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1. Effect of frailty on 6-month outcome after traumatic brain injury: a multicentre cohort study with external validation

Author: Galimberti, S, Graziano, F, Maas, A, Isernia, G, Lecky, F, Jain, S, Sun, X, Gardner, R, Taylor, S, Markowitz, A, Manley, G, Valsecchi, M, Bellelli, G, Citerio, G, Ackerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo Lozano, G, Carbonara, M, Castano-Leon, A, Cavallo, S, Chevallard, G, Chieregato, A, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, De Keyser, V, Degos, V, Della Corte, F, den Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maegele, M, Majdan, M, Manara, A, Marechal, H, Martino, C, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Oresic, M, Ortolano, F, Otesile, O, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rehorcikova, V, Retel Helmrich, I, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Singh, R, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Te Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Valeinis, E, Vallance, S, Vamos, Z, van der Jagt, M, van der Naalt, J, Van der Steen, G, van Dijck, J, van Erp, I, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, van Wijk, R, Vande Vyvere, T, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wilson, L, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Ziverte, A, Zoerle, T, Adeoye, O, Badjatia, N, Barber, J, Bergin, M, Boase, K, Bodien, Y, Chesnut, R, Corrigan, J, Crawford, K, Diaz-Arrastia, R, Dikmen, S, Duhaime, A, Ellenbogen, R, Feeser, V, Ferguson, A, Foreman, B, Gaudette, E, Giacino, J, Gonzalez, L, Gopinath, S, Grandhi, R, Gullapalli, R, Hemphill, C, Hotz, G, Huie, R, Jha, R, Keene, C, Kitagawa, R, Korley, F, Kramer, J, Kreitzer, N, Levin, H, Lindsell, C, Machamer, J, Madden, C, Martin, A, Mcallister, T, Mccrea, M, Merchant, R, Mukherjee, P, Nelson, L, Ngwenya, L, Noel, F, Nolan, A, Okonkwo, D, Palacios, E, Perl, D, Puccio, A, Rabinowitz, M, Robertson, C, Rodgers, R, Rosand, J, Rosenthal, E, Sander, A, Sandsmark, D, Sugar, G, Schneider, A, Schnyer, D, Seabury, S, Sherer, M, Stein, M, Temkin, N, Toga, A, Torres-Espin, A, Valadka, A, Vassar, M, Wang, V, Yue, J, Yuh, E, Zafonte, R, Galimberti S., Graziano F., Maas A. I. R., Isernia G., Lecky F., Jain S., Sun X., Gardner R. C., Taylor S. R., Markowitz A. J., Manley G. T., Valsecchi M. G., Bellelli G., Citerio G., Ackerlund C., Adams H., Amrein K., Andelic N., Andreassen L., Anke A., Antoni A., Audibert G., Azouvi P., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B. -M., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Carbayo Lozano G., Carbonara M., Castano-Leon A. M., Cavallo S., Chevallard G., Chieregato A., Clusmann H., Coburn M. S., Coles J., Cooper J. D., Correia M., Covic A., Curry N., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., Dawes H., De Keyser V., Degos V., Della Corte F., den Boogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P. A., Gratz J., Gravesteijn B., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Haitsma I., Helbok R., Helseth E., Horton L., Huijben J., Hutchinson P. J., Jacobs B., Jankowski S., Jarrett M., Jiang J. -Y., Johnson F., Jones K., Karan M., Kolias A. G., Kompanje E., Kondziella D., Koskinen L. -O., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Ledoux D., Lefering R., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maegele M., Majdan M., Manara A., Marechal H., Martino C., Mattern J., McFadyen C., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Oresic M., Ortolano F., Otesile O., Palotie A., Parizel P. M., Payen J. -F., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Pisica D., Ples H., Polinder S., Pomposo I., Posti J. P., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Rehorcikova V., Retel Helmrich I., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roe C., Roise O., Rosenfeld J., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schafer N., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Singh R. D., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Stevens R., Stewart W., Steyerberg E. W., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Te Ao B., Tenovuo O., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Valeinis E., Vallance S., Vamos Z., van der Jagt M., van der Naalt J., Van der Steen G., van Dijck J. T. J. M., van Erp I. A., van Essen T. A., Van Hecke W., van Heugten C., Van Praag D., van Veen E., van Wijk R., Vande Vyvere T., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K. K. W., Wiegers E., Williams G., Wilson L., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F. A., Ziverte A., Zoerle T., Adeoye O., Badjatia N., Barber J., Bergin M., Boase K., Bodien Y., Chesnut R., Corrigan J., Crawford K., Diaz-Arrastia R., Dikmen S., Duhaime A. -C., Ellenbogen R., Feeser V., Ferguson A. R., Foreman B., Gaudette E., Giacino J., Gonzalez L., Gopinath S., Grandhi R., Gullapalli R., Hemphill C., Hotz G., Huie R., Jha R., Keene C. D., Kitagawa R., Korley F., Kramer J., Kreitzer N., Levin H., Lindsell C., Machamer J., Madden C., Martin A., McAllister T., McCrea M., Merchant R., Mukherjee P., Nelson L., Ngwenya L. B., Noel F., Nolan A., Okonkwo D., Palacios E., Perl D., Puccio A., Rabinowitz M., Robertson C., Rodgers R. B., Rosand J., Rosenthal E., Sander A., Sandsmark D., Sugar G., Schneider A., Schnyer D., Seabury S., Sherer M., Stein M., Temkin N., Toga A., Torres-Espin A., Valadka A., Vassar M., Wang K., Wang V., Yue J. K., Yuh E., Zafonte R., Galimberti, S, Graziano, F, Maas, A, Isernia, G, Lecky, F, Jain, S, Sun, X, Gardner, R, Taylor, S, Markowitz, A, Manley, G, Valsecchi, M, Bellelli, G, Citerio, G, Ackerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo Lozano, G, Carbonara, M, Castano-Leon, A, Cavallo, S, Chevallard, G, Chieregato, A, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, De Keyser, V, Degos, V, Della Corte, F, den Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maegele, M, Majdan, M, Manara, A, Marechal, H, Martino, C, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Oresic, M, Ortolano, F, Otesile, O, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rehorcikova, V, Retel Helmrich, I, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Singh, R, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Te Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Valeinis, E, Vallance, S, Vamos, Z, van der Jagt, M, van der Naalt, J, Van der Steen, G, van Dijck, J, van Erp, I, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, van Wijk, R, Vande Vyvere, T, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wilson, L, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Ziverte, A, Zoerle, T, Adeoye, O, Badjatia, N, Barber, J, Bergin, M, Boase, K, Bodien, Y, Chesnut, R, Corrigan, J, Crawford, K, Diaz-Arrastia, R, Dikmen, S, Duhaime, A, Ellenbogen, R, Feeser, V, Ferguson, A, Foreman, B, Gaudette, E, Giacino, J, Gonzalez, L, Gopinath, S, Grandhi, R, Gullapalli, R, Hemphill, C, Hotz, G, Huie, R, Jha, R, Keene, C, Kitagawa, R, Korley, F, Kramer, J, Kreitzer, N, Levin, H, Lindsell, C, Machamer, J, Madden, C, Martin, A, Mcallister, T, Mccrea, M, Merchant, R, Mukherjee, P, Nelson, L, Ngwenya, L, Noel, F, Nolan, A, Okonkwo, D, Palacios, E, Perl, D, Puccio, A, Rabinowitz, M, Robertson, C, Rodgers, R, Rosand, J, Rosenthal, E, Sander, A, Sandsmark, D, Sugar, G, Schneider, A, Schnyer, D, Seabury, S, Sherer, M, Stein, M, Temkin, N, Toga, A, Torres-Espin, A, Valadka, A, Vassar, M, Wang, V, Yue, J, Yuh, E, Zafonte, R, Galimberti S., Graziano F., Maas A. I. R., Isernia G., Lecky F., Jain S., Sun X., Gardner R. C., Taylor S. R., Markowitz A. J., Manley G. T., Valsecchi M. G., Bellelli G., Citerio G., Ackerlund C., Adams H., Amrein K., Andelic N., Andreassen L., Anke A., Antoni A., Audibert G., Azouvi P., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B. -M., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Carbayo Lozano G., Carbonara M., Castano-Leon A. M., Cavallo S., Chevallard G., Chieregato A., Clusmann H., Coburn M. S., Coles J., Cooper J. D., Correia M., Covic A., Curry N., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., Dawes H., De Keyser V., Degos V., Della Corte F., den Boogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P. A., Gratz J., Gravesteijn B., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Haitsma I., Helbok R., Helseth E., Horton L., Huijben J., Hutchinson P. J., Jacobs B., Jankowski S., Jarrett M., Jiang J. -Y., Johnson F., Jones K., Karan M., Kolias A. G., Kompanje E., Kondziella D., Koskinen L. -O., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Ledoux D., Lefering R., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maegele M., Majdan M., Manara A., Marechal H., Martino C., Mattern J., McFadyen C., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Oresic M., Ortolano F., Otesile O., Palotie A., Parizel P. M., Payen J. -F., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Pisica D., Ples H., Polinder S., Pomposo I., Posti J. P., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Rehorcikova V., Retel Helmrich I., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roe C., Roise O., Rosenfeld J., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schafer N., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Singh R. D., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Stevens R., Stewart W., Steyerberg E. W., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Te Ao B., Tenovuo O., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Valeinis E., Vallance S., Vamos Z., van der Jagt M., van der Naalt J., Van der Steen G., van Dijck J. T. J. M., van Erp I. A., van Essen T. A., Van Hecke W., van Heugten C., Van Praag D., van Veen E., van Wijk R., Vande Vyvere T., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K. K. W., Wiegers E., Williams G., Wilson L., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F. A., Ziverte A., Zoerle T., Adeoye O., Badjatia N., Barber J., Bergin M., Boase K., Bodien Y., Chesnut R., Corrigan J., Crawford K., Diaz-Arrastia R., Dikmen S., Duhaime A. -C., Ellenbogen R., Feeser V., Ferguson A. R., Foreman B., Gaudette E., Giacino J., Gonzalez L., Gopinath S., Grandhi R., Gullapalli R., Hemphill C., Hotz G., Huie R., Jha R., Keene C. D., Kitagawa R., Korley F., Kramer J., Kreitzer N., Levin H., Lindsell C., Machamer J., Madden C., Martin A., McAllister T., McCrea M., Merchant R., Mukherjee P., Nelson L., Ngwenya L. B., Noel F., Nolan A., Okonkwo D., Palacios E., Perl D., Puccio A., Rabinowitz M., Robertson C., Rodgers R. B., Rosand J., Rosenthal E., Sander A., Sandsmark D., Sugar G., Schneider A., Schnyer D., Seabury S., Sherer M., Stein M., Temkin N., Toga A., Torres-Espin A., Valadka A., Vassar M., Wang K., Wang V., Yue J. K., Yuh E., and Zafonte R.
Abstract: Background: Frailty is known to be associated with poorer outcomes in individuals admitted to hospital for medical conditions requiring intensive care. However, little evidence is available for the effect of frailty on patients’ outcomes after traumatic brain injury. Many frailty indices have been validated for clinical practice and show good performance to predict clinical outcomes. However, each is specific to a particular clinical context. We aimed to develop a frailty index to predict 6-month outcomes in patients after a traumatic brain injury. Methods: A cumulative deficit approach was used to create a novel frailty index based on 30 items dealing with disease states, current medications, and laboratory values derived from data available from CENTER-TBI, a prospective, longitudinal observational study of patients with traumatic brain injury presenting within 24 h of injury and admitted to a ward or an intensive care unit at 65 centres in Europe between Dec 19, 2014, and Dec 17, 2017. From the individual cumulative CENTER-TBI frailty index (range 0–30), we obtained a standardised value (range 0–1), with high scores indicating higher levels of frailty. The effect of frailty on 6-month outcome evaluated with the extended Glasgow Outcome Scale (GOSE) was assessed through a proportional odds logistic model adjusted for known outcome predictors. An unfavourable outcome was defined as death or severe disability (GOSE score ≤4). External validation was performed on data from TRACK-TBI, a prospective observational study co-designed with CENTER-TBI, which enrolled patients with traumatic brain injury at 18 level I trauma centres in the USA from Feb 26, 2014, to July 27, 2018. CENTER-TBI is registered with ClinicalTrials.gov, NCT02210221; TRACK-TBI is registered at ClinicalTrials.gov, NCT02119182. Findings: 2993 participants (median age was 51 years [IQR 30–67], 2058 [69%] were men) were included in this analysis. The overall median CENTER-TBI frailty index score was 0·07
Published: 2022

2. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Physiology and Big Data

Author: Beqiri, E, Badjatia, N, Ercole, A, Foreman, B, Hu, P, Hu, X, Larovere, K, Meyfroidt, G, Moberg, D, Robba, C, Rosenthal, E, Smielewski, P, Wainwright, M, Park, S, Citerio, G, Beqiri, Erta, Badjatia, Neeraj, Ercole, Ari, Foreman, Brandon, Hu, Peter, Hu, Xiao, LaRovere, Kerri, Meyfroidt, Geert, Moberg, Dick, Robba, Chiara, Rosenthal, Eric, Smielewski, Peter, Wainwright, Mark S, Park, Soojin, Citerio, Giuseppe, Beqiri, E, Badjatia, N, Ercole, A, Foreman, B, Hu, P, Hu, X, Larovere, K, Meyfroidt, G, Moberg, D, Robba, C, Rosenthal, E, Smielewski, P, Wainwright, M, Park, S, Citerio, G, Beqiri, Erta, Badjatia, Neeraj, Ercole, Ari, Foreman, Brandon, Hu, Peter, Hu, Xiao, LaRovere, Kerri, Meyfroidt, Geert, Moberg, Dick, Robba, Chiara, Rosenthal, Eric, Smielewski, Peter, Wainwright, Mark S, Park, Soojin, and Citerio, Giuseppe
Abstract: Background: The implementation of multimodality monitoring in the clinical management of patients with disorders of consciousness (DoC) results in physiological measurements that can be collected in a continuous and regular fashion or even at waveform resolution. Such data are considered part of the “Big Data” available in intensive care units and are potentially suitable for health care-focused artificial intelligence research. Despite the richness in content of the physiological measurements, and the clinical implications shown by derived metrics based on those measurements, they have been largely neglected from previous attempts in harmonizing data collection and standardizing reporting of results as part of common data elements (CDEs) efforts. CDEs aim to provide a framework for unifying data in clinical research and help in implementing a systematic approach that can facilitate reliable comparison of results from clinical studies in DoC as well in international research collaborations. Methods: To address this need, the Neurocritical Care Society’s Curing Coma Campaign convened a multidisciplinary panel of DoC “Physiology and Big Data” experts to propose CDEs for data collection and reporting in this field. Results: We report the recommendations of this CDE development panel and disseminate CDEs to be used in physiologic and big data studies of patients with DoC. Conclusions: These CDEs will support progress in the field of DoC physiologic and big data and facilitate international collaboration.
Published: 2023

3. Pathological Computed Tomography Features Associated with Adverse Outcomes after Mild Traumatic Brain Injury: A TRACK-TBI Study with External Validation in CENTER-TBI

Author: Yuh, E, Jain, S, Sun, X, Pisica, D, Harris, M, Taylor, S, Markowitz, A, Mukherjee, P, Verheyden, J, Giacino, J, Levin, H, Mccrea, M, Stein, M, Temkin, N, Diaz-Arrastia, R, Robertson, C, Lingsma, H, Okonkwo, D, Maas, A, Manley, G, Adeoye, O, Badjatia, N, Boase, K, Bodien, Y, Corrigan, J, Crawford, K, Dikmen, S, Duhaime, A, Ellenbogen, R, Feeser, V, Ferguson, A, Foreman, B, Gardner, R, Gaudette, E, Gonzalez, L, Gopinath, S, Gullapalli, R, Hemphill, J, Hotz, G, Keene, C, Kramer, J, Kreitzer, N, Lindsell, C, Machamer, J, Madden, C, Martin, A, Mcallister, T, Merchant, R, Nelson, L, Ngwenya, L, Noel, F, Nolan, A, Palacios, E, Perl, D, Rabinowitz, M, Rosand, J, Sander, A, Satris, G, Schnyer, D, Seabury, S, Toga, A, Valadka, A, Vassar, M, Zafonte, R, Citerio, G, Yuh E. L., Jain S., Sun X., Pisica D., Harris M. H., Taylor S. R., Markowitz A. J., Mukherjee P., Verheyden J., Giacino J. T., Levin H. S., McCrea M., Stein M. B., Temkin N. R., Diaz-Arrastia R., Robertson C. S., Lingsma H. F., Okonkwo D. O., Maas A. I. R., Manley G. T., Adeoye O., Badjatia N., Boase K., Bodien Y., Corrigan J. D., Crawford K., Dikmen S., Duhaime A. -C., Ellenbogen R., Feeser V. R., Ferguson A. R., Foreman B., Gardner R., Gaudette E., Gonzalez L., Gopinath S., Gullapalli R., Hemphill J. C., Hotz G., Keene C. D., Kramer J., Kreitzer N., Lindsell C., MacHamer J., Madden C., Martin A., McAllister T., Merchant R., Nelson L., Ngwenya L. B., Noel F., Nolan A., Palacios E., Perl D., Rabinowitz M., Rosand J., Sander A., Satris G., Schnyer D., Seabury S., Toga A., Valadka A., Vassar M., Zafonte R., Citerio G., Yuh, E, Jain, S, Sun, X, Pisica, D, Harris, M, Taylor, S, Markowitz, A, Mukherjee, P, Verheyden, J, Giacino, J, Levin, H, Mccrea, M, Stein, M, Temkin, N, Diaz-Arrastia, R, Robertson, C, Lingsma, H, Okonkwo, D, Maas, A, Manley, G, Adeoye, O, Badjatia, N, Boase, K, Bodien, Y, Corrigan, J, Crawford, K, Dikmen, S, Duhaime, A, Ellenbogen, R, Feeser, V, Ferguson, A, Foreman, B, Gardner, R, Gaudette, E, Gonzalez, L, Gopinath, S, Gullapalli, R, Hemphill, J, Hotz, G, Keene, C, Kramer, J, Kreitzer, N, Lindsell, C, Machamer, J, Madden, C, Martin, A, Mcallister, T, Merchant, R, Nelson, L, Ngwenya, L, Noel, F, Nolan, A, Palacios, E, Perl, D, Rabinowitz, M, Rosand, J, Sander, A, Satris, G, Schnyer, D, Seabury, S, Toga, A, Valadka, A, Vassar, M, Zafonte, R, Citerio, G, Yuh E. L., Jain S., Sun X., Pisica D., Harris M. H., Taylor S. R., Markowitz A. J., Mukherjee P., Verheyden J., Giacino J. T., Levin H. S., McCrea M., Stein M. B., Temkin N. R., Diaz-Arrastia R., Robertson C. S., Lingsma H. F., Okonkwo D. O., Maas A. I. R., Manley G. T., Adeoye O., Badjatia N., Boase K., Bodien Y., Corrigan J. D., Crawford K., Dikmen S., Duhaime A. -C., Ellenbogen R., Feeser V. R., Ferguson A. R., Foreman B., Gardner R., Gaudette E., Gonzalez L., Gopinath S., Gullapalli R., Hemphill J. C., Hotz G., Keene C. D., Kramer J., Kreitzer N., Lindsell C., MacHamer J., Madden C., Martin A., McAllister T., Merchant R., Nelson L., Ngwenya L. B., Noel F., Nolan A., Palacios E., Perl D., Rabinowitz M., Rosand J., Sander A., Satris G., Schnyer D., Seabury S., Toga A., Valadka A., Vassar M., Zafonte R., and Citerio G.
Abstract: Importance: A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. Objective: To identify pathological CT features associated with adverse outcomes after mTBI. Design, Setting, and Participants: The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. Exposures: Acute nonpenetrating head trauma. Main Outcomes and Measures: Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. Results: In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intrav
Published: 2021

4. Therapeutic hypothermia protocols

Author: Badjatia, N., primary
Published: 2017
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5. Worldwide Organization of Neurocritical Care: Results from the PRINCE Study Part 1

Author: Suarez, J. I., Martin, R. H., Bauza, C., Georgiadis, A., Venkatasubba Rao, C. P., Calvillo, E., Hemphill, J. C., Sung, G., Oddo, M., Taccone, Fabio Silvio, Leroux, P. D., Layon, A. J., Sarwal, A., Ali, A., Lele, A., Jarquin-Valdivia, A. A., Misiewska-Kaczur, A., Ahmad, A., Deeb, A. M., Jabbary, A. A., Fathy, A., Chan, A., Kern, CHRISTOPH ALEXANDER, Gritsan, A., Bshabshe, A. A., Malek, A., Schiefecker, A., Neto, A. R., ALHAJJ HASSAN, Ali, Zahrani, A. R. A., Sukumaran, A. V., Sarma, A. K., Aneman, A., Kramer, A., Naidech, A., Lacerda Gallardo, A. J., Miller, A., O'Connor, A., Kim, A., Afshinnik, A., Katila, A., Paulson, A., Parra, A., Rosengart, A., Almemari, A., Sanchez, B., Ray, B., Mccrum, B., Tegedor, B. V., Nathan, B., Tan, B., Emanuel, B., Pfaulser, B., Nazliel, B., Gil, B., Hightower, B., Francis, B., Roberts, B., Chaudhry, B., Romero, C., Graffagnino, C., VANDEN BERGHE, GREET CLARA, Hobohm, C., Dias, C., Bradford, C., Basignani, C., Chang, C., Junker, C., Lazaridis, C., Mcarthur, C., Williamson, C., Hebert, C., Ethan Kahn, D., Harvey, D., Laskowitz, D. T., Milzman, D., Chung, D., Greer, D., Seder, D., Miller, D. W., Barge, D., Roberts, D., Jordan, D., Bhonagiri, D., Nair, D., Aggarwal, D. G., Kutsogiannis, D. J., Laiwattana, D., Pinto, D. B., Bautista, D., Perez, D., Herrera, E. A., Singares, E. S., Manno, E., Wilensky, E. M., Giraldo, E. A., Jenkinson, E., Yarad, E., Zavala, E., Tesoro, E., Eskiogly, E., Bershad, E. M., Rosenthal, E., Coronel, E. B., Gordon, E., Salgado, E., Poch, E. J., Eriksson, E., Taccone, F. S., Al-Suwaidan, F., Sorond, F., Bilotta, F., Goldenberg, F. D., Rosciani, F., Bass, F., Bernard, F., Julian, F. B., Rasulo, F., Rincon, F., Santos, G., Anderson, G., Henderson, G., Meyfroidt, G., Wong, G. K. C., Aguilar, G., Rodriguez-Vega, G., Tamayo, G., Johnston, G., Kapinos, G., Abrego, G. C., Paul, G., Xu, G., Domeniconi, G., Dugan, G., Murthy, H. H. K., Peled, H., Zraiki, H., Alvarez, H., Rodgers, H., Vaitkevicius, H., Schumacher, H. C., Kobata, H., Al-Jehani, H., Lopez Delgado, H. J., Olmecah, H. M., Madrinan-Navia, H., Tran, H., Seppelt, I., Schirotzek, I., Medary, I. B., Maldonado, I. L., da Silva, I. R. F., Hemphill III, J. C., Javier Provencio, J., Mora, J. E., Abdullah, J. M., Langdon, J. R., Claassen, J., de Oliveira, J., Shilkin, J., Horn, J., Teitelbaum, J., Frank, J. I., Fletcher, J. J., Berkeley, J., Andersson, KIM JIMMY, Kirkwood, J., Welbourne, J., Song, J., Domingues, J. R. S., Paxton, J., Falla, J., Lokin, J., Dissin, J., Bonomo, J., Martinez, J. E., Mejia-Mantilla, J. H., Ramirez-Arce, J., Palo, J. E., Moretti, J. I., Gonzalez, J. R. Y., Levine, J. M., Medow, J., Pou, J. A. L., Ciro, J. D., Paucar, J. L. C., Wright, J. C., Bosel, J., Martinez, J., Mijangos-Mendez, J. C., Chalela, J., Granillo, J. F., Sohal, J., Hirsch, K. G., Donaldson, K., Cummings, K., Hubner, K. E., Wartenberg, K., Goyal, K., Sheth, K., Kunze, K., O'Phelan, K., Sheehan, K., Altaweel, L., Cross, L., Barrachina, L. G., Kuisle, L., Connolyy, L. S., Tack, L., Johnson, L., Shutter, L., Pelunkova, L., Ramos-Gomez, L. A., Camputaro, L. A., Kamran Athar, M., Madhusudan, M., Hashmi, M., Mokhtari, M., Jibaja, M., Muller, M. C. A., Costilla, M., Mirski, M., Ochoa, M. E., Pegoli, M., Dujardin, M. -F., Allasia, M., Teran, M. D., Gorman, Michael Murray, Chapman, M., Amatangelo, M., Nagayama, M., Dickinson, M., Koenig, M., Moreda, M., Berman, M., De Georgia, M., Kuiper, M., O'Leary, M., Rodricks, M., Schneck, M., Torbey, M., Defilippis, M., Meeker, M., Allen, David Michael, Llano, M., Villalobos, M., Treggiari, M., Tuppeny, M., Sharaby, M., Kottapally, M., Mcnett, M., Mcbride, M., Gomez, M., Varga, M., Kumar, M., Yazbeck, M. F., Smith, M., Stevenson Porter, N., Hammond, N., Karanjia, N., Sokhal, N., Singhal, N. S., Badjatia, N., Maldonado, N., Ko, N., Marinoff, N., Hernandez Aguilar, Orisel, Krauchi, O. R., Sanchez, O., Gomez, O., Rivera, O. S., Gilvaz, P. C., Raffa, P., Varelas, P., Promsin, P., Merlani, P., Shushma, P., Allan, P., Biston, P., Vespa, P., Amorim, P., de Azambuja Rodrigues, P. M., Hopkins, P., Hantson, P., Vanamoorthy, P., Gupta, P., Garvin, R., Badenes, R., Damani, R., Helbok, R., Dhar, R., Rawal, R., Carandang, R., Guisado, R., Luengo, R. -I. G., Sajjad, R., Davis, R., Rison, R. A., Hoesch, R., Murillo, R., Smith, R., Ball, R., Beer, R., Reshi, R. A., Landry, R., Puvanendiran, S., Ansari, S., Mukaddam, S., Garg, S., Mishra, S., Clark, S., Napolitano, Silvano, Pattnaik, S., Vosylius, S., John, S., Josephson, S. A., Glickman, S., Brehaut, S. S., Shiraz, S. A., Aguilera, S., Sternberg, S., Chou, S., Vallance, S., Lasocki, S., Schoenenberger, S., Bird, S., Finfer, S., Shieber, S., Vadi, S., Samavedam, S., Cordina, S., Feske, S., Glassner, S., Dixit, S., Dowling, S., Tena, S. A., Bowling, S., Francken, S., Muehlschlegel, S., Renard, S., Poli, S., Carter, T., Bleck, T. P., Trim, T., Breitenfeld, T., Van Bui, T., Shukla, U., Sinha, V., Rajajee, V., Aiyagari, V., Mccredie, V., Svigelj, V., Verma, V., Rao, V. A., David Freeman, W., Smith, W. S., Videtta, W., Habre, W., Hall, W., Coplin, W. M., Abdo, W. F., Wittebole, X., Titova, Y., PRINCE Study Investigators, Layon, A.J., Sarwal, A., Ali, A., Lele, A., Jarquin-Valdivia, A.A., Misiewska-Kaczur, A., Ahmad, A., Deeb, A.M., Jabbary, A.A., Fathy, A., Chan, A., Kern, A., Georgiadis, A., Gritsan, A., Bshabshe, A.A., Malek, A., Schiefecker, A., Neto, A.R., Hassan, A., Zahrani, ARA, Sukumaran, A.V., Sarma, A.K., Aneman, A., Kramer, A., Naidech, A., Lacerda Gallardo, A.J., Miller, A., O'Connor, A., Kim, A., Afshinnik, A., Katila, A., Paulson, A., Parra, A., Rosengart, A., Almemari, A., Sanchez, B., Ray, B., McCrum, B., Tegedor, B.V., Nathan, B., Tan, B., Emanuel, B., Pfaulser, B., Nazliel, B., Gil, B., Hightower, B., Francis, B., Roberts, B., Chaudhry, B., Romero, C., Graffagnino, C., Berghe, C., Hobohm, C., Dias, C., Bradford, C., Basignani, C., Chang, C., Venkatasubba Rao, C.P., Junker, C., Lazaridis, C., McArthur, C., Williamson, C., Hebert, C., Ethan Kahn, D., Harvey, D., Laskowitz, D.T., Milzman, D., Chung, D., Greer, D., Seder, D., Miller, D.W., Barge, D., Roberts, D., Jordan, D., Bhonagiri, D., Nair, D., Aggarwal, D.G., Kutsogiannis, D.J., Laiwattana, D., Pinto, D.B., Bautista, D., Perez, D., Herrera, E.A., Singares, E.S., Manno, E., Wilensky, E.M., Giraldo, E.A., Jenkinson, E., Yarad, E., Zavala, E., Tesoro, E., Eskiogly, E., Bershad, E.M., Rosenthal, E., Coronel, E.B., Gordon, E., Salgado, E., Poch, E.J., Calvillo, E., Eriksson, E., Taccone, F.S., Al-Suwaidan, F., Sorond, F., Bilotta, F., Goldenberg, F.D., Rosciani, F., Bass, F., Bernard, F., Julian, F.B., Rasulo, F., Rincon, F., Santos, G., Anderson, G., Henderson, G., Meyfroidt, G., Sung, G., Wong, GKC, Aguilar, G., Rodriguez-Vega, G., Tamayo, G., Johnston, G., Kapinos, G., Abrego, G.C., Paul, G., Xu, G., Domeniconi, G., Dugan, G., Murthy, HHK, Peled, H., Zraiki, H., Alvarez, H., Rodgers, H., Vaitkevicius, H., Schumacher, H.C., Kobata, H., Al-Jehani, H., Lopez Delgado, H.J., Olmecah, H.M., Madrinan-Navia, H., Tran, H., Seppelt, I., Schirotzek, I., Medary, I.B., Maldonado, I.L., da Silva, IRF, Hemphill Iii, J.C., Javier Provencio, J., Mora, J.E., Abdullah, J.M., Langdon, J.R., Claassen, J., de Oliveira, J., Shilkin, J., Horn, J., Teitelbaum, J., Frank, J.I., Fletcher, J.J., Berkeley, J., Kim, J., Kirkwood, J., Welbourne, J., Song, J., Domingues, JRS, Paxton, J., Falla, J., Lokin, J., Dissin, J., Bonomo, J., Martinez, J.E., Mejia-Mantilla, J.H., Ramirez-Arce, J., Palo, J.E., Moretti, J.I., Suarez, J.I., Gonzalez, JRY, Levine, J.M., Medow, J., Pou, JAL, Ciro, J.D., Paucar, JLC, Wright, J.C., Bosel, J., Martinez, J., Mijangos-Mendez, J.C., Chalela, J., Granillo, J.F., Sohal, J., Hirsch, K.G., Donaldson, K., Cummings, K., Hubner, K.E., Wartenberg, K., Goyal, K., Sheth, K., Kunze, K., O'Phelan, K., Sheehan, K., Altaweel, L., Cross, L., Barrachina, L.G., Kuisle, L., Connolyy, L.S., Tack, L., Johnson, L., Shutter, L., Pelunkova, L., Ramos-Gomez, L.A., Camputaro, L.A., Kamran Athar, M., Madhusudan, M., Hashmi, M., Mokhtari, M., Jibaja, M., Muller, MCA, Costilla, M., Mirski, M., Ochoa, M.E., Pegoli, M., Dujardin, M.F., Allasia, M., Teran, M.D., Gorman, M., Chapman, M., Amatangelo, M., Nagayama, M., Dickinson, M., Koenig, M., Moreda, M., Berman, M., De Georgia, M., Kuiper, M., O'Leary, M., Rodricks, M., Schneck, M., Torbey, M., DeFilippis, M., Meeker, M., Allen, M., Llano, M., Villalobos, M., Treggiari, M., Tuppeny, M., Sharaby, M., Kottapally, M., McNett, M., McBride, M., Gomez, M., Varga, M., Kumar, M., Yazbeck, M.F., Smith, M., Stevenson Porter, N., Hammond, N., Karanjia, N., Sokhal, N., Singhal, N.S., Badjatia, N., Maldonado, N., Ko, N., Marinoff, N., Hernandez, O., Krauchi, O.R., Sanchez, O., Gomez, O., Rivera, O.S., Gilvaz, P.C., Raffa, P., Varelas, P., Promsin, P., Merlani, P., Shushma, P., Allan, P., Biston, P., Vespa, P., Amorim, P., de Azambuja Rodrigues, P.M., Hopkins, P., Hantson, P., Vanamoorthy, P., Gupta, P., Garvin, R., Badenes, R., Damani, R., Helbok, R., Dhar, R., Rawal, R., Carandang, R., Guisado, R., Luengo, R.G., Sajjad, R., Davis, R., Rison, R.A., Hoesch, R., Murillo, R., Smith, R., Ball, R., Beer, R., Reshi, R.A., Landry, R., Puvanendiran, S., Ansari, S., Mukaddam, S., Garg, S., Mishra, S., Clark, S., Napolitano, S., Pattnaik, S., Vosylius, S., John, S., Josephson, S.A., Glickman, S., Brehaut, S.S., Shiraz, S.A., Aguilera, S., Sternberg, S., Chou, S., Vallance, S., Lasocki, S., Schoenenberger, S., Bird, S., Finfer, S., Shieber, S., Vadi, S., Samavedam, S., Cordina, S., Feske, S., Glassner, S., Dixit, S., Dowling, S., Tena, S.A., Bowling, S., Francken, S., Muehlschlegel, S., Renard, S., Poli, S., Carter, T., Bleck, T.P., Trim, T., Breitenfeld, T., Van Bui, T., Shukla, U., Sinha, V., Rajajee, V., Aiyagari, V., McCredie, V., Svigelj, V., Verma, V., Rao, V.A., David Freeman, W., Smith, W.S., Videtta, W., Habre, W., Hall, W., Coplin, W.M., Abdo, W.F., Wittebole, X., Titova, Y., Intensive Care Medicine, ANS - Neuroinfection & -inflammation, Other Research, ACS - Pulmonary hypertension & thrombosis, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, and UCL - (SLuc) Service de soins intensifs
Subjects: Internationality, Scope of practice, Latin Americans, medicine.medical_treatment, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Pharmacists, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Clinical Protocols, Central Nervous System Diseases, law, Observational study, Epidemiology, Neurocritical care, Case report form, Academic Medical Centers, Intensive care unit, Telemedicine, Europe, Intensive Care Units, Prospective, Transportation of Patients, Neurology, Practice Guidelines as Topic, Critical care, Outcomes, Original Work, Respiratory Therapy, medicine.medical_specialty, Asia, Tomography Scanners, X-Ray Computed, Critical Care, Health Personnel, Oceania, Respiratory therapist, Neurosurgery, Pharmacist, Personnel Management, Resource Allocation, Middle East, 03 medical and health sciences, Physicians, medicine, Humans, Fellowships and Scholarships, business.industry, Internship and Residency, Neurointensive care, 030208 emergency & critical care medicine, Latin America, Family medicine, North America, Neurology (clinical), business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: Introduction Neurocritical care focuses on the care of critically ill patients with an acute neurologic disorder and has grown significantly in the past few years. However, there is a lack of data that describe the scope of practice of neurointensivists and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide. To address these issues, we designed a multicenter, international, point-prevalence, cross-sectional, prospective, observational, non-interventional study in the setting of neurocritical care (PRINCE Study). Methods In this manuscript, we analyzed data from the initial phase of the study that included registration, hospital, and intensive care unit (ICU) organizations. We present here descriptive statistics to summarize data from the registration case report form. We performed the Kruskal–Wallis test followed by the Dunn procedure to test for differences in practices among world regions. Results We analyzed information submitted by 257 participating sites from 47 countries. The majority of those sites, 119 (46.3%), were in North America, 44 (17.2%) in Europe, 34 (13.3%) in Asia, 9 (3.5%) in the Middle East, 34 (13.3%) in Latin America, and 14 (5.5%) in Oceania. Most ICUs are from academic institutions (73.4%) located in large urban centers (44% > 1 million inhabitants). We found significant differences in hospital and ICU organization, resource allocation, and use of patient management protocols. The highest nursing/patient ratio was in Oceania (100% 1:1). Dedicated Advanced Practiced Providers are mostly present in North America (73.7%) and are uncommon in Oceania (7.7%) and the Middle East (0%). The presence of dedicated respiratory therapist is common in North America (85%), Middle East (85%), and Latin America (84%) but less common in Europe (26%) and Oceania (7.7%). The presence of dedicated pharmacist is highest in North America (89%) and Oceania (85%) and least common in Latin America (38%). The majority of respondents reported having a dedicated neuro-ICU (67% overall; highest in North America: 82%; and lowest in Oceania: 14%). Conclusion The PRINCE Study results suggest that there is significant variability in the delivery of neurocritical care. The study also shows it is feasible to undertake international collaborations to gather global data about the practice of neurocritical care. Electronic supplementary material The online version of this article (10.1007/s12028-019-00750-3) contains supplementary material, which is available to authorized users.
Published: 2020

6. Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

Author: Rao C, Suarez J, Martin R, Bauza C, Georgiadis A, Calvillo E, Hemphill J, Sung G, Oddo M, Taccone F, LeRoux P, Domeniconi G, Camputaro L, Villalobos M, Allasia M, Goldenberg F, Teran M, Rosciani F, Alvarez H, Costilla M, Videtta W, Perez D, Raffa P, Seppelt I, Rodgers H, Paxton J, Bhonagiri D, Aneman A, Jenkinson E, Bradford C, Finfer S, Yarad E, Bass F, Hammond N, O'Connor A, Bird S, Smith R, Barge D, Shilkin J, Woods W, Roberts B, O'Leary M, Vallance S, Helbok R, Beer R, Pfaulser B, Schiefecker A, Almemari A, Mukaddam S, Wittebole X, Berghe C, Dujardin M, Renard S, Hantson P, Biston P, Meyfroidt G, da Silva I, de Oliveira J, Neto A, Domingues J, Rodrigues P, Teitelbaum J, Chapman M, McCredie V, Marinoff N, Perez A, Kutsogiannis D, Bernard F, Kramer A, Moretti J, Aguilera S, Poch E, Romero C, Wong G, Song J, Xu G, Mejia-Mantilla J, Madrinan-Navia H, Martinez J, Ochoa M, Bautista D, Varga M, Gomez M, Ciro J, Gil B, Murillo R, Hernandez O, Ramirez-Arce J, Breitenfeld T, Gallardo A, Delgado H, Gonzalez J, Hache-Marliere M, Pinto D, Llano M, Salgado E, Jibaja M, Wright J, Harvey D, Verma V, Hopkins P, Chan A, Welbourne J, Dowling S, Katila A, Lasocki S, Wartenberg K, Hobohm C, Poli S, Schirotzek I, Bosel J, Schoenenberger S, Francken S, Shieber S, Kern A, Falla J, Herrera E, Gilvaz P, Goyal K, Sokhal N, Sohal J, Aggarwal D, Ray B, Pattnaik S, Garg S, Dixit S, Rawal R, Samavedam S, Madhusudan M, Paul G, Mishra S, Shushma P, Shukla U, Sinha V, Vanamoorthy P, Vadi S, Mokhtari M, Rasulo F, Pegoli M, Bilotta F, Nagayama M, Kobata H, Vosylius S, Abdullah J, Granillo J, Mijangos-Mendez J, Horn J, Muller M, Kuiper M, Abdo W, McArthur C, Newby L, Hashmi M, Shiraz S, Abrego G, Coronel E, Rivera O, Paucar J, Gomez O, Palo J, Lokin J, Misiewska-Kaczur A, Dias C, Amorim P, Andre S, Rodriguez-Vega G, Gritsan A, Titova Y, Al Jabbary A, Al Zahrani A, Pelunkova L, Zraiki H, Deeb A, Al Bshabshe A, Al-Jehani H, Al-Suwaidan F, Svigelj V, Ramos-Gomez L, Aguilar G, Badenes R, Pou J, Zavala E, Julian F, Barrachina L, Tegedor B, Tena S, Krauchi O, Tamayo G, Sanchez B, Gonzalezluengo R, Puvanendiran S, Merlani P, Laiwattana D, Promsin P, Nazliel B, Eriksson E, Chalela J, Miller D, Guisado R, Gordon E, Murthy H, Paulson A, Rajajee V, Sheehan K, Williamson C, Ball R, Allan P, Berkeley J, Muehlschlegel S, Carandang R, Hall W, Sarwal A, Damani R, Maldonado N, Tan B, Gupta P, Lazaridis C, Bershad E, Ansari S, Singares E, Manno E, Provencio J, Chaudhry B, McBride M, Dhar R, Roberts D, Allen M, Schumacher H, Habre W, Sheth K, Greer D, Kunze K, Varelas P, Tack L, Porter N, Junker C, Rodricks M, Tuppeny M, Basignani C, Napolitano S, Anderson G, Donaldson K, Davis R, Sternberg S, Giraldo E, Tran H, Coplin W, Badjatia N, Fathy A, Reshi R, Bonomo J, Seder D, Connolyy L, McCrum B, Carter T, Treggiari M, Dickinson M, Rison R, Mirski M, John S, Bleck T, Malek A, Trim T, Smith M, Athar M, Rincon F, Altaweel L, Vespa P, Emanuel B, Eskiogly E, McNett M, Sukumaran A, Shutter L, Milzman D, Glassner S, OPhelan K, Rosenthal E, Kottapally M, Smith W, Ko N, Josephson S, Kim A, Singhal N, Ahmad A, Meeker M, Hirsch K, Nair D, Chou S, Santos G, Clark S, Feske S, Henderson G, Sorond F, Vaitkevicius H, Chung D, Kim J, Amatangelo M, Kapinos G, Torbey M, Kahn D, Chang C, Koenig M, Gorman M, Langdon J, Dissin J, Cross L, Peled H, Claassen J, Ali A, Layon A, Miller A, Wilensky E, Kumar M, Levine J, Maldonado I, Schneck M, Lele A, Sarma A, Yazbeck M, Johnston G, Jarquin-Valdivia A, Johnson L, Kuisle L, Sajjad R, Glickman S, Garvin R, Parra A, DeFilippis M, Fletcher J, Freeman W, Rao V, Olmecah H, Dugan G, Medary I, Hoesch R, Brehaut S, Afshinnik A, Moreda M, Graffagnino C, Laskowitz D, Naidech A, Francis B, Berman M, Tesoro E, Medow J, Jordan D, Aiyagari V, Rosengart A, De Georgia M, Bowling S, Sharaby M, Nathan B, Landry R, Hebert C, Hubner K, Karanjia N, Hightower B, Cummings K, Kirkwood J, Frank J, Hassan A, Sanchez O, Cordina S, Mora J, Bui T, PRINCE Study Investigators, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de soins intensifs, and Meyfroidt, Geert
Subjects: medicine.medical_specialty, IMPACT, NEUROSCIENCES, Clinical Neurology, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], TRAUMATIC BRAIN-INJURY, UNITED-STATES, Outcomes, INTENSIVE-CARE, Critical Care and Intensive Care Medicine, Logistic regression, VALIDATION, 03 medical and health sciences, 0302 clinical medicine, Critical Care Medicine, General & Internal Medicine, Observational study, Intensive care, Severity of illness, Epidemiology, Neurocritical care, Medicine, Case report form, Science & Technology, business.industry, LENGTH-OF-STAY, Glasgow Coma Scale, Neurointensive care, 030208 emergency & critical care medicine, Critical care, Prospective, Emergency medicine, PATTERNS, Neurosciences & Neurology, Neurology (clinical), business, Life Sciences & Biomedicine, CRITICALLY-ILL PATIENTS, GLASGOW COMA SCALE, 030217 neurology & neurosurgery
Abstract: Contains fulltext : 218566pub.pdf (Publisher’s version ) (Closed access) Contains fulltext : 218566pos.pdf (Author’s version postprint ) (Open Access) BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.
Published: 2019
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7. P-006 Update on the reperfusion with cooling in cerebral acute ischemia II (RECCLAIM II) trial

Author: Gupta, R, primary, Zaidi, S, additional, Jumaa, M, additional, Badjatia, N, additional, and Yoo, A, additional
Published: 2021
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8. Acute Spinal Cord Ischemia: Treatment with Intravenous and Intra-Arterial Thrombolysis, Hyperbaric Oxygen and Hypothermia

Author: Lee, K., Strozyk, D., Rahman, C., Lee, L. K., Fernandes, E. M., Claassen, J., Badjatia, N., Mayer, S. A., and Pile-Spellman, J.
Published: 2009
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9. Electrographic seizures after subarachnoid hemorrhage lead to derangement of brain homeostasis in humans

Author: Claassen, J, Perotte, A, Albers, D, Schmidt, J, Tu, B, Badjatia, N, Lee, K, Mayer, S, Connolly, E, Hirsch, L, and Hripcsak, G
Published: 2011
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10. Monitoring Inflammation (Including Fever) in Acute Brain Injury

Author: Provencio J. J., Badjatia N., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Provencio, J, Badjatia, N, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Neurology, Critical Care, Fever, Monitoring, medicine.medical_treatment, Inflammation, Targeted temperature management, Critical Care and Intensive Care Medicine, C-reactive protein, Predictive Value of Tests, White blood cell, Neurocritical care, medicine, Humans, Brain injury, Intensive care medicine, Immunity, Cellular, biology, business.industry, Shivering, Neurointensive care, Prognosis, medicine.anatomical_structure, Brain Injuries, Inflammatory cascade, biology.protein, Neurology (clinical), Inflammation Mediators, medicine.symptom, business, Biomarkers
Abstract: Inflammation is an important part of the normal physiologic response to acute brain injury (ABI). How inflammation is manifest determines if it augments or hinders the resolution of ABI. Monitoring body temperature, the cellular arm of the inflammatory cascade, and inflammatory proteins may help guide therapy. This summary will address the utility of inflammation monitoring in brain-injured adults. An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure inflammation in ABI. Ninety-four articles were included in this review. Current evidence suggests that control of inflammation after ABI may hold promise for advances in good outcomes. However, our understanding of how much inflammation is good and how much is deleterious is not yet clear. Several important concepts emerge form our review. First, while continuous temperature monitoring of core body temperature is recommended, temperature pattern alone is not useful in distinguishing infectious from noninfectious fever. Second, when targeted temperature management is used, shivering should be monitored at least hourly. Finally, white blood cell levels and protein markers of inflammation may have a limited role in distinguishing infectious from noninfectious fever. Our understanding of optimal use of inflammation monitoring after ABI is limited currently but is an area of active investigation.
Published: 2014
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11. Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations

Author: Helbok R., Olson D. W. M., Le Roux P. D., Vespa P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Helbok, R, Olson, D, Le Roux, P, Vespa, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: Ventriculostomy, medicine.medical_specialty, Neurology, Subarachnoid hemorrhage, Critical Care, Intracranial Pressure, Traumatic brain injury, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine, Humans, Cerebral perfusion pressure, Intracranial pressure, Coma, Intracerebral hemorrhage, Brain Diseases, integumentary system, business.industry, Patient Selection, musculoskeletal, neural, and ocular physiology, Prognosis, medicine.disease, Neurophysiological Monitoring, humanities, nervous system diseases, Brain edema, Coma, CPP, ICP, Intracerebral hemorrhage, Subarachnoid hemorrhage, Ventriculostomy, Cerebrovascular Circulation, Anesthesia, Neurology (clinical), medicine.symptom, business
Abstract: The effect of intracranial pressure (ICP) and the role of ICP monitoring are best studied in traumatic brain injury (TBI). However, a variety of acute neurologic illnesses e.g., subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, meningitis/encephalitis, and select metabolic disorders, e.g., liver failure and malignant, brain tumors can affect ICP. The purpose of this paper is to review the literature about ICP monitoring in conditions other than TBI and to provide recommendations how the technique may be used in patient management. A PubMed search between 1980 and September 2013 identified 989 articles; 225 of which were reviewed in detail. The technique used to monitor ICP in non-TBI conditions is similar to that used in TBI; however, indications for ICP monitoring often are intertwined with the presence of obstructive hydrocephalus and hence the use of ventricular catheters is more frequent. Increased ICP can adversely affect outcome, particularly when it fails to respond to treatment. However, patients with elevated ICP can still have favorable outcomes. Although the influence of ICP-based care on outcome in non-TBI conditions appears less robust than in TBI, monitoring ICP and cerebral perfusion pressure can play a role in guiding therapy in select patients.
Published: 2014
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12. International Multidisciplinary Consensus Conference on Multimodality Monitoring: ICU Processes of Care

Author: McNett M. M., Horowitz D. A., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Hutchinson P., Kumar M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Mcnett, M, Horowitz, D, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Hutchinson, P, Kumar, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Consensus, Internationality, Critical Care, Population, MEDLINE, Benchmark, Critical Care and Intensive Care Medicine, law.invention, Clinical Protocols, Ambulatory care, law, Intensive care, Critical care nursing, Health care, Neurocritical care, Humans, Medicine, Mortality, Intensive care medicine, education, Outcome, education.field_of_study, business.industry, Process Assessment, Health Care, Neurointensive care, medicine.disease, Quality, Neurophysiological Monitoring, Intensive care unit, Brain Injuries, Neurology (clinical), Medical emergency, business
Abstract: There is an increased focus on evaluating processes of care, particularly in the high acuity and cost environment of intensive care. Evaluation of neurocritical-specific care and evidence-based protocol implementation are needed to effectively determine optimal processes of care and effect on patient outcomes. General quality measures to evaluate intensive care unit (ICU) processes of care have been proposed; however, applicability of these measures in neurocritical care populations has not been established. A comprehensive literature search was conducted for English language articles from 1990 to August 2013. A total of 1,061 articles were reviewed, with 145 meeting criteria for inclusion in this review. Care in specialized neurocritical care units or by neurocritical teams can have a positive impact on mortality, length of stay, and in some cases, functional outcome. Similarly, implementation of evidence-based protocol-directed care can enhance outcome in the neurocritical care population. There is significant evidence to support suggested quality indicators for the general ICU population, but limited research regarding specific use in neurocritical care. Quality indices for neurocritical care have been proposed; however, additional research is needed to further validate measures.
Published: 2014
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13. Monitoring Nutrition and Glucose in Acute Brain Injury

Author: Badjatia N., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Badjatia, N, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: Blood Glucose, medicine.medical_specialty, Neurology, Critical Care, Population, Critical Care and Intensive Care Medicine, Enteral Nutrition, medicine, Humans, education, Adverse effect, Intensive care medicine, Neurophysiological Monitoring, Blood glucose monitoring, education.field_of_study, medicine.diagnostic_test, business.industry, Neurointensive care, Calorimetry, Indirect, Anthropometry, Nutrition Assessment, Parenteral nutrition, Brain Injuries, Neurology (clinical), Energy Metabolism, Brain injury, Energy expenditure, Glucose, Monitoring, Nitrogen balance, Nutritional assessment, business
Abstract: The metabolic response to injury is well described; however, very little is understood about optimal markers to measure this response. This summary will address the current evidence about monitoring nutritional status including blood glucose after acute brain injury (ABI). An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure nutritional status and blood glucose levels in the neurocritical care population. A total of 45 articles were included in this review. Providing adequate and timely nutritional support can help improve outcome after ABI. However, the optimal content and total nutrition requirements remain unclear. In addition, how best to monitor the nutritional status in ABI is still being elucidated, and at present, there is no validated optimal method to monitor the global response to nutritional support on a day-to-day basis in ABI patients. Nitrogen balance may be monitored to assess the adequacy of caloric intake as it relates to protein energy metabolism, but indirect calorimetry, anthropometric measurement, or serum biomarker requires further validation. The adverse effects of hyperglycemia in ABI are well described, and data indicate that blood glucose should be carefully controlled in critically ill patients. However, the optimal frequency or duration for blood glucose monitoring after ABI remains poorly defined. There are significant knowledge gaps about monitoring nutritional status and response to nutritional interventions in ABI; these need to be addressed and hence few recommendations can be made. The optimal frequency and duration of blood glucose monitoring need further study.
Published: 2014
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14. Multimodality Monitoring: Informatics, Integration Data Display and Analysis

Author: Schmidt J. M., De Georgia M., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Taccone F., Schmidt, J, De Georgia, M, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, and Taccone, F
Subjects: Information management, Telemedicine, Decision support system, Critical Care, business.industry, Critical care, Data display, Data integration, Decision support, Informatics, Neuromonitoring, Critical Care and Intensive Care Medicine, computer.software_genre, Neurophysiological Monitoring, Health informatics, Data science, Data warehouse, Systems Integration, Intensive care, Informatics, Data Display, Humans, Medicine, Medical Informatics Applications, Neurology (clinical), business, computer, Data integration
Abstract: The goal of multimodality neuromonitoring is to provide continuous, real-time assessment of brain physiology to prevent, detect, and attenuate secondary brain injury. Clinical informatics deals with biomedical data, information, and knowledge including their acquisition, storage, retrieval, and optimal use for clinical decision-making. An electronic literature search was conducted for English language articles describing the use of informatics in the intensive care unit setting from January 1990 to August 2013. A total of 64 studies were included in this review. Clinical informatics infrastructure should be adopted that enables a wide range of linear and nonlinear analytical methods be applied to patient data. Specific time epochs of clinical interest should be reviewable. Analysis strategies of monitor alarms may help address alarm fatigue. Ergonomic data display that present results from analyses with clinical information in a sensible uncomplicated manner improve clinical decision-making. Collecting and archiving the highest resolution physiologic and phenotypic data in a comprehensive open format data warehouse is a crucial first step toward information management and two-way translational research for multimodality monitoring. The infrastructure required is largely the same as that needed for telemedicine intensive care applications, which under the right circumstances improves care quality while reducing cost.
Published: 2014
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15. International Multidisciplinary Consensus Conference on Multimodality Monitoring: ICU Processes of Care

Author: Mcnett, M, Horowitz, D, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Hutchinson, P, Kumar, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, McNett M. M., Horowitz D. A., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Hutchinson P., Kumar M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Mcnett, M, Horowitz, D, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Hutchinson, P, Kumar, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, McNett M. M., Horowitz D. A., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Hutchinson P., Kumar M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: There is an increased focus on evaluating processes of care, particularly in the high acuity and cost environment of intensive care. Evaluation of neurocritical-specific care and evidence-based protocol implementation are needed to effectively determine optimal processes of care and effect on patient outcomes. General quality measures to evaluate intensive care unit (ICU) processes of care have been proposed; however, applicability of these measures in neurocritical care populations has not been established. A comprehensive literature search was conducted for English language articles from 1990 to August 2013. A total of 1,061 articles were reviewed, with 145 meeting criteria for inclusion in this review. Care in specialized neurocritical care units or by neurocritical teams can have a positive impact on mortality, length of stay, and in some cases, functional outcome. Similarly, implementation of evidence-based protocol-directed care can enhance outcome in the neurocritical care population. There is significant evidence to support suggested quality indicators for the general ICU population, but limited research regarding specific use in neurocritical care. Quality indices for neurocritical care have been proposed; however, additional research is needed to further validate measures.
Published: 2014

16. Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies

Author: Figaji, A, Puppo, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Figaji A., Puppo C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Riker R., Robertson C., Schmidt J. M., Taccone F., Figaji, A, Puppo, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Figaji A., Puppo C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: The burden of disease and so the need for care is often greater at hospitals in emerging economies. This is compounded by frequent restrictions in the delivery of good quality clinical care due to resource limitations. However, there is substantial heterogeneity in this economically defined group, such that advanced brain monitoring is routinely practiced at certain centers that have an interest in neurocritical care. It also must be recognized that significant heterogeneity in the delivery of neurocritical care exists even within individual high-income countries (HICs), determined by costs and level of interest. Direct comparisons of data between HICs and the group of low- and middle-income countries (LAMICs) are made difficult by differences in patient demographics, selection for ICU admission, therapies administered, and outcome assessment. Evidence suggests that potential benefits of multimodality monitoring depend on an appropriate environment and clinical expertise. There is no evidence to suggest that patients in LAMICs where such resources exist should be treated any differently to patients from HICs. The potential for outcome benefits in LAMICs is arguably greater in absolute terms because of the large burden of disease; however, the relative cost/benefit ratio of such monitoring in this setting must be viewed in context of the overall priorities in delivering health care at individual institutions.
Published: 2014

17. Multimodality Monitoring: Informatics, Integration Data Display and Analysis

Author: Schmidt, J, De Georgia, M, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Taccone, F, Schmidt J. M., De Georgia M., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Taccone F., Schmidt, J, De Georgia, M, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Taccone, F, Schmidt J. M., De Georgia M., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., and Taccone F.
Abstract: The goal of multimodality neuromonitoring is to provide continuous, real-time assessment of brain physiology to prevent, detect, and attenuate secondary brain injury. Clinical informatics deals with biomedical data, information, and knowledge including their acquisition, storage, retrieval, and optimal use for clinical decision-making. An electronic literature search was conducted for English language articles describing the use of informatics in the intensive care unit setting from January 1990 to August 2013. A total of 64 studies were included in this review. Clinical informatics infrastructure should be adopted that enables a wide range of linear and nonlinear analytical methods be applied to patient data. Specific time epochs of clinical interest should be reviewable. Analysis strategies of monitor alarms may help address alarm fatigue. Ergonomic data display that present results from analyses with clinical information in a sensible uncomplicated manner improve clinical decision-making. Collecting and archiving the highest resolution physiologic and phenotypic data in a comprehensive open format data warehouse is a crucial first step toward information management and two-way translational research for multimodality monitoring. The infrastructure required is largely the same as that needed for telemedicine intensive care applications, which under the right circumstances improves care quality while reducing cost.
Published: 2014

18. Monitoring Inflammation (Including Fever) in Acute Brain Injury

Author: Provencio, J, Badjatia, N, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Provencio J. J., Badjatia N., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Provencio, J, Badjatia, N, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Provencio J. J., Badjatia N., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Inflammation is an important part of the normal physiologic response to acute brain injury (ABI). How inflammation is manifest determines if it augments or hinders the resolution of ABI. Monitoring body temperature, the cellular arm of the inflammatory cascade, and inflammatory proteins may help guide therapy. This summary will address the utility of inflammation monitoring in brain-injured adults. An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure inflammation in ABI. Ninety-four articles were included in this review. Current evidence suggests that control of inflammation after ABI may hold promise for advances in good outcomes. However, our understanding of how much inflammation is good and how much is deleterious is not yet clear. Several important concepts emerge form our review. First, while continuous temperature monitoring of core body temperature is recommended, temperature pattern alone is not useful in distinguishing infectious from noninfectious fever. Second, when targeted temperature management is used, shivering should be monitored at least hourly. Finally, white blood cell levels and protein markers of inflammation may have a limited role in distinguishing infectious from noninfectious fever. Our understanding of optimal use of inflammation monitoring after ABI is limited currently but is an area of active investigation.
Published: 2014

19. Monitoring Nutrition and Glucose in Acute Brain Injury

Author: Badjatia, N, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Badjatia N., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Badjatia, N, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Badjatia N., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: The metabolic response to injury is well described; however, very little is understood about optimal markers to measure this response. This summary will address the current evidence about monitoring nutritional status including blood glucose after acute brain injury (ABI). An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure nutritional status and blood glucose levels in the neurocritical care population. A total of 45 articles were included in this review. Providing adequate and timely nutritional support can help improve outcome after ABI. However, the optimal content and total nutrition requirements remain unclear. In addition, how best to monitor the nutritional status in ABI is still being elucidated, and at present, there is no validated optimal method to monitor the global response to nutritional support on a day-to-day basis in ABI patients. Nitrogen balance may be monitored to assess the adequacy of caloric intake as it relates to protein energy metabolism, but indirect calorimetry, anthropometric measurement, or serum biomarker requires further validation. The adverse effects of hyperglycemia in ABI are well described, and data indicate that blood glucose should be carefully controlled in critically ill patients. However, the optimal frequency or duration for blood glucose monitoring after ABI remains poorly defined. There are significant knowledge gaps about monitoring nutritional status and response to nutritional interventions in ABI; these need to be addressed and hence few recommendations can be made. The optimal frequency and duration of blood glucose monitoring need further study.
Published: 2014

20. International Multidisciplinary Consensus Conference on Multimodality Monitoring: Cerebral Metabolism

Author: Hutchinson, P, O'Phelan, K, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Hutchinson P., O'Phelan K., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Hutchinson, P, O'Phelan, K, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Hutchinson P., O'Phelan K., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Microdialysis is a powerful technique, which enables the chemistry of the extracellular space to be measured directly. Applying this technique to patients in neurointensive care has increased our understanding of the pathophysiology of traumatic brain injury and spontaneous hemorrhage. In parallel, it is important to determine the place of microdialysis in assisting in the management of patients on an individual intention to treat basis. This is made possible by the availability of analyzers which can measure the concentration of glucose, pyruvate, lactate, and glutamate at the bedside. Samples can then be stored for later analysis of other substrate and metabolites e.g., other amino acids and cytokines. The objective of this paper is to review the fundamental literature pertinent to the clinical application of microdialysis in neurointensive care and to give recommendations on how the technique can be applied to assist in patient management and contribute to outcome. A literature search detected 1,933 publications of which 55 were used for data abstraction and analysis. The role of microdialysis was evaluated in three conditions (traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage) and recommendations focused on three fundamental areas (relationship to outcome, application of microdialysis to guide therapy, and the ability of microdialysis to predict secondary deterioration).
Published: 2014

21. Clinical Monitoring Scales in Acute Brain Injury: Assessment of Coma, Pain, Agitation, and Delirium

Author: Riker, R, Fugate, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Robertson, C, Schmidt, J, Taccone, F, Riker R. R., Fugate J. E., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Robertson C., Schmidt J. M., Taccone F., Riker, R, Fugate, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Robertson, C, Schmidt, J, Taccone, F, Riker R. R., Fugate J. E., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation–Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.
Published: 2014

22. Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Author: Oddo, M, Bosel, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Oddo M., Bosel J., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Oddo, M, Bosel, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Oddo M., Bosel J., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.
Published: 2014

23. Monitoring of Cerebral Blood Flow and Ischemia in the Critically Ill

Author: Miller, C, Armonda, R, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Miller C., Armonda R., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Miller, C, Armonda, R, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Miller C., Armonda R., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Secondary ischemic injury is common after acute brain injury and can be evaluated with the use of neuromonitoring devices. This manuscript provides guidelines for the use of devices to monitor cerebral blood flow (CBF) in critically ill patients. A Medline search was conducted to address essential pre-specified questions related to the utility of CBF monitoring. Peer-reviewed recommendations were constructed according to the GRADE criteria based upon the available supporting literature. Transcranial Doppler ultrasonography (TCD) and transcranial color-coded duplex sonography (TCCS) are predictive of angiographic vasospasm and delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. TCD and TCCS may be beneficial in identifying vasospasm after traumatic brain injury. TCD and TCCS have shortcomings in identifying some secondary ischemic risks. Implantable thermal diffusion flowmetry (TDF) probes may provide real-time continuous quantitative assessment of ischemic risks. Data are lacking regarding ischemic thresholds for TDF or their correlation with ischemic injury and clinical outcomes.TCD and TCCS can be used to monitor CBF in the neurocritical care unit. Better and more developed methods of continuous CBF monitoring are needed to limit secondary ischemic injury in the neurocritical care unit.
Published: 2014

24. Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring

Author: Chesnut, R, Videtta, W, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Armonda, R, Badjatia, N, Boesel, J, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Chesnut R., Videtta W., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Armonda R., Badjatia N., Boesel J., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Chesnut, R, Videtta, W, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Armonda, R, Badjatia, N, Boesel, J, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Chesnut R., Videtta W., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Armonda R., Badjatia N., Boesel J., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.
Published: 2014

25. Monitoring of Cerebral Autoregulation

Author: Czosnyka, M, Miller, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Czosnyka M., Miller C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Czosnyka, M, Miller, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Czosnyka M., Miller C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Pressure autoregulation is an important hemodynamic mechanism that protects the brain against inappropriate fluctuations in cerebral blood flow in the face of changing cerebral perfusion pressure (CPP). Static autoregulation represents how far cerebrovascular resistance changes when CPP varies, and dynamic autoregulation represents how fast these changes happen. Both have been monitored in the setting of neurocritical care to aid prognostication and contribute to individualizing CPP targets in patients. Failure of autoregulation is associated with a worse outcome in various acute neurological diseases. Several studies have used transcranial Doppler ultrasound, intracranial pressure (ICP with vascular reactivity as surrogate measure of autoregulation), and near-infrared spectroscopy to continuously monitor the impact of spontaneous fluctuations in CPP on cerebrovascular physiology and to calculate derived variables of autoregulatory efficiency. Many patients who undergo such monitoring demonstrate a range of CPP in which autoregulatory efficiency is optimal. Management of patients at or near this optimal level of CPP is associated with better outcomes in traumatic brain injury. Many of these studies have utilized the concept of the pressure reactivity index, a correlation coefficient between ICP and mean arterial pressure. While further studies are needed, these data suggest that monitoring of autoregulation could aid prognostication and may help identify optimal CPP levels in individual patients.
Published: 2014

26. The International Multi-disciplinary Consensus Conference on Multimodality Monitoring: Future Directions and Emerging Technologies

Author: Vespa, P, Menon, D, Le Roux, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Vespa P., Menon D., Le Roux P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Vespa, P, Menon, D, Le Roux, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Vespa P., Menon D., Le Roux P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: Neuromonitoring has evolved rapidly in recent years and there now are many new monitors that have revealed a great deal about the ongoing pathophysiology of brain injury and coma. Further evolution will include the consolidation of multi-modality monitoring (MMM), the development of next-generation informatics tools to identify complex physiologic events and decision support tools to permit targeted individualized care. In this review, we examine future directions and emerging technologies in neuromonitoring including: (1) device development, (2) what is the current limitation(s) of MMM in its present format(s), (3) what would improve the ability of MMM to enhance neurocritical care, and (4) how do we develop evidence for use of MMM?
Published: 2014

27. Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations

Author: Helbok, R, Olson, D, Le Roux, P, Vespa, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Helbok R., Olson D. W. M., Le Roux P. D., Vespa P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Helbok, R, Olson, D, Le Roux, P, Vespa, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Helbok R., Olson D. W. M., Le Roux P. D., Vespa P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: The effect of intracranial pressure (ICP) and the role of ICP monitoring are best studied in traumatic brain injury (TBI). However, a variety of acute neurologic illnesses e.g., subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, meningitis/encephalitis, and select metabolic disorders, e.g., liver failure and malignant, brain tumors can affect ICP. The purpose of this paper is to review the literature about ICP monitoring in conditions other than TBI and to provide recommendations how the technique may be used in patient management. A PubMed search between 1980 and September 2013 identified 989 articles; 225 of which were reviewed in detail. The technique used to monitor ICP in non-TBI conditions is similar to that used in TBI; however, indications for ICP monitoring often are intertwined with the presence of obstructive hydrocephalus and hence the use of ventricular catheters is more frequent. Increased ICP can adversely affect outcome, particularly when it fails to respond to treatment. However, patients with elevated ICP can still have favorable outcomes. Although the influence of ICP-based care on outcome in non-TBI conditions appears less robust than in TBI, monitoring ICP and cerebral perfusion pressure can play a role in guiding therapy in select patients.
Published: 2014

28. Electrophysiologic Monitoring in Acute Brain Injury

Author: Claassen, J, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Claassen J., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Claassen, J, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, Claassen J., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., and Taccone F.
Abstract: To determine the optimal use and indications of electroencephalography (EEG) in critical care management of acute brain injury (ABI). An electronic literature search was conducted for articles in English describing electrophysiological monitoring in ABI from January 1990 to August 2013. A total of 165 studies were included. EEG is a useful monitor for seizure and ischemia detection. There is a well-described role for EEG in convulsive status epilepticus and cardiac arrest (CA). Data suggest EEG should be considered in all patients with ABI and unexplained and persistent altered consciousness and in comatose intensive care unit (ICU) patients without an acute primary brain condition who have an unexplained impairment of mental status. There remain uncertainties about certain technical details, e.g., the minimum duration of EEG studies, the montage, and electrodes. Data obtained from both EEG and EP studies may help estimate prognosis in ABI patients, particularly following CA and traumatic brain injury. Data supporting these recommendations is sparse, and high quality studies are needed. EEG is used to monitor and detect seizures and ischemia in ICU patients and indications for EEG are clear for certain disease states, however, uncertainty remains on other applications.
Published: 2014

29. Electrophysiologic monitoring in acute brain injury

Author: Claassen J., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Claassen, J, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Neurology, Critical Care, Traumatic brain injury, Ischemia, Electroencephalography, Critical Care and Intensive Care Medicine, EEG-fMRI, law.invention, Brain Ischemia, law, Seizures, medicine, Humans, Evoked potential, medicine.diagnostic_test, business.industry, Patient Selection, medicine.disease, Intensive care unit, Heart Arrest, Bispectral index, Electroencephalography, Evoked potential, Ischemia, Prognosis, Quantitative EEG, Seizure, Bispectral index, Anesthesia, Brain Injuries, Emergency medicine, Neurology (clinical), business
Abstract: To determine the optimal use and indications of electroencephalography (EEG) in critical care management of acute brain injury (ABI). An electronic literature search was conducted for articles in English describing electrophysiological monitoring in ABI from January 1990 to August 2013. A total of 165 studies were included. EEG is a useful monitor for seizure and ischemia detection. There is a well-described role for EEG in convulsive status epilepticus and cardiac arrest (CA). Data suggest EEG should be considered in all patients with ABI and unexplained and persistent altered consciousness and in comatose intensive care unit (ICU) patients without an acute primary brain condition who have an unexplained impairment of mental status. There remain uncertainties about certain technical details, e.g., the minimum duration of EEG studies, the montage, and electrodes. Data obtained from both EEG and EP studies may help estimate prognosis in ABI patients, particularly following CA and traumatic brain injury. Data supporting these recommendations is sparse, and high quality studies are needed. EEG is used to monitor and detect seizures and ischemia in ICU patients and indications for EEG are clear for certain disease states, however, uncertainty remains on other applications.
Published: 2014

30. Monitoring of brain and systemic oxygenation in neurocritical care patients

Author: Oddo M., Bosel J., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Oddo, M, Bosel, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, Taccone, F, and Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Subjects: medicine.medical_specialty, Neurology, Critical Care, Intracranial Pressure, business.industry, Traumatic brain injury, Neurointensive care, Reproducibility of Results, Brain Hypoxia, Oxygenation, Critical Care and Intensive Care Medicine, medicine.disease, Prognosis, Neurophysiological Monitoring, Brain oxygen, Carbon dioxide, Jugular oxygen saturation, Near-infrared spectroscopy, Neurocritical care, Systemic oxygenation, Oxygen monitoring, Intensive care, Brain Injuries, Medicine, Humans, Neurology (clinical), Oximetry, Cerebral perfusion pressure, business, Intensive care medicine
Abstract: Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.
Published: 2014

31. Intracranial pressure monitoring: fundamental considerations and rationale for monitoring

Author: Chesnut R., Videtta W., Vespa P., Le Roux P., Menon D. K., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Armonda R., Badjatia N., Boesel J., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Chesnut, R, Videtta, W, Vespa, P, Le Roux, P, Menon, D, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Armonda, R, Badjatia, N, Boesel, J, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Neurology, Critical Care, Intracranial Pressure, Traumatic brain injury, Physical examination, Critical Care and Intensive Care Medicine, medicine, Humans, Brain injury, Cerebral perfusion pressure, Coma, Intracranial pressure, Multimodality monitoring, Cerebral perfusion pressure, Intensive care medicine, Neurophysiological Monitoring, Intracranial pressure, integumentary system, medicine.diagnostic_test, business.industry, musculoskeletal, neural, and ocular physiology, Patient Selection, medicine.disease, Prognosis, nervous system diseases, Brain Injuries, Intracranial pressure monitoring, Observational study, Neurology (clinical), business
Abstract: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.
Published: 2014

32. Multimodality monitoring consensus statement: monitoring in emerging economies

Author: Figaji A., Puppo C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Riker R., Robertson C., Schmidt J. M., Taccone F., Figaji, A, Puppo, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Consensus, Critical Care, media_common.quotation_subject, Developing country, Context (language use), Critical Care and Intensive Care Medicine, Multimodality, Resource (project management), Clinical Protocols, Health care, medicine, Developing countries, Low- and middle-income countries, Multimodality monitoring, Neurocritical care, Traumatic brain injury, Humans, Quality (business), Intensive care medicine, Emerging markets, Developing Countries, media_common, business.industry, Patient Selection, Neurointensive care, medicine.disease, Neurophysiological Monitoring, Brain Injuries, Neurology (clinical), Medical emergency, business
Abstract: The burden of disease and so the need for care is often greater at hospitals in emerging economies. This is compounded by frequent restrictions in the delivery of good quality clinical care due to resource limitations. However, there is substantial heterogeneity in this economically defined group, such that advanced brain monitoring is routinely practiced at certain centers that have an interest in neurocritical care. It also must be recognized that significant heterogeneity in the delivery of neurocritical care exists even within individual high-income countries (HICs), determined by costs and level of interest. Direct comparisons of data between HICs and the group of low- and middle-income countries (LAMICs) are made difficult by differences in patient demographics, selection for ICU admission, therapies administered, and outcome assessment. Evidence suggests that potential benefits of multimodality monitoring depend on an appropriate environment and clinical expertise. There is no evidence to suggest that patients in LAMICs where such resources exist should be treated any differently to patients from HICs. The potential for outcome benefits in LAMICs is arguably greater in absolute terms because of the large burden of disease; however, the relative cost/benefit ratio of such monitoring in this setting must be viewed in context of the overall priorities in delivering health care at individual institutions.
Published: 2014

33. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care

Author: Le Roux, P, Menon, D, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boeesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, McNett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, M, Taccone, F., CITERIO, GIUSEPPE, Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boeesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, M, and Taccone, F
Subjects: multimodality monitoring in intensive care
Abstract: Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data. © 2014 Springer-Verlag and ESICM.
Published: 2014

34. Monitoring of Cerebral Blood Flow and Ischemia in the Critically Ill

Author: Miller C., Armonda R., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Miller, C, Armonda, R, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: Subarachnoid hemorrhage, Critical Care, Traumatic brain injury, Ultrasonography, Doppler, Transcranial, Ischemia, Critical Care and Intensive Care Medicine, Brain Ischemia, medicine, Neurocritical care, Humans, medicine.diagnostic_test, business.industry, Neurointensive care, Transcranial Doppler, Vasospasm, Cerebral blood flow, medicine.disease, Cerebral Angiography, Thermal diffusion flowmetry, Anesthesia, Cerebrovascular Circulation, cardiovascular system, Neurology (clinical), business, Rheology, Cerebral angiography, Multimodality monitoring
Abstract: Secondary ischemic injury is common after acute brain injury and can be evaluated with the use of neuromonitoring devices. This manuscript provides guidelines for the use of devices to monitor cerebral blood flow (CBF) in critically ill patients. A Medline search was conducted to address essential pre-specified questions related to the utility of CBF monitoring. Peer-reviewed recommendations were constructed according to the GRADE criteria based upon the available supporting literature. Transcranial Doppler ultrasonography (TCD) and transcranial color-coded duplex sonography (TCCS) are predictive of angiographic vasospasm and delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. TCD and TCCS may be beneficial in identifying vasospasm after traumatic brain injury. TCD and TCCS have shortcomings in identifying some secondary ischemic risks. Implantable thermal diffusion flowmetry (TDF) probes may provide real-time continuous quantitative assessment of ischemic risks. Data are lacking regarding ischemic thresholds for TDF or their correlation with ischemic injury and clinical outcomes.TCD and TCCS can be used to monitor CBF in the neurocritical care unit. Better and more developed methods of continuous CBF monitoring are needed to limit secondary ischemic injury in the neurocritical care unit.
Published: 2014

35. Clinical Monitoring Scales in Acute Brain Injury: Assessment of Coma, Pain, Agitation, and Delirium

Author: Riker R. R., Fugate J. E., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Robertson C., Schmidt J. M., Taccone F., Riker, R, Fugate, J, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Robertson, C, Schmidt, J, and Taccone, F
Subjects: medicine.medical_specialty, Neurology, Critical Care, Sedation, Pain, Disorders of consciousness, Critical Care and Intensive Care Medicine, medicine, Humans, Coma, Intensive care medicine, Psychomotor Agitation, Coma, Delirium, Neurologic examination, Pain, Scale, Sedation, Neurologic Examination, Trauma Severity Indices, business.industry, Glasgow Coma Scale, Neurointensive care, Delirium, Reproducibility of Results, Pain scale, medicine.disease, Anesthesia, Brain Injuries, Neurology (clinical), medicine.symptom, business
Abstract: Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation–Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.
Published: 2014

36. Monitoring of Cerebral Autoregulation

Author: Czosnyka M., Miller C., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Hutchinson P., Kumar M., McNett M., Naidech A., Oddo M., Olson D., O'Phelan K., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Czosnyka, M, Miller, C, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: Mean arterial pressure, Critical Care, Intracranial Pressure, Traumatic brain injury, business.industry, musculoskeletal, neural, and ocular physiology, Autoregulation, Cerebral blood flow, Cerebral perfusion pressure, Near-infrared spectroscopy, Pressure reactivity, Transcranial doppler ultrasound, Prognosis, Critical Care and Intensive Care Medicine, medicine.disease, Neurophysiological Monitoring, Cerebral autoregulation, Transcranial Doppler, Cerebral blood flow, Brain Injuries, Cerebrovascular Circulation, Anesthesia, medicine, Homeostasis, Humans, Autoregulation, Neurology (clinical), Cerebral perfusion pressure, business, Intracranial pressure
Abstract: Pressure autoregulation is an important hemodynamic mechanism that protects the brain against inappropriate fluctuations in cerebral blood flow in the face of changing cerebral perfusion pressure (CPP). Static autoregulation represents how far cerebrovascular resistance changes when CPP varies, and dynamic autoregulation represents how fast these changes happen. Both have been monitored in the setting of neurocritical care to aid prognostication and contribute to individualizing CPP targets in patients. Failure of autoregulation is associated with a worse outcome in various acute neurological diseases. Several studies have used transcranial Doppler ultrasound, intracranial pressure (ICP with vascular reactivity as surrogate measure of autoregulation), and near-infrared spectroscopy to continuously monitor the impact of spontaneous fluctuations in CPP on cerebrovascular physiology and to calculate derived variables of autoregulatory efficiency. Many patients who undergo such monitoring demonstrate a range of CPP in which autoregulatory efficiency is optimal. Management of patients at or near this optimal level of CPP is associated with better outcomes in traumatic brain injury. Many of these studies have utilized the concept of the pressure reactivity index, a correlation coefficient between ICP and mean arterial pressure. While further studies are needed, these data suggest that monitoring of autoregulation could aid prognostication and may help identify optimal CPP levels in individual patients.
Published: 2014

37. International Multidisciplinary Consensus Conference on Multimodality Monitoring: Cerebral Metabolism

Author: Hutchinson P., O'Phelan K., Le Roux P., Menon D. K., Vespa P., Citerio G., Bader M. K., Brophy G. M., Diringer M. N., Stocchetti N., Videtta W., Armonda R., Badjatia N., Boesel J., Chesnut R., Chou S., Claassen J., Czosnyka M., De Georgia M., Figaji A., Fugate J., Helbok R., Horowitz D., Kumar M., McNett M., Miller C., Naidech A., Oddo M., Olson D., Provencio J., Puppo C., Riker R., Robertson C., Schmidt J. M., Taccone F., Hutchinson, P, O'Phelan, K, Le Roux, P, Menon, D, Vespa, P, Citerio, G, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Boesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, J, and Taccone, F
Subjects: Microdialysis, medicine.medical_specialty, Subarachnoid hemorrhage, Neurology, Consensus, Critical Care, Traumatic brain injury, Critical Care and Intensive Care Medicine, Multidisciplinary approach, medicine, Humans, Intensive care medicine, Intracerebral hemorrhage, Intention-to-treat analysis, business.industry, Glucose, Glutamate, Intracerebral hemorrhage, Lactate, Lactate pyruvate ratio, Microdialysis, Subarachnoid hemorrhage, Traumatic brain injury, Neurointensive care, Brain, Subarachnoid Hemorrhage, medicine.disease, Neurophysiological Monitoring, Brain Injuries, Neurology (clinical), business, Biomarkers
Abstract: Microdialysis is a powerful technique, which enables the chemistry of the extracellular space to be measured directly. Applying this technique to patients in neurointensive care has increased our understanding of the pathophysiology of traumatic brain injury and spontaneous hemorrhage. In parallel, it is important to determine the place of microdialysis in assisting in the management of patients on an individual intention to treat basis. This is made possible by the availability of analyzers which can measure the concentration of glucose, pyruvate, lactate, and glutamate at the bedside. Samples can then be stored for later analysis of other substrate and metabolites e.g., other amino acids and cytokines. The objective of this paper is to review the fundamental literature pertinent to the clinical application of microdialysis in neurointensive care and to give recommendations on how the technique can be applied to assist in patient management and contribute to outcome. A literature search detected 1,933 publications of which 55 were used for data abstraction and analysis. The role of microdialysis was evaluated in three conditions (traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage) and recommendations focused on three fundamental areas (relationship to outcome, application of microdialysis to guide therapy, and the ability of microdialysis to predict secondary deterioration).
Published: 2014

38. Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

Author: Badjatia, N., primary, Monahan, A., additional, Carpenter, A., additional, Zimmerman, J., additional, Schmidt, J. M., additional, Claassen, J., additional, Connolly, E. S., additional, Mayer, S. A., additional, Karmally, W., additional, and Seres, D., additional
Published: 2015
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39. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: Evidentiary Tables : A Statement for Healthcare Professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine

Author: Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Bösel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Javier Provencio, J, Puppo, C, Riker, R, Roberson, C, Schmidt, M, Taccone, F, McNett, M, Taccone, F., CITERIO, GIUSEPPE, Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Bösel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Javier Provencio, J, Puppo, C, Riker, R, Roberson, C, Schmidt, M, Taccone, F, McNett, M, Taccone, F., and CITERIO, GIUSEPPE
Abstract: A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.
Published: 2014

40. Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine

Author: Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Böesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, M, Taccone, F, CITERIO, GIUSEPPE, McNett, M, Taccone, F., Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Böesel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O'Phelan, K, Provencio, J, Puppo, C, Riker, R, Robertson, C, Schmidt, M, Taccone, F, CITERIO, GIUSEPPE, McNett, M, and Taccone, F.
Abstract: Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.
Published: 2014

41. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: A List of Recommendations and Additional Conclusions: A Statement for Healthcare Professionals From the Neurocritical Care Society and the European Society of Intensive Care Medicine

Author: Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Bösel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O’Phelan, K, Provencio, J, Puppo, C, Riker, R, Roberson, C, Schmidt, M, Taccone, F, McNett, M, Le Roux, P, Menon, D, Citerio, G, Vespa, P, Bader, M, Brophy, G, Diringer, M, Stocchetti, N, Videtta, W, Armonda, R, Badjatia, N, Bösel, J, Chesnut, R, Chou, S, Claassen, J, Czosnyka, M, De Georgia, M, Figaji, A, Fugate, J, Helbok, R, Horowitz, D, Hutchinson, P, Kumar, M, Mcnett, M, Miller, C, Naidech, A, Oddo, M, Olson, D, O’Phelan, K, Provencio, J, Puppo, C, Riker, R, Roberson, C, Schmidt, M, Taccone, F, and McNett, M
Abstract: Careful patient monitoring using a variety of techniques including clinical and laboratory evaluation, bedside physiological monitoring with continuous or non-continuous techniques and imaging is fundamental to the care of patients who require neurocritical care. How best to perform and use bedside monitoring is still being elucidated. To create a basic platform for care and a foundation for further research the Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to develop recommendations about physiologic bedside monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews as a background to the recommendations. In this article, we highlight the recommendations and provide additional conclusions as an aid to the reader and to facilitate bedside care.
Published: 2014

42. Achieving normothermia in febrile subarachnoid hemorrhage patients: feasibility and safety of a novel intravascular cooling catheter. (Poster Abstracts)

Author: O'Donnell, J, Guanci, M, Badjatia, N, and McDonald, CT
Subjects: Subarachnoid hemorrhage -- Care and treatment, Body temperature -- Health aspects -- Management, Health, Health care industry, Company business management, Management, Care and treatment, Health aspects
Abstract: Purpose: The purpose of this study was to see if the sub-arachnoid hemorrhage (SAH) patient with fever could be kept normothermic using the Intravascular Cooling Catheter (ICC), (Celcius Contro™ System, [...]
Published: 2003

43. Effect of rebleeding on the course and incidence of vasospasm after subarachnoid hemorrhage.

Author: Lord AS, Fernandez L, Schmidt JM, Mayer SA, Claassen J, Lee K, Connolly ES, Badjatia N, Lord, A S, Fernandez, L, Schmidt, J M, Mayer, S A, Claassen, J, Lee, K, Connolly, E S, and Badjatia, N
Published: 2012
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44. A Common Single Nucleotide Polymorphism Within Hemostasis Pathways Is Associated with Hematoma Expansion After Intracerebral Hemorrhage

Author: Appelboom, G., primary, Piazza, M., additional, Bruce, S.S., additional, Hwang, B., additional, Badjatia, N., additional, Drogba, L., additional, De Witte, O., additional, and Connolly, S., additional
Published: 2013
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45. Early neurological deterioration after subarachnoid haemorrhage: risk factors and impact on outcome

Author: Helbok, R., primary, Kurtz, P., additional, Vibbert, M., additional, Schmidt, M. J., additional, Fernandez, L., additional, Lantigua, H., additional, Ostapkovich, N. D., additional, Connolly, S. E., additional, Lee, K., additional, Claassen, J., additional, Mayer, S. A., additional, and Badjatia, N., additional
Published: 2012
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46. Posterior Reversible Encephalopathy Syndrome in a Patient with Microscopic Polyangiitis (P01.127)

Author: Minen, M., primary, Gold, C., additional, and Badjatia, N., additional
Published: 2012
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47. Impact of Underfeeding and Protein Catabolism on Hospital-Acquired Infections after Subarachnoid Hemorrhage (S19.004)

Author: Badjatia, N., primary, Monahan, A., additional, Carpenter, A., additional, Friedman, L., additional, Zimmerman, J., additional, Schmidt, J. M., additional, Claassen, J., additional, Lee, K., additional, Connolly, S., additional, Mayer, S., additional, Karmally, W., additional, and Seres, D., additional
Published: 2012
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48. Comparison between Institutionally-Defined Clinical Criteria and CDC-Criteria for the Diagnosis of Ventriculostomy-Related Infection (P02.220)

Author: Czeisler, B., primary, Choi, H. A., additional, Guo, K., additional, Bernstein, P., additional, Presciutti, M., additional, Lantigua, H., additional, Carpenter, A., additional, Zhang, J., additional, Ko, S.-B., additional, Schmidt, J. M., additional, Claassen, J., additional, Mayer, S., additional, Lee, K., additional, Connolly, E. S., additional, and Badjatia, N., additional
Published: 2012
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49. Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage (P06.257)

Author: Ortega-Gutierrez, S., primary, Petersen, N., additional, Reccius, A., additional, Huang, A., additional, Linares-Tapia, G., additional, Marshall, R., additional, and Badjatia, N., additional
Published: 2012
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50. Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation

Author: Ko, S.- B., primary, Choi, H. A., additional, Gilmore, E., additional, Schmidt, J. M., additional, Claassen, J., additional, Lee, K., additional, Mayer, S. A., additional, and Badjatia, N., additional
Published: 2012
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