitors and mycophenolate mofetil. Depression is the most commonly encountered neurotoxicity; however, severe but rare adverse neurological effects related to these therapies have been reported.

Ventilatory management and extubation criteria of the neurological/neurosurgical patient.

Approximately 200 000 patients per year will require mechanical ventilation secondary to neurological injury or disease. The associated mortality, morbidity, and costs are significant. The neurological patient presents a unique set of challenges to airway management, mechanical ventilation, and defining extubation readiness.

Intracerebral hemorrhage: new challenges and steps forward.

Intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality. With the aging population, increased use of anticoagulants, and changing racial and ethnic landscape of the United States, the incidence of ICH will increase over the next decade. Improvements in preventative strategies to treat hypertension and atrial fibrillation are necessary to change the trajectory of this increase.

Update on intracerebral hemorrhage.

Purpose Of Review: This article provides an update on the latest diagnostic and therapeutic trials relating to the management of intracerebral hemorrhage (ICH).

Recent Findings: Early hematoma expansion and worsening cerebral edema may account for delayed neurologic deterioration after ICH.

Summary: Despite advances in other areas of stroke, there has been no significant improvement in the morbidity and mortality after ICH.

Evolution of a multidisciplinary cerebrovascular center: lessons learned.

The Cerebrovascular Center at the Cleveland Clinic is an integrated, multidisciplinary center comprising vascular neurologists, neurointensivists, physiatrists, open and endovascular neurosurgeons, interventional neurologists and interventional neuroradiologists administered through a single financial center with unified governance and leadership. This report describes the history and evolution of the center from conceptualization to the present, as well as outlining lessons learned in the formation and maturation of the group.

Status epilepticus: current treatment strategies.

Status epilepticus is a neurological emergency that is commonly encountered by the neurohospitalist. Successful treatment depends upon the recognition of prolonged seizure activity and the acute mobilization of available resources. Pharmacologic treatment regimens have been shown to decrease the time needed for successful control of seizures and have provided for the rapid administration of anticonvulsant medications.

Predictors of neurologic outcome in hypothermia after cardiac arrest.

Objective: To evaluate the predictive value of neurologic prognostic indicators for patients treated with hypothermia after surviving cardiopulmonary arrest.

Methods: Patients who survived cardiopulmonary arrest were prospectively collected from June 2006 to October 2009. Detailed neurologic examinations were performed.

Prediction of angiographic vasospasm after aneurysmal subarachnoid hemorrhage: value of the Hijdra sum scoring system.

Background: Vasospasm is a major complication of aneurysmal subarachnoid hemorrhage (SAH) and affects clinical outcome. The ability to predict cerebral vasospasm after SAH would allow the neuro-intensivist to institute preemptive and more aggressive therapy.

Methods: Social, clinical, and radiological information on adult SAH patients recently admitted to our hospital were reviewed.

Timing of computed tomography and prediction of vasospasm after aneurysmal subarachnoid hemorrhage.

Background: The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time interval during which this study needs to be completed.

Methods: Clinical and radiological information on adult SAH patients were reviewed.

Primary intracerebral hemorrhage: update on epidemiology, pathophysiology, and treatment strategies.

Intracerebral hemorrhage (ICH) is a common and devastating condition. Its incidence is expected to increase as the population ages, and its epidemiology is changing. Advances in understanding the pathogenesis of ICH have recently been made.

Thunderclap headache and normal computed tomographic results: value of cerebrospinal fluid analysis.

Objective: To determine the sensitivity, specificity, and negative and positive predictive values of cerebrospinal fluid (CSF) xanthochromia for detection of ruptured cerebral aneurysms in patients with thunderclap headache (sudden and severe headache with maximal intensity at onset).

Patients And Methods: We identified patients who presented to our emergency department with symptoms of thunderclap headache between January 1, 1998, and January 1, 2008. Those with normal results on computed tomography (CT) of the head were selected for inclusion in the study.

A prospective trial of elective extubation in brain injured patients meeting extubation criteria for ventilatory support: a feasibility study.

Introduction: To assess the safety and feasibility of recruiting mechanically ventilated patients with brain injury who are solely intubated for airway protection and randomising them into early or delayed extubation, and to obtain estimates to refine sample-size calculations for a larger study. The design is a single-blinded block randomised controlled trial. A single large academic medical centre is the setting.

Pronouncing brain death: Contemporary practice and safety of the apnea test.

Background: Little is known of hospital practice in brain death determination, specialty involvement, and followed procedures, including the apnea test.

Methods: We reviewed 228 patients pronounced brain dead at Mayo Clinic from 1996 to 2007. We performed a detailed review of clinical determination of brain death, intensive care support, apnea test procedure, and complications.

Predictors of outcome in warfarin-related intracerebral hemorrhage.

Background: Intracerebral hemorrhage (ICH) associated with warfarin sodium therapy is becoming more common as the use of this medication increases in the aging population.

Objective: To delineate factors associated with early mortality, determine variables responsible for poor functional outcome, and evaluate possible reasons for expansion of hemorrhage and associated parenchymal edema.

Design: Retrospective study of clinical and radiologic information for 88 patients with warfarin-associated ICH.