Therapeutic Advances in Pulmonary and Critical Care Medicine,
Год журнала:
2025,
Номер
20
Опубликована: Июнь 1, 2025
Inflammatory,
neurologic,
and
cardiac
biomarkers
appear
to
have
varying
significance
in
the
prognostication
of
patients
with
arrest.
Post-cardiac
arrest
syndrome
is
a
condition
characterized
by
systemic
ischemia
reperfusion
injury,
neurologic
damage,
myocardial
dysfunction.
The
relative
these
remains
unclear
an
area
active
investigation.
In
this
narrative
review,
we
aim
describe
what
currently
known
about
role
inflammatory,
A
PubMed
review
was
performed
for
relevant
articles.
Articles
that
studied
adult
were
included.
This
determined
play
key
facilitating
release
mediates
inflammation,
ischemic
brain
Inflammatory
more
clinical
utility
than
biomarkers.
When
combined
physical
exam,
imaging
electroencephalograph
findings,
blood
can
be
useful
making
predictions
patient
outcomes
post-cardiac
Despite
utility,
no
single
biomarker
has
sufficient
power
predict
independently.
Ongoing
research
investigating
strong
interest.
conclusion,
all
understanding
both
short-term
long-term
To
date,
parameter
been
shown
reliably
outcome
patients.
Such
remain
JAMA Neurology,
Год журнала:
2024,
Номер
81(4), С. 405 - 405
Опубликована: Март 4, 2024
Importance
Among
the
most
impactful
neurologic
assessments
is
that
of
neuroprognostication,
defined
here
as
prediction
recovery
from
disorders
consciousness
caused
by
severe,
acute
brain
injury.
Across
a
range
injury
etiologies,
these
determinations
often
dictate
whether
life-sustaining
treatment
continued
or
withdrawn;
thus,
they
have
major
implications
for
morbidity,
mortality,
and
health
care
costs.
Neuroprognostication
relies
on
diverse
array
tests,
including
behavioral,
radiologic,
physiological,
serologic
markers,
evaluate
brain’s
functional
structural
integrity.
Observations
Prognostic
such
examination,
electroencephalography,
conventional
computed
tomography
magnetic
resonance
imaging
(MRI),
been
foundational
in
assessing
patient’s
current
level
capacity
recovery.
Emerging
techniques,
MRI,
diffusion
advanced
forms
provide
new
ways
evaluating
brain,
leading
to
evolving
schemes
characterizing
function
novel
methods
predicting
Conclusions
Relevance
Neuroprognostic
markers
are
rapidly
integrity
after
discovered.
Many
techniques
remain
development,
further
research
needed
optimize
their
prognostic
utility.
However,
even
efforts
underway,
series
promising
findings
coupled
with
imperfect
predictive
value
high
stakes
prompted
clinical
guidelines
endorse
emerging
neuroprognostication.
Thus,
clinicians
thrust
into
an
uncertain
predicament
which
not
yet
perfected
but
too
ignore.
This
review
illustrates
current,
likely
future,
landscapes
markers.
No
matter
how
much
evolve
improve,
must
be
approached
humility
individualized
reflect
each
values.
Intensive Care Medicine,
Год журнала:
2023,
Номер
49(12), С. 1467 - 1478
Опубликована: Ноя. 9, 2023
Patients
who
are
successfully
resuscitated
following
out-of-hospital
cardiac
arrest
(OHCA)
still
at
a
high
risk
of
neurological
damage
and
death.
Inflammation
brain
injury
components
the
post-cardiac
syndrome,
can
be
assessed
by
systemic
interleukin
6
(IL-6)
neuron-specific
enolase
(NSE).
Anti-inflammatory
treatment
with
methylprednisolone
may
dampen
inflammation,
thereby
improving
outcome.
This
study
aimed
to
determine
if
prehospital
high-dose
could
reduce
IL-6
NSE
in
comatose
OHCA
patients.
The
STEROHCA
trial
was
randomized,
blinded,
placebo-controlled,
phase
II
performed
two
centers
Denmark.
Resuscitated
patients
suspected
etiology
were
randomly
assigned
1:1
single
intravenous
injection
250
mg
or
placebo.
co-primary
outcome
reduction
NSE-blood
levels
measured
daily
for
72
h
from
admission.
main
secondary
survival
180
days
follow-up.
We
randomized
137
(n
=
68)
placebo
69).
found
reduced
(p
<
0.0001)
intervention
group,
median
(interquartile
range,
IQR)
24
2.1
pg/ml
(1.0;
7.1)
30.7
(14.2;
59)
group.
observed
no
difference
between
groups
0.22),
48
18.8
ug/L
(14.4;
24.6)
14.8
(11.2;
19.4)
respectively.
In
51
(75%)
survived
44
(64%)
Prehospital
patients,
resulted
after
h,
but
did
not
levels.
Journal of Neurotrauma,
Год журнала:
2024,
Номер
41(19-20), С. 2219 - 2237
Опубликована: Фев. 7, 2024
Intimate
partner
violence
(IPV)
is
a
significant,
global
public
health
concern.
Women,
individuals
with
historically
underrepresented
identities,
and
disabilities
are
at
high
risk
for
IPV
tend
to
experience
severe
injuries.
There
has
been
growing
concern
about
the
of
exposure
IPV-related
head
trauma,
resulting
in
brain
injury
(IPV-BI),
its
consequences.
Past
work
suggests
that
significant
proportion
women
exposed
IPV-BI,
likely
representing
distinct
phenotype
compared
BI
other
etiologies.
An
IPV-BI
often
co-occurs
psychological
trauma
mental
complaints,
leading
unique
issues
related
identifying,
prognosticating,
managing
outcomes.
The
goal
this
review
identify
important
gaps
research
clinical
practice
suggest
potential
solutions
address
them.
We
summarize
five
key
priority
areas:
(1)
considerations
study
design;
(2)
understanding
non-fatal
strangulation
as
form
BI;
(3)
identifying
objective
biomarkers
IPV-BI;
(4)
consideration
chronicity,
cumulative
late
effects
(5)
factor
engagement.
Our
concludes
call
action
help
investigators
develop
ecologically
valid
studies
addressing
identified
clinical-research
knowledge
strategies
improve
care
IPV-BI.
By
reducing
current
answering
these
calls
action,
we
will
approach
trauma-informed
manner,
ultimately
improving
outcomes
quality
life
those
impacted
by
Journal of Neurochemistry,
Год журнала:
2022,
Номер
163(3), С. 179 - 219
Опубликована: Авг. 11, 2022
Neurofilament
proteins
(Nf)
have
been
validated
and
established
as
a
reliable
body
fluid
biomarker
for
neurodegenerative
pathology.
This
review
covers
seven
Nf
isoforms,
light
(NfL),
two
splicing
variants
of
medium
(NfM),
heavy
(NfH),
Intensive Care Medicine,
Год журнала:
2023,
Номер
49(9), С. 1062 - 1078
Опубликована: Июль 28, 2023
The
cerebral
oxygen
cascade
includes
three
key
stages:
(a)
convective
delivery
representing
the
bulk
flow
of
to
vascular
bed;
(b)
diffusion
from
blood
into
brain
tissue;
and
(c)
cellular
utilisation
for
aerobic
metabolism.
All
stages
may
become
dysfunctional
after
resuscitation
cardiac
arrest
contribute
hypoxic–ischaemic
injury
(HIBI).
Improving
by
optimising
has
been
widely
investigated
as
a
strategy
mitigate
HIBI.
However,
clinical
trials
aimed
at
have
yielded
neutral
results.
Advances
in
understanding
HIBI
pathophysiology
suggest
that
impairments
pertaining
should
also
be
considered
identifying
therapeutic
strategies
management
patients.
Culprit
mechanisms
these
include
widening
barrier
due
peri-vascular
oedema
mitochondrial
dysfunction.
An
integrated
approach
encompassing
both
intra-parenchymal
non-invasive
neuromonitoring
techniques
aid
detecting
pathophysiologic
changes
enable
patient-specific
reducing
severity
Frontiers in Aging Neuroscience,
Год журнала:
2022,
Номер
14
Опубликована: Ноя. 1, 2022
Neurological
biomarkers
are
particularly
valuable
to
clinicians
as
they
can
be
used
for
diagnosis,
prognosis,
or
response
treatment.
This
field
of
neurology
has
evolved
considerably
in
recent
years
with
the
improvement
analytical
methods,
allowing
detection
not
only
cerebrospinal
fluid
(CSF)
but
also
less
invasive
fluids
like
blood.
These
advances
greatly
facilitate
repeated
quantification
biomarkers,
including
at
asymptomatic
stages
disease.
Among
various
informative
neurological
disorders,
neurofilaments
(NfL)
have
proven
particular
interest
many
contexts,
such
neurodegenerative
diseases,
traumatic
brain
injury,
multiple
sclerosis,
stroke,
and
cancer.
Here
we
discuss
these
different
pathologies
potential
value
NfL
assay
management
patients,
both
diagnosis
prognosis.
We
describe
added
compared
other
currently
monitor
diseases
described
this
review.
Cells,
Год журнала:
2023,
Номер
12(11), С. 1546 - 1546
Опубликована: Июнь 5, 2023
Extracorporeal
membrane
oxygenation
(ECMO),
in
conjunction
with
its
life-saving
benefits,
carries
a
significant
risk
of
acute
brain
injury
(ABI).
Hypoxic-ischemic
(HIBI)
is
one
the
most
common
types
ABI
ECMO
patients.
Various
factors,
such
as
history
hypertension,
high
day
1
lactate
level,
low
pH,
cannulation
technique,
large
peri-cannulation
PaCO2
drop
(∆PaCO2),
and
early
pulse
pressure,
have
been
associated
development
HIBI
The
pathogenic
mechanisms
are
complex
multifactorial,
attributing
to
underlying
pathology
requiring
initiation
itself.
likely
occur
or
peri-decannulation
time
secondary
refractory
cardiopulmonary
failure
before
after
ECMO.
Current
therapeutics
target
pathological
mechanisms,
cerebral
hypoxia
ischemia,
by
employing
targeted
temperature
management
case
extracorporeal
resuscitation
(eCPR),
optimizing
O2
saturations
perfusion.
This
review
describes
pathophysiology,
neuromonitoring,
therapeutic
techniques
improve
neurological
outcomes
patients
order
prevent
minimize
morbidity
HIBI.
Further
studies
aimed
at
standardizing
relevant
neuromonitoring
techniques,
perfusion,
minimizing
severity
once
it
occurs
will
long-term
Neurocritical Care,
Год журнала:
2024,
Номер
41(1), С. 20 - 28
Опубликована: Фев. 1, 2024
Abstract
Background
Central
nervous
system
(CNS)
injury
following
initiation
of
veno-venous
extracorporeal
membrane
oxygenation
(VV-ECMO)
is
common.
An
acute
decrease
in
partial
pressure
arterial
carbon
dioxide
(PaCO
2
)
VV-ECMO
has
been
suggested
as
an
etiological
factor,
but
the
challenges
diagnosing
CNS
injuries
made
discerning
a
relationship
between
PaCO
and
difficult.
Methods
We
conducted
prospective
cohort
study
adult
patients
undergoing
for
respiratory
failure.
Arterial
blood
gas
measurements
were
obtained
prior
to
VV-ECMO,
at
every
2–4
h
first
24
h.
Neuroimaging
was
within
7–14
days
who
suspected
having
neurological
or
unable
be
examined
because
sedation.
collected
biospecimens
measure
brain
biomarkers
[neurofilament
light
(NF-L);
glial
fibrillary
acidic
protein
(GFAP);
phosphorylated-tau
181]
7
VV-ECMO.
assessed
both
over
with
using
mixed
methods
linear
regression.
Finally,
we
explored
effects
absolute
change
on
serum
levels
by
separate
regression
each
biomarker
three
exposures
hypothesized
result
injury.
Results
In
our
cohort,
12
59
(20%)
had
overt
identified
head
computed
tomography.
The
steeper
developed
(−
0.32%,
95%
confidence
interval
−
0.25
0.39)
compared
those
without
0.18%,
0.14
0.21,
P
interaction
<
0.001).
mean
concentration
NF-L
increased
time
higher
(464
[739])
(127
[257];
=
GFAP
(4278
[11,653]
pg/ml)
(116
[108]
pg/ml;
NF-L,
GFAP,
tau
stratified
thresholds
showed
no
differences
significant
time.
Conclusions
Although
rapid
decreases
slightly
greater
versus
without,
data
overlap
absence
relationships
suggests
other
pathophysiologic
variables
are
likely
play.