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.
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.
Really interesting article in the latest issue of JAMA Neurology: Specific EEG changes, known as periodic discharges (PDs), seem to be of value in predicting brain tissue hypoxia in vulnerable patients with acute brain injury. In this investigation, Witsch and colleagues included 90 patients with high-grade subarachnoid haemorrhage and monitored them with continuous EEG in addition to… Continue reading EEG and Oxygenation in Acute Brain Injury
Watch this lecture by Michael Avidan, Washington University School of Medicine. Introduction and clinical use of EEG. Another resource are the learning modules of Partners Healthcare. Register for free at www.anesthesiaeeg.com.
Ivan came across this very useful and reasonably understandable introduction to EEG monitoring for anaesthetic use. It´s put together by the guys at ICETAP (International Consortium for EEG Training of Anesthesia Practitioners). It´s part of a series of tutorials on all things EEG for complete novices.
Published in 2011 by Schmidt et al (free full-text in Stroke), this article looks at CPP thresholds for cerebral hypoxia in SAH patients. They went through multimodal monitoring data for 30 patients with poor-grade SAH. Using microdialysis and brain tissue oxygenation as their main determinants of hypoxia, they found that patients with a CPP <70… Continue reading Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage
Moerman et al, Anesthesiology Aug 2015. Link to PubMed here. In this study, paradoxical changes in ScO2 after pharmacological-induced pressure changes occurred exclusively in patients with intact cerebral autoregulation, corroborating the hypothesis that these paradoxical responses might be attributable to a functional cerebral autoregulation.
Now more than three years old, but still an absolute landmark study and mandatory reading for anyone who cares for neurotrauma patients. Smallish trial but very well carried out and yielding some remarkable findings. A commonly cited article by Randy Chesnut and his group showing equipoise between an ICP-driven protocol and management determined by CT… Continue reading BEST TRIP – ICP vs. CT/clinical exam for TBI