Author: "Brophy G. M." - Searchworks@Jio Institute Digital Library Search Results

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1. Early hemostatic responses to trauma identified with hierarchical clustering analysis

Author: White, N. J., Contaifer, D., Jr, Martin, E. J., Newton, J. C., Mohammed, B. M., Bostic, J. L., Brophy, G. M., Spiess, B. D., Pusateri, A. E., Ward, K. R., and Brophy, D. F.
Published: 2015
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2. 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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3. 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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4. 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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5. 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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6. 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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7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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. Safety of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial

Author: Brophy, G. M., Mazzeo, Anna, Robles, J. R., Gilman, C. G., Hayes, R. L., and Bullock, M. R.
Subjects: Cyclosporin A
Published: 2008

30. Vestibular influences on cat lumbar paravertebral muscles

Author: Brophy, G. M., Rossiter, C. D., Bolton, P. S., and Yates, B. J.
Published: 1997
Full Text: View/download PDF

31. Clinical utility of serum levels of ubiquitin C-terminal hydrolase as a biomarker for severe traumatic brain injury

Author: Mondello, S., Linnet, A., Buki, A., Robicsek, S., Gabrielli, A., Tepas, J., Papa, L., Brophy, G. M., Tortella, F., Hayes, R. L., and Kevin Wang
Subjects: Proteomics, Adult, Male, Critical Care, Adolescent, Biomarkers, Critical Care, Diagnosis, Head Injury, Outcome, Proteomics, UCH-L1, Enzyme-Linked Immunosorbent Assay, Article, Young Adult, Predictive Value of Tests, UCH-L1, Diagnosis, Humans, Glasgow Coma Scale, Prospective Studies, Outcome, Aged, Aged, 80 and over, Trauma Severity Indices, Middle Aged, Head Injury, Brain Injuries, Case-Control Studies, Acute Disease, Female, Ubiquitin Thiolesterase, Biomarkers
Abstract: Brain damage markers released in cerebrospinal fluid (CSF) and blood may provide valuable information about diagnosis and outcome prediction after traumatic brain injury (TBI).To examine the concentrations of ubiquitin C-terminal hydrolase-L1 (UCH-L1), a novel brain injury biomarker, in CSF and serum of severe TBI patients and their association with clinical characteristics and outcome.This case-control study enrolled 95 severe TBI subjects (Glasgow Coma Scale [GCS] score, 8). Using sensitive UCH-L1 sandwich ELISA, we studied the temporal profile of CSF and serum UCH-L1 levels over 7 days for severe TBI patients.Comparison of serum and CSF levels of UCH-L1 in TBI patients and control subjects shows a robust and significant elevation of UCH-L1 in the acute phase and over the 7-day study period. Serum and CSF UCH-L1 receiver-operating characteristic curves further confirm strong specificity and selectivity for diagnosing severe TBI vs controls, with area under the curve values in serum and CSF statistically significant at all time points up to 24 hours (P.001). The first 12-hour levels of both serum and CSF UCH-L1 in patients with GCS score of 3 to 5 were also significantly higher than those with GCS score of 6 to 8. Furthermore, UCH-L1 levels in CSF and serum appear to distinguish severe TBI survivors from nonsurvivors within the study, with nonsurvivors having significantly higher and more persistent levels of serum and CSF UCH-L1. Cumulative serum UCH-L1 levels5.22 ng/mL predicted death (odds ratio, 4.8).Serum levels of UCH-L1 appear to have potential clinical utility in diagnosing TBI, including correlating to injury severity and survival outcome.

32. Adjunctive rifampin therapy for central nervous system staphylococcal infections.

Author: Brackbill ML and Brophy GM
Subjects: Central Nervous System Diseases microbiology, Humans, Retrospective Studies, Staphylococcal Infections microbiology, Staphylococcus aureus drug effects, Treatment Outcome, Antibiotics, Antitubercular therapeutic use, Central Nervous System Diseases drug therapy, Rifampin therapeutic use, Staphylococcal Infections drug therapy
Abstract: Objective: To review the published clinical data assessing the role of adjunctive rifampin therapy for the treatment of staphylococcal central nervous system (CNS) infections., Data Sources: A MEDLINE search (January 1966-March 2000) of English-language literature pertaining to CNS staphylococcal infections and rifampin was performed; tertiary sources were also used., Data Extraction: Human data and case reports were included, as no clinical trials have been published., Data Synthesis: Retrospective reviews of rifampin used in combination with other antibiotics for serious bacterial infections show conflicting results. Few case reports have described clinical successes with adjunctive rifampin therapy for CNS infections., Conclusions: The routine use of adjunctive rifampin for CNS infections cannot be justified.
Published: 2001
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33. Multidisciplinary management of sedation and analgesia in critical care.

Author: Sessler CN, Grap MJ, and Brophy GM
Abstract: Management of sedation and analgesia in critical care medicine is a multidisciplinary process that involves physicians, nurses, pharmacists, and other healthcare providers. Optimal management of these common issues includes recognition of the importance of predisposing and causative conditions that contribute to the sensations of pain and discomfort, anxiety, and delirium. Treatment includes pharmacological intervention, correction of predisposing factors, and use of other preventative and nonpharmacological measures. It is increasingly clear that, although necessary for patient comfort, sedative and analgesic medications can have adverse consequences, including side-effects as well as prolonged mechanical ventilation and ICU length of stay. Optimal use of sedative and analgesic medications involves matching unique properties of specific medications with individual patient characteristics. Guidelines that minimize unnecessary variability in practice, prevent excessive medication, and emphasize management based on individual patient characteristics improve the effective utilization of these medications.
Published: 2001
Full Text: View/download PDF

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33 results on '"Brophy G. M."'

1. Early hemostatic responses to trauma identified with hierarchical clustering analysis

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

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

4. International Multidisciplinary Consensus Conference on Multimodality Monitoring: ICU Processes of Care

5. Monitoring Nutrition and Glucose in Acute Brain Injury

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

7. Electrophysiologic monitoring in acute brain injury

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

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

10. Multimodality monitoring consensus statement: monitoring in emerging economies

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

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

13. Monitoring of Cerebral Autoregulation

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

15. International Multidisciplinary Consensus Conference on Multimodality Monitoring: ICU Processes of Care

16. Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies

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

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

19. Monitoring Nutrition and Glucose in Acute Brain Injury

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

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

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

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

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

25. Monitoring of Cerebral Autoregulation

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

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

28. Electrophysiologic Monitoring in Acute Brain Injury

29. Safety of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial

30. Vestibular influences on cat lumbar paravertebral muscles

31. Clinical utility of serum levels of ubiquitin C-terminal hydrolase as a biomarker for severe traumatic brain injury

32. Adjunctive rifampin therapy for central nervous system staphylococcal infections.

33. Multidisciplinary management of sedation and analgesia in critical care.

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33 results on '"Brophy G. M."'

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