Neurocritical Care

 

Description:

A significant number of critically ill neurological and neurosurgical patients are still managed in the medical or surgical ICU by non-neurointensivists, who have a hard time appreciating the delicate needs of these patients. This dynamic guide reviews current topics facing neurocritical care providers in a straight-forward, structured, and practical way. Providing clear summaries in the management of neuro critical care conditions, this text allows for accessible, highly structured, and focused protocols for the assessment, day-to-day management, and treatment of critically ill patients in various ICU settings. This comprehensive, thorough guide to the management and treatment of neurologic and neurosurgical patients is an excellent companion for trainees preparing for the Neurovascular Boards, Neurologists, Neurosurgeons and critical care physicians, alike. Designed by leaders in their field, this thorough guide presents practical, state-of-the-art suggestions for physicians worldwide.

 

Table of Contents:

 

Chapter 1 The Neurological Assessment of the Critically Ill Patient

General Approach to the Neurological Assessment

Sedation

Delirium

Stupor and Coma

Assessing a Patient with Impaired Consciousness

1. Initial Stabilization

2. Initial Assessment

3. Focused Neurological Exam

GCS and FOUR Score

Respiratory Patterns

The Eye Exam

Brainstem Reflexes

Pupillary Responses

Eyelid and Corneal Reflexes

Oculocephalic Reflex

Oculovestibular (Caloric) Reflex

Gag and Cough Reflexes

Motor Responses

Assessing Neuromuscular Complications

Conclusion

References

Chapter 2 Cerebral Blood Flow Physiology and Metabolism in the Neurocritical Care Unit

Normal Physiology of Cerebral Blood Flow

Autoregulation

Relationship Between CBF and PaCO2

Cerebral Ischemia

CBF in Acute Ischemic Stroke

CBF in Intracerebral Hemorrhage

CBF in Subarachnoid Hemorrhage

CBF in Traumatic Brain Injury

Techniques for CBF Measurement

Fick Principle

Central Volume Principle

Thermal Diffusion

Transcranial Doppler (TCD)

Near-infrared Spectroscopy (NIRS)

References

Chapter 3 Cerebral Edema and Intracranial Pressure in the Neurocritical Care Unit

References

Chapter 4 Hypothermia in the Neurocritical Care Unit: Physiology and Applications

Introduction

Mechanism of Neuroprotection

Approach to Hypothermia

Clinical Applications of Hypothermia

Hypothermia and Cardiac Arrest

Hypothermia and Ischemic Stroke

Hypothermia and Intracerebral Hemorrhage

Hypothermia and Subarachnoid Hemorrhage

Hypothermia and Traumatic Brain Injury

Hypothermia and Spinal Cord Injury

Hypothermia and Status Epilepticus

Conclusions

References

Chapter 5 Analgesia, Sedation, and Paralysis in the Neurocritical Care Unit

Sedation

Indications for Sedation

Sedation Assessment

Subjective Assessment of Sedation and Agitation

Pharmacology of Selected Sedatives

Benzodiazepines

Midazolam (Versed)

Lorazepam (Ativan)

Diazepam (Valium)

Synergistic Sedation Regimens with Benzodiazepines

Propofol (2,6-Diisopropyl Phenol)

Propofol Infusion Syndrome (PRIS)

α2-Agonists

Dexmedetomidine (Precedex)

Clonidine (Catapres)

Neuroleptics

Haloperidol (Butyrophenone)

Droperidol (Inapsine)

Other Sedatives

Etomidate

Ketamine

Barbiturates

Diphenhydramine (Benadryl)

Recommendations

Delirium

Treatment of Delirium

Nonpharmacologic Strategies

Analgesia

Pain Assessment

Analgesic Agents

Opiates

Fentanyl (Sublimaze)

Remifentanil (Ultiva)

Morphine Sulfate

Hydromorphone (Dilaudid)

Oxycodone (Percocet, Percodan)

Codeine (Empirin #2,3,4; Tylenol #2,3,4)

Tramadol (Ultram)

Narcotics with Active Metabolites

Nonopiates

Ketamine

Local Anesthetics (Lidocaine, Bupivacaine, Others)

Acetaminophen (Tylenol)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Ketoralac (Toradol)

Ibuprofen (Motrin)

Selective COX-2 Inhibitors

Drugs for Neuropathic Pain

Gabapentin

Neuromuscular Blockade

Indications

Pharmacology of Neuromuscular-Receptor Blockers

Aminosteroidal Compounds

Pancuronium

Pipecuronium

Vecuronium

Rocuronium

Benzylisoquinolinium Compounds

d-Tubocurarine

Atracurium

Cisatracurium

Doxacurium

Mivacurium

Recommendations for Monitoring Degree of Blockade

Potential Complications of Neuromuscular Blockade Use in the ICU

Prolonged Recovery from NMBAs

Acute Quadriplegic Myopathy Syndrome

Drug-Drug Interactions of NMBAs

References

Chapter 6 Airway Management and Mechanical Ventilation in the Neurocritical Care Unit

Introduction

General Airway and Ventilation Management Concerns

Airway Management

Indications for Intubation

Contraindications to (Elective) Intubation

Alternatives to Intubation

Preparation for Intubation

Preparation for Difficult Mask Ventilation and Difficult Airway Scenarios

Induction Medication Issues to Consider in the Neurocritically Ill

Intubation in the Setting of Elevated Intracranial Pressure

Intubation in the Setting of Impaired Cerebral Perfusion

Intubation of a Patient with an Unstable Cervical Spine

Reducing Peri-Intubation Risk

Neuromuscular Respiratory Failure

Preintubation Neurological Evaluation

Intubation

Approach to the Difficult Airway

Overview of Ventilation

Effects of Hyperventilation and Hypoventilation on Brain Physiology

Acidemic and Alkalemic Hypocarbia: Potential for Suppression of Spontaneous Hyperventilation

Purposeful Hyperventilation to Control Elevated ICP

Effects of Hyperoxia and Hypoxia on Brain Physiology

Noninvasive Ventilation

Acute Respiratory Distress Syndrome

Airway Pressure and Intracranial Pressure

Liberation from Mechanical Ventilation

Ventilator Weaning

Tracheostomy

Long-Term Ventilation

Summary

References

Chapter 7 Neuropharmacology in the Neurocritical Care Unit

Introduction

Sedatives

Opioid Analgesics

Benzodiazepines

Propofol

Dexmedetomidine

Antiepileptics

Seizure Prophylaxis

Traumatic Brain Injury (TBI)

Aneurysmal Subarachnoid Hemorrhage (aSAH)

AED Therapeutic Drug Monitoring and Drug-Drug Interactions

Fosphenytoin and Phenytoin TDM Targets

Total Concentrations of 10-20 μg/mL

Free (unbound) Concentrations of 1-2 μg/mL

Fosphenytoin and Phenytoin TDM Principles

Fosphenytoin and Phenytoin Drug-Drug Interactions

Phenobarbital TDM Target

Total Concentrations of 15-40 μg/mL

Sodium Valproate and Derivatives TDM Targets

Free (unbound) Concentrations of 1-2 μg/mL

Hyperosmolar Solutions

Antishivering Agents

Cerebral Vasospasm and Delayed Cerebral Ischemia

Systemic Therapies

Triple-H Therapy

Nimodipine

Nicardipine

Magnesium

Locally Administered Therapies

Alteplase

Nicardipine

Verapamil

Papaverine

References

Chapter 8 Intracranial Monitoring in the Neurocritical Care Unit

Introduction

Intracranial Pressure Monitoring

Brain Tissue Oxygen Monitoring

Cerebral Microdialysis

Regional Cerebral Blood Flow Monitoring

Jugular Bulb Saturation

Advanced Neuroimaging as a Neuromonitor

Clinical Algorithms for Monitoring in the Neurocritical Care Unit

Conclusion

References

Chapter 9 Electrophysiologic Monitoring in the Neurocritical Care Unit

Continuous Electroencephalography (CEEG) in the ICU

Detection of Nonconvulsive Seizures and Status Epilepticus

Convulsive Status Epilepticus

Subarachnoid Hemorrhage

Intracerebral Hemorrhage

Ischemic Stroke

Traumatic Brain injury (TBI)

Toxic Metabolic Encephalopathy

Hypoxic-Ischemic Injury

Duration of Monitoring

Monitoring of Ongoing Therapy

Ischemia Detection

Prognosis

Following Cardiac Arrest

Following Other Causes of Acute Brain Injury

What Should Be Treated?

Other Electrophysiologic Studies in the ICU

References

Chapter 10 The Role of Transcranial Doppler as a Monitoring Tool in the Neurocritical Care Unit

Introduction

Subarachnoid Hemorrhage: Detection of Vasospasm

Technical Aspects of TCD

Middle Cerebral Artery Vasospasm

Anterior Cerebral Artery Vasospasm

Internal Carotid Artery Vasospasm

Vertebral and Basilar Arteries Vasospasm

Complete TCD Examination with Lindegaard Ratio Determination

Distal Vasospasm Detection by TCD

TCD in Traumatic Brain Injury: Intracranial Pressure and Cerebral Perfusion Pressure

Brain Death

Assessment of CO2 Reactivity and Pressure Autoregulation

Acute Ischemic Stroke and Monitoring of Recanalization

Monitoring for Emboli

Carotid Endarterectomy and Carotid Artery Stenting

Summary

References

Chapter 11 Ischemic Stroke in the Neurocritical Care Unit

Introduction

What is a ''Severe'' Ischemic Stroke?

When Should a Patient with AIS be Placed in the NCCU?

Acute Assessment in the Emergency Room

Vital Functions

Relevant History

Neurological Exam

Grading the Deficit

Diagnostic Tests

Laboratory

Imaging

Bedside Monitoring

Acute Treatment of Early Ischemic Stroke

Supplementary Oxygen, Airway and Ventilation Management

Blood Pressure

Blood Glucose

Anticoagulation and Antiaggregation

Recanalization

Decision-Making According to Guidelines, Approval and Beyond

Intravenous Thrombolysis

Intra-Arterial Thrombolyis, Mechanical Thrombectomy

Peri-Interventional Care

General Aspects of Ischemic Stroke Management in the NCCU

Airway Management

Ventilation

Analgesia and Sedation

Gastrointestinal Tract

Fluid Status and Nutrition

Glucose Control

Hemoglobin Control

Deep Vein Thrombosis Prophylaxis

Anticoagulation

Infectious Disease Management

Blood Pressure Management

Temperature Management

Seizures

Management of Brain Edema and Raised Intracranial Pressure

Management of Specific Types of Ischemic Stroke

Large Hemispheric Infarction

Space-Occupying Cerebellar Stroke

Basilar Occlusion

Ischemic Stroke from Infective Endocarditis

References

Chapter 12 Intracerebral Hemorrhage in the Neurocritical Care Unit

Epidemiology and Risk Factors

Pathophysiology

Prognosis

Diagnosis

Management

Conclusion

References

Chapter 13 Management of Cerebral Venous Thrombosis in the Neurocritical Care Unit

Definition and Epidemiology

Definition

Incidence

Age and Sex

Risk Factors

Diagnosis

Clinical Manifestations of CVT

Imaging of the Brain and Venous Sinuses

Computed Tomography

Magnetic Resonance Imaging

Venography

Blood Tests and Other Imaging Studies

Triage and Prognosis

Triage

Prognosis

Treatment

Acute Management

Anticoagulation

Thrombolysis and Thrombectomy

Symptom Management

Intracranial Hypertension

Seizures

Treatment of Specific Conditions

Long-Term Management

Oral Anticoagulation

Pregnancy

Pharmacology

Heparin

Monitoring Schedule

Precautions

LMWH (enoxaparin)

Monitoring Schedule

Precautions

Warfarin

Monitoring Schedule

Precautions

References

Chapter 14 Subarachnoid Hemorrhage in the Neurocritical Care Unit

Epidemiology

Risk Factors

Clinical Presentation

Diagnosis

Prognostic Indicators

Pathophysiology/Etiology

Management and Treatment of SAH and its Complications

General Emergency and Critical Care Management

Recurrent Hemorrhage

Treatment of Increased Intracranial Pressure

Volume Status

Treatment of Seizures

Aneurysm Repair

Delayed Cerebral Ischemia

Monitoring for Delayed Cerebral Ischemia

Prevention of Delayed Cerebral Ischemia

Management of Delayed Cerebral Ischemia

Electrolyte Disturbances

Treatment of Medical Complications

Fever

Hyperglycemia

Anemia

Neurogenic Stunned Myocardium and Pulmonary Edema

Special Considerations for Angiogram-Negative Subarachnoid Hemorrhage

Trauma

Vertebral Artery Dissection

Missed Aneurysms

Dural and Spinal Arteriovenous Malformations

Mycotic Aneurysms

Pituitary Apoplexy

Perimesencephalic/Prepontine SAH

Future Perspectives

References

Chapter 15 Status Epilepticus in the Neurocritical Care Unit

Introduction

Epidemiology

Etiology

Classification of Status Epilepticus

Generalized Convulsive Status Epilepticus

Nonconvulsive Status Epilepticus

Refractory Status Epilepticus

Diagnostic Workup

Routine Workup

Telemetry

Selective workup

Management

Prehospital Treatment

Initial In-Hospital Treatment of Status Epilepticus and Prevention of Recurrence of Seizures

First-Line Therapeutic Agents: Benzodiazepines

Second-Line Agents

Phenytoin

Valproic Acid

Levetiracetam

Phenobarbital

Lacosamide

Advanced Management of Refractory Status Epilepticus

Midazolam

Propofol

Barbiturates

Ketamine

Other Antiepileptic Drugs

Ketogenic Diet

Inhaled Anesthetics

Steroids/Immunotherapy

Nonpharmacological Therapies

Hypothermia

Electroconvulsive Therapy

Surgery

Treatment Duration and Intensity

Complications

Prognosis and Outcome

References

Chapter 16 Neuromuscular Disorders in the Neurocritical Care Unit

Neuromuscular Respiratory Failure

Clinical Features

Anatomical Localization

Differential Diagnosis

Basic Principles of Management

Specific Neuromuscular Diseases Encountered in the Intensive Care Unit

Amyotrophic Lateral Sclerosis

Guillain-Barré Syndrome

Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Treatment

Myasthenia Gravis

Pathophysiology

Clinical Features

Diagnosis

Treatment

Botulism

Critical Illness Neuromyopathy

References

Chapter 17 Management of Head Trauma in the Neurocritical Care Unit

Introduction

Epidemiology

Classification

Pathology and Pathophysiology

Primary Brain Injury

Blunt TBI

Contusions

Intracranial Hemorrhage

Diffuse Axonal Injury

Penetrating TBI

Blast Injury

Secondary Brain Injury

Cerebral Hemodynamics

Intracranial Hypertension

Macrovascular Dysfunction

Microvascular Dysfunction

Cell Energy Dysfunction

Clinical Evaluation and Diagnosis

Clinical Evaluation

Primary Survey

Secondary Survey

Laboratory Evaluation

Imaging

CT of the Head

Neck Imaging

Vascular Imaging

Management

Prehospital Care

Emergency Department Management

Herniation: Identify and Treat

Surgical Intervention

Surgery for Increased ICP

Intensive Care Unit Management

Organization of Care

Traumatic Brain Injury Guidelines

Neurocritical Care

Goals of Care

Monitoring

Airway Management

Oxygenation and Ventilation

Oxygen

Carbon Dioxide

Acute Lung Injury and Acute Respiratory Distress Syndrome

Blood Pressure and Fluid Status

Fluids

Hemoglobin Management

Coagulation

Intracranial Pressure

Indications for Invasive ICP Monitoring

Type of Monitor

Management of Increased ICP

Cerebral Perfusion Pressure

Multimodality Neuromonitoring and New Strategies of Care

Pharmacology in TBI Critical Care

Seizure Prophylaxis

Sedation, Analgesia and Paralytic Agents

Glucocorticoids

Stress Ulcer Prophylaxis

Prophylaxis Against Venous Thromoembolic Events

Venous Thrombolic Event Treatment

Fever and Temperature Control

Glucose Control

Sodium and Electrolytes

Blunt Cerebrovascular Injury

Vasospasm and Traumatic Aneurysms

Autonomic Dysregulation Syndrome

Nutritional Support

Secondary Surgical Procedures

Outcome and Outcome Prediction

Withdrawal of Care and Futility

References

Plates

Chapter 18 Management of Autoimmune Encephalitis in the Neurocritical Care Unit

Diagnostic Approach

Autoimmune Encephalitis Syndrome

Specific Autoimmune Encephalitis Syndromes

Anti-N-methyl-d-Aspartate Receptor Encephalitis

Diagnostic Workup

Serum and CSF Markers

Electroencephalography

Imaging

Tumor Screening

Clinical Outcome

Anti-α-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor Encephalitis

Anti-γ-Aminobutyric Acid A Receptor Encephalitis

Anti-GABAB Receptor Encephalitis

Anti-LGI1 Limbic Encephalitis

Metabotropic Glutamate Receptor 5 (mGluR5) Antibody Syndrome

Overlap with Other Disorders

Cancer Investigation Workup

General and Critical Care Management

Conclusion

References

Chapter 19 Management of Cerebral Salt-Wasting Syndrome and Syndrome of Inappropriate Antidiuresis i

Introduction

Sodium and Fluid Regulation

Hyponatremia

Definition

Significance

Symptoms

Classification and Differential Diagnosis of Hyponatremia

Workup

Important Considerations in the Differential Diagnosis

Cerebral Salt-Wasting Syndrome

Definition and Causes

Pathophysiology

Syndrome of Inappropriate Antidiuresis

Definition and Causes

Pathophysiology

Differentiating CSW from SIAD

Treatment

General Principles

Specific Treatment of CSWS

Specific Treatment of SIAD

Special Patient Populations

Subarachnoid Hemorrhage

Traumatic Brain Injury

Conclusions

References

Chapter 20 Brain Death in the Neurocritical Care Unit

History

Definition

Clinical Evaluation

Etiology of Injury

Drugs and Toxins

Metabolic Derangements

Temperature

Blood Pressure

Neurological Examination

Coma

Brainstem Reflexes

Pupillary Light Response

Oculocephalic Reflex

Oculovestibular Reflex

Corneal Reflex

Gag and Cough Reflex

Other Reflexes

Motor Response

Apnea Testing

Ancillary Testing

Angiography

Conventional Angiography

Computed Tomography Angiography

Magnetic Resonance Angiography

Transcranial Doppler Ultrasound (TCD)

Cerebral Scintigraphy

Electroencephalography

Potential Misdiagnoses

Locked-in Syndrome

Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barré)

Hypothermia

Drug Intoxication

Organ Donation

References

Chapter 21 Neuroterrorism and Drug Overdose in the Neurocritical Care Unit

Introduction

General Management of Drug Overdose

Recreational Drug Abuse and Overdose

Cocaine

Heroin

Alcohol

Opioid Analgesics

Commonly Used Therapeutics in the NCCU

Phenytoin and Fosphenytoin

Heparin

Warfarin

Direct Thrombin Inhibitors

Barbiturates

Benzodiazepines

Tricyclic Antidepressants

Chemical and Biological Terrorism

Biological Agents

Anthrax

Botulinum Toxin

Q Fever

Smallpox

Venezuelan Equine Encephalitis

Tetrodotoxin

Other Agents

Chemical Agents

Organophosphates

Cyanide

Decontamination Principles after Known Chemical Agent Exposure

Conclusion

References

Chapter 22 Infections of the Central Nervous System in the Neurocritical Care Unit

Encephalitis

Viral Causes of Encephalitis

Herpes Simplex Virus Type 1

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture (LP)

Imaging

Other Testing

Therapy

Antivirals

Adjunct Therapies

Antiepileptics

Other Therapies

Prognosis

Varicella Zoster Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Antivirals

Adjunct Therapies

Epstein-Barr Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Imaging

Therapy

Antivirals

Epstein-Barr Human Herpes Virus Type 6

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Cytomegalovirus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Enteroviruses

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Arboviruses

St. Louis Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Therapy

West Nile Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Therapy

Prognosis

Tick-Borne Encephalitis Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Therapy

Influenza Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Prognosis

JC Virus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Bacterial Causes of Encephalitis

Bartonella

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Other Testing

Therapy

Prognosis

Legionella

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Other Testing

Therapy

Mycoplasma

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Therapy

Prognosis

Meningitis

Viral Causes of Meningitis

Bacterial Causes of Meningitis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Other Testing

Imaging

Specific Pathogens

Streptococcus pneumoniae

Haemophilus influenza

Neisseria meningitides

Listeria monocytogenes

Streptococcus agalactiae

Streptococcus pyogenes

Staphylococcus aureus

Other Pathogens

Therapy

Empiric Antibiotics

Adjunct Therapies

Prognosis

Fungal Causes of Meningitis

Cryptococcus

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Antifungals

Adjunct Therapies

Prognosis

Candidiasis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Aspergillosis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Zygomycosis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Prognosis

Coccidioidomycosis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Therapy

Prognosis

Histoplasmosis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Other Testing

Imaging

Therapy

Prognosis

Mycobacterial Causes Of Meningitis

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Imaging

Other Testing

Therapy

Antibiotics

Adjunct Therapies

Prognosis

Central Nervous System Abscess

Signs and Symptoms

Bacterial Causes of Cerebral Abscess

Background

Diagnostic Workup

Laboratory

Imaging

Chest CT or Chest Radiograph

Other Testing

Specific Pathogens

Therapy

Antibiotics

Adjunct Therapies

Surgical Intervention

Fungal Causes of Cerebral Abscess

Spinal Epidural Abscess

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Etiologies

Therapy

Surgery

Antibiotics

Prognosis

Subdural Empyema

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Other Testing/Culture

Therapy

Surgery

Antibiotics

Prognosis

Ventricular Catheter Infections

Extraventricular Drain Infections

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Pathogens

Therapy

Surgery

Antibiotics

CSF Shunt Infections

Background

Signs and Symptoms

Diagnostic Workup

Laboratory

Lumbar Puncture

Serum Testing

Imaging

Therapy

Surgery

Antibiotics

References

Chapter 23 Management of the Spinal Cord Injury in the Neurocritical Care Unit

Epidemiology

Traumatic

Nontraumatic

Diagnosis

Physical Exam

Imaging

Pathophysiology

Traumatic SCI

Nontraumatic SCI

Complications

Cardiovascular

Respiratory

Genitourinary

Gastrointestinal

Hematological

Integument

Conclusion

Acknowledgement

References

Chapter 24 Postoperative Management in the Neurocritical Care Unit

General Considerations

Admission to NICU and Peri-operative Handoff

Neurological Assessment

Intracranial Pressure Control and Multimodal Monitoring

Hemodynamic Control

Fluid Balance

Maintenance Fluids

Electrolytes

Glucose Control

ICU Prophylaxis

Postoperative Fever

Subarachnoid Hemorrhage

Patient Grading

Decreasing the Risk of Rerupture of the Aneurysm

NICU Management after Endovascular Aneurysm Coiling

Vasospasm Assessment and Treatment

Carotid Endarterectomy and Carotid Stenting

Antiplatelet Agents

Blood Pressure Management and Cardiac Function

Ischemic and Hemorrhagic Stroke

Cerebral Hyperperfusion Syndrome (Normal Pressure Hyperperfusion Breakthrough)

Nerve Injury

Wound Hematoma

Craniotomy for Supratentorial Tumors

Postoperative Edema

Antiepileptics

Postoperative Imaging

Hemorrhage

Cerebral Edema

Pneumocephalus

Seizures

Posterior Fossa Craniectomy for Tumor

Cranial Nerve Injuries

Hydrocephalus

Cerebrospinal Fluid Fistula

Craniotomy for Resection of an Arteriovenous Malformation

Trans-Sphenoidal Pituitary Resection

Diabetes Insipidus

Cerebrospinal Fluid Rhinorrhea

Visual Deterioration and Ophthalmoplegia

Vascular Injury

Epilepsy Surgery

Anterior Temporal Lobectomy

Corpus Callosotomy

Deep Brain Stimulation

Conclusion

References

Chapter 25 Ethical Considerations in the Neurocritical Care Unit

Introduction

Medical Ethics

What's Ethical?

Assessing Decision-Making Capacity in the Neuro-ICU

Informed Consent

Decision-Making and Competency

Disclosure

Understanding

Voluntariness

Alternative Methods to Obtain Consent in Critically Ill Patients without Decision-Making Capacity

Advance Directive or Living Will

Substituted Judgment Standard

Best Interest Standard

The Principle of ''Clear And Convincing Evidence''

End-of-Life

Is There a Difference between Withdrawing and Withholding?

Applying Ethical Principles for Human Research in the ICU

Consent for Research by the Patient's Legally Authorized Representative

Consent for Research by the Patient's Legally Authorized Surrogate

Deferred and Waiver of Consent for Research in Emergency Situations

Should We Require Consent for Research in Critically Ill Patients?

Should We Exclude Critically Ill Patients Who Lack Decision-Making Capacity from Clinical Research?

Opt-Out Approach

References

Chapter 26 Pulmonary Consult: Management of Severe Hypoxia in the Neurocritical Care Unit

Introduction

Pulmonary Vascular Disease

Patent Foramen Ovale/Shunt

Obstructive Lung Disease

Acute Lung Injury and Acute Respiratory Distress Syndrome

Berlin Criteria (Emphasis on Staging of Severity)

The Implications of Clinical Management on the Berlin Definition

Lung Injury Score

Epidemiology of Severe Hypoxemia in General ICU Populations (Table 26.3)

Epidemiology of ARDS in Acute Stroke

Epidemiology of ARDS in Traumatic Brain Injury

Usual Care Management of Severe Hypoxemia

Current Standards

Low Tidal Volume

Alternative Ventilator Modes

Sedative Approaches

Propofol

Dexmedetomidine

Fluid Management

Bronchoscopic and Procedural Considerations

Severe Hypoxemia Management Strategies (Figure 26.3)

Prone Positioning

The Role of Neuromuscular Blockers

High-Frequency Oscillatory Ventilation

Inhaled Vasodilators

Steroids

Extracorporeal Life Support

Concerns for NCC Patients

ICP Elevation

Neurogenic Pulmonary Edema

Special Considerations for COPD

Special Considerations for Venous Thromboembolism

Recommendations for the Prevention of VTE

References

Chapter 27 Management of Refractory Arrhythmias in the Neurocritical Care Unit

Introduction

Presentation

Pathophysiology

Onset and Predictors of Arrhythmias

Specific Rhythm Abnormalities

Narrow Complex Arrhythmias

Atrial Fibrillation

Etiology

Clinical Manifestations

Diagnosis

Acute Treatment

Long-Term Treatment

Anticoagulation

Summary

Atrial Flutter

Sinus Tachycardia and Bradycardia

Atrial Tachycardia

AV Nodal Re-Entry Tachycardia

Orthodromic AVRT

Wolff-Parkinson-White Syndrome

Multifocal Atrial Tachycardia

Premature Atrial Complexes

AV Junctional Tachycardia

Summary of Narrow Complex Tachycardias

Wide Complex Tachycardias

Ventricular Tachycardia

Torsades de Pointes

Premature Ventricular Complexes

Accelerated Idioventricular Rhythm

Ventricular Fibrillation

Management of Wide Complex Tachycardia

Conduction Blocks

First-Degree AV Block

Second-Degree AV Block

Complete AV Block

Permanent Pacemakers

Outcomes with Rhythm Disturbances

Summary

References

Chapter 28 An Infectious Diseases Consult in the Neurocritical Care Unit

Workup of Fever in the ICU

Management of Common Infections

Pneumonia

Intravascular Catheter-Related Infections

Clostridium difficile Colitis

Urinary Tract Infections

Sepsis

Infection Control

References

Chapter 29 A Nephrology Consult in the Neurocritical Care Unit

Acute Kidney Injury

Definition of Acute Kidney Injury

AKIN Criteria for AKI

RIFLE Criteria for AKI

Chronic Kidney Disease

AKI Etiology

Symptoms of AKI

Diagnostic Approach to AKI

Initial Management of AKI

Ongoing Management of AKI

Blood Pressure/Intravascular Volume

Nutrition/Uremic Toxin Generation

Nephrotoxin Avoidance/Pharmacologic Monitoring

Electrolyte Disorders

Potassium Disorders

Hypokalemia

Approach to Hypokalemia

Principles of Therapy

Hyperkalemia

Approach to Hyperkalemia

Treatment of Hyperkalemia

Hypercalcemia

Hypocalcemia

Hypermagnesemia

Hypomagnesemia

Acid-Base Disorders

Metabolic Acidosis

Normal Compensation in Metabolic Disorders

Metabolic Alkalosis

Renal Replacement Therapy

Description of the Procedure

Choice of Modality

Vascular Access for Dialysis

Indications for Dialysis

Hyperkalemia

Volume Overload

Uremic Syndrome

Toxic Ingestions

Metabolic Acidosis

Special Considerations for Renal Failure in the Neurocritical Care Patient

Intracranial Hypertension

Sodium Management

Coagulopathy

Radiocontrast Imaging

References

Chapter 30 Management of Hepatic Encephalopathy in the Neurocritical Care Unit

Introduction

Pathophysiological Considerations

HE in Acute Liver Failure

HE in Cirrhosis and Chronic Porto-Systemic Shunting

HE in Acute on Chronic Liver Failure

Diagnosis

Approach to Management

HE in Acute Liver Failure

HE in Cirrhosis

Reduction of Intestinal Production and Systemic Absorption of Ammonia

Increased Systemic Metabolism of Ammonia

Inhibition of Benzodiazepine Receptors

Reduction of False Neurotransmitter Levels

HE in Chronic Portal-Systemic Shunting

HE in Acute on Chronic Liver Failure (ACLF)

Therapeutic Implications of the Emerging Concept of a Disturbed Gut Microbiome as a Contributor to A

References

Chapter 31 Hypoxic Encephalopathy in the Neurocritical Care Unit

Pathophysiology

Clinical Features and Diagnosis

Management

Prehospital and Initial Management

Induction of Therapeutic Hypothermia

Management in the Intensive Care Unit

Management of Rewarming, Shivering, Sedation, and Analgesia

Organ-Specific Management Strategies

Central Nervous System

Cardiovascular Management

Mechanical Ventilation

Renal, Endocrine, Hematologic, and Gastrointestinal Management

Prognostication

References

Chapter 32 Management of Delirium in the Neurocritical Care Unit

Epidemiology of Delirium

Definition of Delirium

Delirium Subtypes

Screening for Delirium

Pathophysiology of Delirium

Diagnostic Evaluation

Management of Delirium

Primary Prevention of Delirium

Identification of Patients at High Risk of Developing Delirium

Delirium Prevention

Pharmacological Treatment of Delirium

Conclusion

References

Chapter 33 Generalized Weakness in the Neurocritical Care Unit

Introduction

Causes of Generalized Weakness in the ICU

Evaluation of Generalized Weakness in the ICU

History

Clinical Examination

General Examination

Neurological Examination

Differential Diagnosis

Disorders of the Central Nervous System

Spinal Cord Injury

Structural Lesions in the Central Nervous System

Disorders of the Anterior Horn Cells

Amyotrophic Lateral Sclerosis

Acute Poliomyelitis

West Nile Virus

Hopkin's Syndrome

Disorders of the Peripheral Nerves

Guillain-Barré Syndrome

Chronic Inflammatory Demyelinating Polyneuropathy

Critical Illness Polyneuropathy

Multifocal Motor Neuropathy

Compressive Neuropathies

Porphyria

Vasculitic Neuropathy

Disorders of the Neuromuscular Junction

Myasthenia Gravis

Lambert-Eaton Myasthenic Syndrome

Botulism

Prolonged Neuromuscular Blockade

Disorders of the Muscle

Critical Illness Myopathy

Rhabdomyolysis

Other Muscle Diseases

Conclusion

References

Chapter 34 Management of Severely Brain-Injured Patients Recovering from Coma in the Neurocritical C

Introduction

Disorders of Consciousness

Definition

Differential Brain Activity

Diagnosis and Consciousness Assessment

The Glasgow Coma Scale

The Full Outline of UnResponsiveness Scale

The Coma Recovery Scale

The Nociception Coma Scale

Prognosis

Treatment

Patients with Covert Cognition

Conclusion

Acknowledgments

References

Chapter 35 Acute Demyelinating Disorders in the Neurocritical Care Unit

Introduction

Acute Inflammatory Demyelinating Diseases

Acute Disseminated Encephalomyelitis

Clinical Presentation

Diagnosis

Treatment and Management

Acute Multiple Sclerosis (Marburg Variant)

Neuromyelitis Optica (Devic Disease)

Clinical Presentation

Diagnosis

Treatment and Management

Tumefactive Multiple Sclerosis

Diagnosis

Treatment and Management

Balo Concentric Sclerosis

Differential Diagnosis

Heroin-Associated Spongiform Leukoencephalopathy

Clinical Presentation

Diagnosis

Treatment and Management

Central Pontine Myelinolysis

Clinical Presentation

Diagnosis

Treatment and Management

Progressive Multifocal Leukoencephalopathy

Clinical Presentation

Diagnosis

Treatment and Management

Emergency Complications

References

Chapter 36 Building a Case for a Neurocritical Care Unit

Introduction

ICU and NICU models

Outcomes in NICU Patient Populations

NICU and Ischemic or Hemorrhagic Stroke

NICU Outcomes in Traumatic Brain Injury (TBI)

NICU and Status Epilepticus

NICU Documentation

NICU Financial Cost-Benefit

Conclusion

References

Chapter 37 Neurointensive (NCCU) Care Business Planning

Introduction

Developing a Business Plan

Overview

Business Plan Details

Executive Summary

Description of Initiative/Program/Product/Service

Mission and/or Vision Statement

Strategic Rationale

Market Analysis

Resource Requirements

Financial Plan

Milestones and Metrics

Risks and Contingencies

Summary

Appendix

Financial Commitment

Presenting to Administration

Billing and Revenue Models

Research Integration

Neurointensive Care Unit Models

The Joint Commission's Comprehensive Stroke Certification

Building an Advanced Practice Provider Intensive Care Model

Staffing

Summary

References

Further Reading

Index

 

An aparitie	18 July 2019
Autor	Michel T. Torbey
Dimensiuni	22.1 x 2.79 x 28.19 cm
Editura	Cambridge University Press
Format	Hardcover
ISBN	9781107064959
Limba	Engleza
Nr pag	466