SNACC’s article of the month for July is an excellent narrative review on the pharmacodynamics of vasopressors in health and in the setting of brain injury. The review is preceded by an introductory commentary by neuroscand.com contributor Dr. Riikka Takala.
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.
From our quality-focused colleagues at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) comes this set of guidelines for management of the most common emergencies encountered in neuroanaesthetic practice. Conceived with the purpose of addressing complex emergent issues in a concise, goal-directed and simplified manner, these cognitive aids are clear-cut and based on… Continue reading SNACC – How to Handle Neuroanaesthetic Emergencies
Just published: the European Society of Intensive Care Medicine´s consensus document on fluid administration in the NICU. It covers all manner of neurocritical conditions and sums up the available evidence for various fluid therapy approaches. As expected there are few recommendations that aren´t already well established and by now fairly uncontroversial (multimodal monitoring, avoiding colloids,… Continue reading Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation
We covered the subject of beta-blockade in traumatic brain injury last autumn in this article, where we summarised the increasing evidence that it seems to improve survival. A recently published trial (free full text) in the Journal of Trauma and Acute Care Surgery adds further credence to the role of beta-blockers in this patient group. This… Continue reading Another Trial Suggesting Beta-blockers Are Beneficial in TBI: Time for an RCT!
We all recall the elegant curves that ostensibly show the neat relationship between mean arterial blood pressure (or CPP) and cerebral blood flow. This relationship classically has its lower and upper limits, beyond which CBF will vary passively with the systemic pressure. Stay within these limits and all is good, the mantra goes. However, as… Continue reading Cerebral Autoregulation – What do we know?
This is a subject that has been on our backburner for a while and it’s now due for a discussion on neuroscand.com. The use of beta-blockers in traumatic brain injury is nothing new. The indications have been largely centered on targeting and preventing paroxysmal sympathetic hyperactivity (PSH) and associated post-TBI autonomic phenomena. Please see our… Continue reading Beta-blockers and TBI
We have probably all struggled with these phenomena in our TBI patients in the neuro ICU: swinging blood pressures, episodic tachycardia and fever, occurring even several weeks after the initial traumatic event. In this article in the Lancet, Meyfroidt and colleagues offer us some insight into the clinical syndrome now known as paroxysmal sympathetic hyperreactivity.… Continue reading Lancet: Paroxysmal Sympathetic Hyperactivity after TBI – An Underrecognized Clinical Entity
Excellent review of asssessment of cerebral circulation by Donnelly et al. in Critical Care May 2016. The authors go through most of today’s available modalities and review their utility in neurocritical care. Find the article here.
It is widely accepted that hypotension in patients with traumatic brain injury is associated with poorer outcomes, as confirmed in a number of studies. But is there really a reliable cut-off for when we should be happy with a TBI patient´s blood pressure in a prehospital setting? A recent article in JAMA Surgery (Spaite et… Continue reading Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?