Prognostication and Shared Decision Making in Neurocritical Care

Elsevier eBooks, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Rediscovery of Acute Lung Injury in Cardiac Arrest: Breathing fresh air into a neglected component of the post-cardiac arrest syndrome

Resuscitation, Journal Year: 2025, Volume and Issue: unknown, P. 110495 - 110495

Published: Jan. 1, 2025

Language: Английский

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Cardiovascular complications in chronic active Epstein–Barr virus disease: a case report and literature review

Frontiers in Pediatrics, Journal Year: 2025, Volume and Issue: 12

Published: Jan. 10, 2025

Cardiovascular involvement is a rare but severe complication of Epstein-Barr virus (EBV) infections. Patients with chronic active EBV (CAEBV) are at increased risk developing cardiovascular complications and have poor prognosis. Here, we report the case pediatric patient CAEBV EBV- hemophagocytic lymphohistiocytosis (HLH) complicated giant coronary artery aneurysm (CAA) thrombosis, Valsalva sinus aneurysm, ascending aorta dilation seven years after disease onset. A previously healthy 3-year-old girl was initially misdiagnosed as presenting incomplete Kawasaki by lesions (CALs) for which she received intravenous immunoglobulin aspirin therapy. Subsequently, transferred to our hospital, where diagnosed her having primary infection. After acyclovir therapy, clinical symptoms resolved negative EBV-DNA, discharged home treatment remaining CALs. However, did not regular follow-ups that. Seven later, 10-year-old developed prolonged fever fatigue, EBV-associated (EBV-HLH) due presence high EBV-DNA load, fever, splenomegaly, bicytopenia, hypertriglyceridemia, hypofibrinogenemia, hemophagocytosis, low NK-cell activity, levels ferritin soluble CD25. The echocardiography images showed left right aneurysms, dilation. Her parents agreed therapy immunoglobulin, methylprednisolone, antiplatelet, anticoagulant, standard EBV-HLH. complications, including CAAs lesions, resolve. Three weeks finally asymptomatic. Unfortunately, one month discharge, recurred girl. guardian had refused took economic difficulties. During subsequent follow-up visit, subsequently passed away. We reported infection who fatal (CAAs aortic lesions) onset Clinicians should be aware these during long-term patients infection, especially in and/or

Language: Английский

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Timing of neuroprognostication in the ICU

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

Purpose of review Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies mitigate self-fulfilling prophecy, and how approach indeterminate prognosis. Recent findings The goal neuroprognostication provide a timely prediction patient's neurologic outcome so treatment can proceed in accordance with values preferences. should be delayed until at least 72 h and/or only when necessary prognostic data available avoid early withdraw life-sustaining on patients who may otherwise survive good outcome. Clinicians aware limitations predictors models, role flawed heuristics influence surrogate decision-maker bias end-of-life decisions. Summary ABI systematic, use highly reliable multimodal data, involve experts minimize risk erroneous perpetuating prophecy. Even such standards are rigorously upheld, prognosis indeterminate. cases, clinicians engage shared decision-making surrogates consider time-limited trial.

Language: Английский

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Hypoxic Encephalopathy Post-Cardiac Arrest

Elsevier eBooks, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Earlier Detection of Brain Injury Using Optical Brain Pulse Monitoring in Critically Ill Patients Following Cardiac Arrest

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 21, 2025

Abstract IMPORTANCE Point-of-care, non-invasive brain monitoring in critically ill patients following cardiac arrest could provide earlier detection of neurological injury and, when combined with treatments, limit injury. Point-of-care also enable better neuro-prognostication. OBJECTIVES The study assessed the time to using optical pulse (OBPM) compared routine monitoring. association OBPM signals more severe forms was assessed. DESIGN Retrospective analysis enrolled an observational study. SETTING Critical care unit a tertiary academic hospital. PARTICIPANTS Adult requiring mechanical ventilation critical arrest. MAIN OUTCOMES AND MEASURES uses red and infrared light capture waveforms whose morphology reflects relative arteriole venous pressure levels driving microvascular blood flow brain. sensors were placed bilaterally on anterior temporal region scalp, over middle cerebral artery territories. Time defined as period from first by or RESULTS Twelve enrolled, three required veno-arterial extra-corporeal membrane oxygenator support. In-hospital mortality 83% eight developed global hypoxic-ischemic median 57 hours (P < 0.01). In injured morphologies changed often different between hemispheres, high amplitude respiratory waves present. Known poor prognostic waveform present some CONCLUSIONS RELEVANCE detected Earlier improve patient outcomes through treatment KEY POINTS Question Can point-of-care monitoring? Findings this 12 Meaning

Language: Английский

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Emergency medicine updates: Managing the patient with return of spontaneous circulation

The American Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: 93, P. 26 - 36

Published: March 19, 2025

Language: Английский

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Impact of Hypothermic Temperature Control on Plasma and Soft Tissue Pharmacokinetics of Penicillin/Beta-Lactamase Inhibitor Combinations in Patients Resuscitated After Cardiac Arrest

Clinical Pharmacokinetics, Journal Year: 2025, Volume and Issue: unknown

Published: April 10, 2025

Language: Английский

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Emergency medicine updates: Cardiac arrest airway management

The American Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Oxygen and Carbon Dioxide Targets after Cardiac Arrest: An Updated Systematic Review

Resuscitation, Journal Year: 2025, Volume and Issue: unknown, P. 110620 - 110620

Published: April 1, 2025

To perform a systematic review and meta-analysis of oxygen carbon dioxide targets in patients with sustained return spontaneous circulation after cardiac arrest. Searches were conducted MEDLINE, Embase, Evidence-Based Medicine Reviews from August 2019 to March 2025 for randomised trials comparing specific or post-cardiac arrest patients. Two investigators independently reviewed relevance, extracted data, assessed risk bias. Data pooled using random-effects models. The certainty evidence was evaluated GRADE methodology. Fifteen manuscripts 12 included. All limited adult patients, primarily including out-of-hospital arrests. Five the prehospital setting, while six three intensive care unit setting. Risk bias as moderate most outcomes. Meta-analyses found no differences survival favourable functional outcomes when restrictive liberal either There also difference mild hypercapnia normocapnia. rated low moderate. Among resuscitated arrest, neither nor hypercapnia, compared conventional targets, improved

Language: Английский

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