In this post, my first one for 2021, I was lucky enough to be able to choose between a number of great recent publications. Unable to decide, I ended up including them all in one go. As they all centre around a common theme of ICP and haemodynamics, lumping them together didn’t seem entirely illogical.… Continue reading January Roundup: Selected Articles on ICP, Haemodynamic Targets in Acute Brain Injury
In December 2019 the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society and the Neuro Anaesthesia and Critical Care Society published their joint guidelines on how to safely transfer patients with acute brain injury to the appropriate level of care. Focusing on TBI and stroke-related brain injury, this consensus document outlines both… Continue reading Joint AAGBI & NACCS Guidelines on Safe Transfer of the Brain Injured Patient
The landmark 2016 ATACH II trial compared aggressive blood pressure lowering (110-139 mmHg) with standard BP-targets (140-180) in patients with spontaneous ICH, and found no difference between the groups. The main endpoints were mortality and functional neurological outcome (modified Rankin scale). The only discernible difference was a tendency towards less haematoma expansion in the intervention… Continue reading ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome
Intracerebral haemorrhage is associated with a number of haemodynamic consequences. These are not just limited to arrhythmias. Lele and colleagues have summarised the most common and important ones in this review in the Journal of Neurosurgical Anesthesiology.
Meyfroidt and colleagues recently published a commentary in Intensive Care Medicine addressing ten tenets in neurocritical care that merit debate. The article deals with the following ten statements: 1. Only neurointensivists should care about the brain. 2. Clinical examination of neurocritically ill patients is impossible. 3. We should no longer monitor ICP in traumatic brain… Continue reading Meyfroidt et al in ICM: Ten false beliefs in neurocritical care
Tranexamic acid (TXA) has been held as something of a wonder drug. It’s cheap, largely demonstrated to be safe and has been given a role in a number of settings. The 2013 CRASH-2 trial showed improved survival in trauma with bleeding, and thus became one of the most widely cited publications in traumatology and emergency medicine. Several… Continue reading TICH-2: No Benefit From TXA in ICH. What Now?
The 2015 joint American Heart Association/American Stroke Association guidelines for ICH-management can be found here.
Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range. The trial was discontinued early after an interim analysis showed no difference between the groups in… Continue reading ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH
Transfusing thrombocytes to patients taking anti-platelet therapy who develop an intracerebral hemorrhage seems to confer harm, according to the authors of the PATCH trial (abstract). Published recently in the Lancet by Baharoglu et al, this multicentre RCT included 190 patients in order to determine whether platelet transfusion reduces extent of haemorrhage, thereby improving outcome, in ICH associated with… Continue reading PATCH – Trial: Platelets in ICH Harmful
A quick review published in BMJ´s Best Evidence Topic Reports series, April 2016 by Kapil Mohan Rajwani and Azlisham Mohd Nor. They address the issue of lowering elevated blood pressures in patients with an acute ICH. Is it safe and is there evidence to support active BP-management? And if yes, what´s our target? Targeted blood pressure management in… Continue reading Best BETs – Safe to Lower BP in ICH?