Archive for the ‘Neuro’ Category

Sleep like a baby?

The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients.
Patel J, Baldwin J, Bunting P, Laha S
Anaesthesia. 2014 Jun;69(6):540-9

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BIS – magic prediction post arrest ?

A fascinating paper very well reviewed by Dr. James Dawson at the QMC journal club;

The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest Intensive Care Med. 2010 Feb;36(2):281-8. Epub 2009 Oct 22. Continue reading

Special K – time for a reappraisal ?

2 recent articles highlight the potential benefit of an often overlooked induction agent in critically ill patients.

Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Jabre, P. et al. Lancet. Volume 374, Issue 9686, Pages 293 – 300, 25 July 2009.

This multicentre, randomised, blinded trial in 65 french ICUs & 12 field teams enrolled 655 patients to either etomidate or ketamine for emergent intubation for critical illness. Patients were analysed only if they remained in ICU after day 3 (469). Adequate and reasonable power calculation, including predetermined septic & trauma subgroups. Primary end point was maximal SOFA score within 3 days (chosen as etomidate’s effects on adrenocortical axis thought to last <48 hrs). Secondary end points included intubation conditions, and 28 day ICU stay, catecholamine requirement, mortality & adrenocortical insufficiency. Continue reading

Management of Subarachnoid Heamorrhage

Management of aneurysmal subarachnoid heamorrhage. Dringer. M. Critical Care Medicine 37 (2) Feb 2009; 432-440.

A useful & comprehensive educational review article from CCM on the management of SAH, highlighted for interest. Unfortunately for copyright reasons we can’t provide a link to the pdf, but you can access it from the above link if you have an ATHENS account.

Weaning & Extubation Protocols in Neuro ICU

Rate of Re-intubation in mechanically ventilated patient neurosurgical patients : An evaluation of a systematic approach to weaning & extubation. Navalesi, P et al. Critical Care Medicine 2008 (36) 11.

This article was recently presented at QMC’s ICM journal club, who have kindly offered their presentation for inclusion on Critical Insight. You can find it in the blue box on the right, named “QMC Neuro Extubation CCM 2008”.  If your journal club would also like to submit presentations please see the “how to post” page for more info.