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1. Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Author

Anselmo Caricato, Giacomo Della Marca, Eleonora Ioannoni, Serena Silva, Tiziana Benzi Markushi, Eleonora Stival, Daniele Guerino Biasucci, Nicola Montano, Camilla Gelormini, and Isabella Melchionda

Subjects
Electroencephalography, Seizures, Critical care, Continuous EEG, NeuroIntensive care, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.

Published
2020
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2. Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Author

Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Piergiorgio Bresil, Marianne Levin, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson, Robba, C, Graziano, F, Guglielmi, A, Rebora, P, Galimberti, S, Taccone, F, Citerio, G, Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, and Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Vera Spatenkova, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Charikleia Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Primoz Gradisek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson

Subjects
Subarachnoid haemorrhage, Traumatic brain injury, Intracranial pressure, Therapy intensity level, Critical Care and Intensive Care Medicine, Intracranial haemorrhage
Abstract

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with sixmonths mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p

Published
2023
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3. Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study

Author

Fabio Pilato, Serena Silva, Iacopo Valente, Marisa Distefano, Aldobrando Broccolini, Valerio Brunetti, Pietro Caliandro, Giacomo Della Marca, Riccardo Di Iorio, Giovanni Frisullo, Mauro Monforte, Roberta Morosetti, Carla Piano, Rosalinda Calandrelli, Fioravante Capone, Andrea Alexandre, Alessandro Pedicelli, Cesare Colosimo, and Anselmo Caricato

Subjects
acute ischemic stroke, neuro-intensive care unit, thrombolysis, thrombectomy, outcome, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.

Published
2020
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4. Phenotypes of Patients with COVID-19 Who Have a Positive Clinical Response to Helmet Noninvasive Ventilation

Author

Domenico Luca Grieco, Luca S. Menga, Melania Cesarano, Savino Spadaro, Maria Maddalena Bitondo, Cecilia Berardi, Tommaso Rosà, Filippo Bongiovanni, Salvatore Maurizio Maggiore, Massimo Antonelli, Jonathan Montomoli, Giulia Falò, Tommaso Tonetti, Salvatore L. Cutuli, Gabriele Pintaudi, Eloisa S. Tanzarella, Edoardo Piervincenzi, Antonio M. Dell’Anna, Luca Delle Cese, Simone Carelli, Maria Grazia Bocci, Luca Montini, Giuseppe Bello, Daniele Natalini, Gennaro De Pascale, Matteo Velardo, Carlo Alberto Volta, V. Marco Ranieri, Giorgio Conti, Riccardo Maviglia, Giovanna Mercurio, Paolo De Santis, Mariano Alberto Pennisi, Gian Marco Anzellotti, Flavia Torrini, Carlotta Rubino, Tony C. Morena, Veronica Gennenzi, Stefania Postorino, Joel Vargas, Nicoletta Filetici, Donatella Settanni, Miriana Durante, Laura Cascarano, Mariangela Di Muro, Roberta Scarascia, Martina Murdolo, Alessandro Mele, Serena Silva, Carmelina Zaccone, Francesca Pozzana, Alessio Maccaglia, Martina Savino, Antonella Potalivo, Francesca Ceccaroni, Angela Scavone, Gianmarco Lombardi, and Teresa Michi

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Critical Care and Intensive Care Medicine, Respiratory Rate, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Intubation, Intratracheal, Humans, Medicine, Aged, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, COVID-19, Middle Aged, Phenotype, Respiratory Function Tests, Treatment Outcome, Italy, Female, Noninvasive ventilation, business, Phenotypes of Patients with COVID-19
Published
2022
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6. Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Author

Tiziana Benzi Markushi, Camilla Gelormini, Giacomo Della Marca, Eleonora Ioannoni, Daniele G Biasucci, Anselmo Caricato, Nicola Montano, Isabella Melchionda, Serena Silva, and Eleonora Stival

Subjects
Male, medicine.medical_specialty, Headset, Electroencephalography, Continuous EEG, law.invention, NeuroIntensive care, lcsh:RD78.3-87.3, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, law, Seizures, Settore MED/41 - ANESTESIOLOGIA, medicine, Wireless, Humans, Prospective Studies, Electrodes, Monitoring, Physiologic, medicine.diagnostic_test, Critically ill, business.industry, Neurointensive care, 030208 emergency & critical care medicine, Equipment Design, Middle Aged, Intensive care unit, Intensive Care Units, Critical care, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, Settore MED/41, Feasibility Studies, Female, business, Skin lesion, Eeg monitoring, Wireless Technology, 030217 neurology & neurosurgery, Research Article
Abstract

Background In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.

Published
2020

7. Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study

Author

Fioravante Capone, Fabio Pilato, Andrea Alexandre, Mauro Monforte, Giovanni Frisullo, Riccardo Di Iorio, Cesare Colosimo, Rosalinda Calandrelli, Giacomo Della Marca, Anselmo Caricato, Iacopo Valente, Roberta Morosetti, Alessandro Pedicelli, Valerio Brunetti, Serena Silva, Marisa Distefano, Carla Piano, Pietro Caliandro, and Aldobrando Broccolini

Subjects
medicine.medical_specialty, acute ischemic stroke, thrombolysis, medicine.medical_treatment, 030204 cardiovascular system & hematology, Article, law.invention, lcsh:RC321-571, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Intensive care, medicine, In patient, Prospective cohort study, neuro-intensive care unit, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, Cerebral infarction, business.industry, General Neuroscience, Thrombolysis, Odds ratio, medicine.disease, Intensive care unit, Confidence interval, Settore MED/26 - NEUROLOGIA, thrombectomy, outcome, business, 030217 neurology & neurosurgery
Abstract

Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78, 95% confidence interval (CI), 1.20&ndash, 11.90, p = 0.023) and early naso-gastric tube removal (OR, 3.32, 95% CI, 1.04&ndash, 10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase, 95% CI, 0.61&ndash, 0.85, p &lt, 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase, 95% CI, 0.92&ndash, 0.99, p = 0.020) and hemorrhagic transformation (OR, 0.31, 95% CI, 0.11&ndash, 0.84, p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86, 95% CI, 1.65&ndash, 37.39, p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.

Published
2020

8. Delayed cerebral ischemia: is it time to change our practice?

Author

Serena Silva and Anselmo Caricato

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, business.industry, Ischemia, MEDLINE, Vasospasm, Cerebral ischemia, medicine.disease, Brain Ischemia, Brain ischemia, Anesthesiology and Pain Medicine, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, medicine, Cardiology, Humans, Vasospasm, Intracranial, business
Published
2020

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