Lactate is well-known as an important energy substrate for brain tissue and plays a key role in neuroenergetics. Experimental data have shown that exogenous lactate administration may improve metabolism in injured brain cells, and possibly has neuroprotective properties. Till now there has been a paucity of human clinical studies on this subject. Carteron et al… Continue reading Lactate Improves Cerebral Perfusion After Acute Brain Injury – Recent Clinical Trial in Crit Care Med
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
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?
Okonkwo et al, ten ICUs in the United States. Read their article in Critical Care Medicine, November 2017-issue. They found that management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue monitoring reduced brain tissue hypoxia, with a trend toward lower mortality and more favorable outcomes, compared with treatment guided by… Continue reading Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial
A bit more ICP-material for our basic science portfolio: Medscape´s review by Czosnyka and colleagues. It was published in 2007 but remains reasonably current and provides a useful introduction to intracranial pressure monitoring and its derived indices.
I happened upon this review by Wagshul et al, published in 2011. ICP waveforms and the factors influencing them can be difficult to grasp. This article offers an extensive review of the history and science of brain pulsatility. Well worth a read when you have a few spare hours.
This narrative review by Green et al (full text) was published recently in Anaesthesia. It explores the existing literature on the use of near-infrared spectroscopy cerebral oximetry in various settings, including surgery and resuscitation from cardiac arrest.