Complex auditory regularity processing across levels of consciousness in coma: Stage 1 Registered Report.

A key question for the scientific study of consciousness is whether it is possible to identify specific features in brain activity that are uniquely linked to conscious experience. This question has important implications for the development of markers to detect covert consciousness in unresponsive patients. In this regard, many studies have focused on investigating the neural response to complex auditory regularities.

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.

Role of EEG spindle-like activity in post cardiac arrest prognostication.

Aim: EEG is considered in guidelines for poor outcome prognostication in comatose patients after cardiac arrest (CA), but elements related to favorable prognosis have also been increasingly described. While spindle EEG activity is known to herald good outcome in critically ill patients, its occurrence in CA has received limited attention, essentially in pediatric cohorts. We postulated that this feature is related to favorable outcome in adults.

LLL 44-1 Micronutrients in clinical nutrition: Trace elements.

Background: Trace elements are an essential component of metabolism and medical nutrition therapy, with key roles in metabolic pathways, antioxidation, and immunity, which the present course aims at summarizing.

Results: Medical nutrition therapy includes the provision of all essential trace elements. The clinical essential issues are summarized for Copper, Iron, Selenium, Zinc, Iodine, Chromium, Molybdenum, and Manganese: the optimal analytical techniques are presented.

Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study.

Purpose: Intrathecal vasoactive drugs have been proposed in patients with aneurysmal subarachnoid hemorrhage (aSAH) to manage cerebral vasospasm (CV). We analyzed the efficacy of intracisternal nicardipine compared to intraventricular administration to a control group (CG) to determine its impact on delayed cerebral ischemia (DCI) and functional outcomes. Secondary outcomes included the need for intra-arterial angioplasties and the safety profile.

Outcome of comatose patients following cardiac arrest: When mRS completes CPC.

Aim: Good outcome in patients following cardiac arrest (CA) is usually defined as Cerebral Performance Category (CPC) 1-2, while CPC 3 is debated, and CPC 4-5 represent poor outcome. We aimed to assess when the modified Rankin Scale (mRS) can improve CPC outcome description, especially in CPC 3. We further aimed to correlate neuron specific enolase (NSE) with both functional measures to explore their relationship with neuronal damage.

Nociception assessment with videopupillometry in deeply sedated intensive care patients: Discriminative and criterion validations.

Background: Nociceptive assessment in deeply sedated patients is challenging. Validated instruments are lacking for this unresponsive population. Videopupillometry is a promising tool but has not been established in intensive care settings.

The Neurological Pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study.

Background: Improving the prognostication of acute brain injury is a key element of critical care. Standard assessment includes pupillary light reactivity testing with a hand-held light source, but findings are interpreted subjectively; automated pupillometry might be more precise and reproducible. We aimed to assess the association of the Neurological Pupil index (NPi)-a quantitative measure of pupillary reactivity computed by automated pupillometry-with outcomes of patients with severe non-anoxic acute brain injury.

Relationship between serum neuron-specific enolase and EEG after cardiac arrest: A reappraisal.

Objective: Electroencephalogram (EEG) and serum neuron specific enolase (NSE) are frequently used prognosticators after cardiac arrest (CA). This study explored the association between NSE and EEG, considering the role of EEG timing, its background continuity, reactivity, occurrence of epileptiform discharges, and pre-defined malignancy degree.

Methods: Retrospective analysis including 445 consecutive adults from a prospective registry, surviving the first 24 hours after CA and undergoing multimodal evaluation.

Multimodal Prediction of Favorable Outcome After Cardiac Arrest: A Cohort Study.

Objectives: Prognostic guidelines after cardiac arrest (CA) focus on unfavorable outcome prediction; favorable outcome prognostication received less attention. Our aim was to identify favorable outcome predictors and combine them into a multimodal model.

Design: Retrospective analysis of prospectively collected data (January 2016 to June 2021).

Benign EEG for prognostication of favorable outcome after cardiac arrest: A reappraisal.

Aim: The current EEG role for prognostication after cardiac arrest (CA) essentially aims at reliably identifying patients with poor prognosis ("highly malignant" patterns, defined by Westhall et al. in 2014). Conversely, "benign EEGs", defined by the absence of elements of "highly malignant" and "malignant" categories, has limited sensitivity in detecting good prognosis.

Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care.

Vasoplegic syndrome (VS) is a common complication following cardiovascular surgery with cardiopulmonary bypass (CPB), and its incidence varies from 5 to 44%. It is defined as a distributive form of shock due to a significant drop in vascular resistance after CPB. Risk factors of VS include heart failure with low ejection fraction, renal failure, pre-operative use of angiotensin-converting enzyme inhibitors, prolonged aortic cross-clamp and left ventricular assist device surgery.

Continuous versus routine EEG in patients after cardiac arrest: Analysis of a randomized controlled trial (CERTA).

Background: Electroencephalography (EEG) is essential to assess prognosis in patients after cardiac arrest (CA). Use of continuous EEG (cEEG) is increasing in critically-ill patients, but it is more resource-consuming than routine EEG (rEEG). Observational studies did not show a major impact of cEEG versus rEEG on outcome, but randomized studies are lacking.

Venoarterial Extracorporeal Membrane Oxygenation in High-Risk Pulmonary Embolism: A Case Series and Literature Review.

Background: High-risk Pulmonary Embolism (PE) has an ominous prognosis and requires emergent reperfusion therapy, primarily systemic thrombolysis (ST). In deteriorating patients or with contraindications to ST, Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) may be life-saving, as supported by several retrospective studies. However, due to the heterogeneous clinical presentation (refractory shock, resuscitated cardiac arrest (CA) or refractory CA), the real impact of VA-ECMO in high-risk PE remains to be fully determined.

Neuroprognostication Under ECMO After Cardiac Arrest: Are Classical Tools Still Performant?

Background: According to international guidelines, neuroprognostication in comatose patients after cardiac arrest (CA) is performed using a multimodal approach. However, patients undergoing extracorporeal membrane oxygenation (ECMO) may have longer pharmacological sedation and show alteration in biological markers, potentially challenging prognostication. Here, we aimed to assess whether routinely used predictors of poor neurological outcome also exert an acceptable performance in patients undergoing ECMO after CA.

Hypertonic lactate for the treatment of intracranial hypertension in patients with acute brain injury.

Hypertonic lactate (HL) is emerging as alternative treatment of intracranial hypertension following acute brain injury (ABI), but comparative studies are limited. Here, we examined the effectiveness of HL on main cerebral and systemic physiologic variables, and further compared it to that of standard hypertonic saline (HS). Retrospective cohort analysis of ABI subjects who received sequential osmotherapy with 7.

[Transforming operating rooms into an intensive care unit to manage the COVID-19 outbreak].

This article is a descriptive analysis of the organizational steps undertaken to transform eight OR (operating rooms) of the University Hospital Lausanne CHUV into a dedicated ICU (intensive care unit) during the COVID-19 pandemic. An efficient response of our institution was mandatory to timely increase the number of ICU beds. The transformation of an entire floor of a functioning operating ward was deemed the most appropriate solution to provide rapidly a significant number of beds.

[How to reduce the risk of orotracheal intubation in intensive care medicine?].

Intubation is a frequent procedure in the intensive care unit, often performed in an emergency. Because of patients' clinical condition with little physiological reserve, intubation in the critically ill patients is associated with increased risk of complications. A systematic patient's assessment and a codified and rigorous preparation of the team and equipment significantly reduce the risks of intubation.

Acute kidney injury after brain injury: does it exist?

Acute kidney injury (AKI) is frequent after cerebral insults, with an incidence close to 10% in both traumatic brain injury (TBI) and cerebrovascular disease. AKI in this context has substantial impact on mortality and neurological outcome. Numerous factors may play a role in the development of AKI after brain injury: intravascular volume depletion, raised-intra-abdominal pressure, rhabdomyolysis or sepsis in TBI; age, ischemic heart disease or arteriosclerotic disease in stroke.

Trace element and vitamin deficiency: quantum medicine or essential prescription?

Purpose Of Review: In critical care, micronutrients remain perceived as 'quantum' part, that is, a little pertinent component of therapy. Some micronutrients have attracted more attention because of their antioxidant properties. During the last decade, some large size trials have tested their therapeutic potential, generally as 'single high-dose micronutrient intervention', with variable success.

[Vasopressin in the critically ill patient].

Vasopressin (AVP) is a posterior pituitary hormone initially known for its antidiuretic actions. In this article, we recall the biochemical and pharmacological characteristics of the AVP and its analogues. Currently, its main indication in critical care medicine is vasoplegic shock in view of its vasopressive properties.

Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients.

Background: Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown.

Methods: This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h.

Neurological Pupil index for Early Prognostication After Venoarterial Extracorporeal Membrane Oxygenation.

Background: Venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO) after refractory cardiogenic shock or cardiac arrest has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuroprognostication are limited. We examined the prognostic value of clinical neurologic examination, using an automated device for the quantitative measurement of pupillary light reactivity.