Blogs

Critical Care Medicine (07/02/21) DOI: 10.1097/CCM.0000000000005149 Gutierrez, Cristina; Brown, Anne Rain T.; May, Heather P.; et al. https://journals.lww.com/ccmjournal/Abstract/9000/Critically_Ill_Patients_Treated_for_Chimeric.95168.aspx   In a new study, U.S. researchers report a multicenter cohort of patients who required ICU admission due to cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor (CAR) T-cell therapy. The retrospective cohort study included 105 adult patients treated with axicabtagene ciloleucel who experienced CRS or immune effector cell-associated neurotoxicity ...
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Gabrielle Horstman, MD/PhD This month we would like to highlight one of the new programs launched this year by the Inclusion in Neurocritical Care (INCC)  Committee– The INCC Virtual Book Club! This program was created in response to multiple requests from members like you during the 2020 Annual meeting. Fully embracing the virtual nature of the meeting, the idea for a book club stemmed from a very active chat discussion during the Women In Neurocritical Care (WINCC) keynote address given by Dr. Chere Chase-Gregory where she illustrated her personal struggles and successes on her rise as Senior Vice President and Chief Health Equity Officer of Novant Health.  ...
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Richard Leston,  APP Supervisor, Department of Neurosurgery, Clinical Preceptor of APP Neurosurgery Clerkship With: Alexis Catania, PA & Krista O’Leary PA-S South Shore University Hospital was preparing to open its brand-new Neuro ICU in March of 2020, eager to become a major neuroscience center in Suffolk County, New York. This effort involved a rapid expansion of the neurosurgery department, adding a team of neurointensivists, and quadrupling the APP staff over the course of one year.  Unfortunately, COVID-19 delayed the launch of our ICU while we joined in the efforts to combat the pandemic, turning in our pen lights and reflex hammers for stethoscopes and laryngoscopes. After ...
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Journal of the American Medical Association (05/25/21)  DOI: 10.1001/jama.2021.5561 Roquilly, Antoine; Moyer, Jean Denis; Huet, Olivier; et al. https://jamanetwork.com/journals/jama/article-abstract/2780326   For the COBI clinical trial, researchers compared outcomes in adults with traumatic brain injury (TBI) after treatment with or without continuous infusion of hypertonic saline solution. Fluid therapy is critical for individuals sustaining this type of damage, but its effect on neurological recovery was unknown. To learn more, investigators enrolled 370 ICU patients suffering from severe TBI, all of whom received standard care. Half of the participants ...
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By Wade Smith, MD, PhD, FNCS A Mid-Year Check-In Dear NCS Members, It’s hard to believe we’re halfway through 2021. Over the past six months, we’ve made significant strides in COVID-19 recovery, and many cities and states across the United States are looking forward to a safe return to our normal lives and activities. In fact, even live music events are resuming, as the Foo Fighters just played Madison Square Garden’s first full-capacity concert since March 2020 . A safe return to our hobbies means things are surely looking up for our hospitals, practices and patients, too. I wish you all a very safe and enjoyable summer, and I hope you spend ...
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Zachary Threlkeld, MD, Ahmad Riad Ramadan, MD, Sara Hefton, MD, Starane Shepherd, MD, H.E. Hinson, MD INCC Sexual and Gender Minority Subcommittee As part of broader diversity, equity, and inclusion efforts within NCS, the Sexual and Gender Minority (SGM) subcommittee of the Inclusion in Neurocritical Care Committee (INCC) aspires to raise awareness about and mitigate health disparities in SGM individuals, support development of culturally sensitive neurocritical care, and promote the recruitment and retention of SGM individuals who are historically under-represented in neurocritical care and in medicine more broadly.  Sexual and gender minority people ...
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Jon Rosenberg, MD, Weill Cornell Medicine/New York-Presbyterian Hospital Laura Chen, DO, Weill Cornell Medicine/New York-Presbyterian Hospital Judy Ch’ang, MD, Weill Cornell Medicine/New York-Presbyterian Hospital A 34-year-old man presented with a high-grade traumatic brain injury (TBI) after being struck by a motor vehicle. In the emergency department he had a GCS of 3 and was intubated for airway protection. His initial CT showed bilateral frontal subarachnoid hemorrhage, left subdural hematoma and temporal contusion with effacement of his basilar cisterns, and 9mm of midline shift. He was given mannitol and taken to the OR for a left hemicrainectomy, ...
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The Lancet Neurology (04/01/21)  DOI: 10.1016/S1474-4422(20)30494-4 Walgaard, Christa; Jacobs, Bart C; Lingsma, Hester F; et al. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30494-4/fulltext   New research finds no benefit but a risk of serious adverse events from a second intravenous immunoglobulin dose (SID) for patients with Guillain-Barré syndrome with a poor prognosis. Investigators had investigated the efficacy of a SID in this population, as treatment with one standard dose of I.V. immunoglobulin is not sufficient for some patients with severe Guillain-Barré syndrome. The randomized, double-blind study included patients ...
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Bryan Boling, DNP, University of Kentucky Jennifer Mears, PA, Weill Cornell Medicine/New York-Presbyterian Hospital Aarti Sarwal, MD, Wake Forest Baptist Health Judy Ch’ang, MD, Weill Cornell Medicine/New York-Presbyterian Hospital Point-of-care-ultrasound (POCUS) is an indispensable tool used in the diagnosis, screening, procedural guidance, and management of critically ill patients across the world. Unlike other imaging modalities, POCUS is performed and interpreted by the intensivist at the bedside, enabling real-time management decisions while being cost-effective and safe. Literature increasingly supports POCUS use in intensive care, ...
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Peter J. Papadakos MD, FCCM, FCCP, FAARC, FNIV Over the last decade, many unregulated drugs have appeared on the marketplace and have adversely affected our patients. We are all familiar with artificial marijuana which were sold in thousands of convenience stores throughout the country. These synthetic cannabinoids sold with catchy names such as K2, Spice, Scooby, Bizzaro or Snzx. The FDA acted rapidly to educate the public and make them illegal. They impacted our ICU’s with seizures, unconscious, delirium, aggressive and combative behavior, and the effects lasted for hours, and sometimes lead to death.   Over the last few years, another natural compound ...
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Shweta Goswami, MD, University of Florida Sasha Yakhkind, MD, University of Pennsylvania Every year, neurology residents combine the wisdom of their mentors, their experience, their passion, and their personalities to guide them in the decision of sub-specialization. In 2017, 90% of neurology residents planned to complete fellowship before going into practice (1), and the process of application into subspecialty training is nuanced and evolving. Neurocritical care fellowship is part of the United Council for Neurologic Specialties (UCNS), and the match process has been completed through the San Francisco Match (SFMatch) since 2009 (2), a year after the first ...
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Luis Rafael Moscote-Salazar, MD Critical Care Unit, Bogotá, Colombia Centro Policlínico del Olaya I ván David Lozada-Martínez, MS University of Cartagena Cartagena, Colombia View Blog in English Las enfermedades neurológicas y neuroquirúrgicas son una de las principales causas de morbilidad y mortalidad en todo el mundo, y América Latina no es una excepción [1-3]. La incorporación de la atención neurocrítica ha representado un cambio de paradigma en el manejo de estas enfermedades [4]. Sin embargo, el advenimiento de la reciente pandemia ha representado  una serie de desafíos para la atención neurocrítica en países de ingresos bajos y medianos ...
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Luis Rafael Moscote-Salazar, MD Critical Care Unit, Bogotá, Colombia Centro Policlínico del Olaya I ván David Lozada-Martínez, MS University of Cartagena Cartagena, Colombia Blog en Español Neurological and neurosurgical diseases are a major cause of morbidity and mortality worldwide, and Latin America is no exception [1-3]. The incorporation of neurocritical care has represented a paradigm shift in the management of these diseases [4]. However, the advent of the recent pandemic represented a series of challenges for neurocritical care in low- and middle-income countries [5] such as those in Latin America, and in turn has led to the development ...
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By Wade Smith, MD, PhD, FNCS The Value of Volunteer Leadership Dear NCS Members, A foundation of NCS is its volunteers. As a member, if you have not yet volunteered for a role in NCS, please consider doing so. Serving as your NCS President in a year when we are emerging from the COVID-19 pandemic was challenging but an honor. It is so gratifying to witness the members of our society working on the frontlines of healthcare at all times, especially over the past 16 months. I have served as an NCS volunteer leader for several years, and my term as president has been the most rewarding yet. I am thankful to each one of you for sharing your stories, ...
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Shivani Ghoshal, MD Currents is excited to launch a new Arts Corner to recognize visual, performing, and creative artworks pertaining to neurocritical care, as well as makers within our own community. The practice of neurocritical care is as humbling as it is rewarding, and requires mindfulness both of oneself and one’s peers. We hope this corner will be a step toward recognizing creative outlets for NCS members and bringing our community closer together even while we are apart.  For its debut, we’d like to introduce Shivani Ghoshal, a neuro-intensivist and burgeoning artist who will be leading this new section. Outside of hospital and research work, Shivani ...
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JAMA Neurology (05/03/21) DOI: 10.1001/jamaneurol.2021.0925 Murthy, Santosh B.; Zhang, Cenai; Diaz, Ivan; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2779594 Intracerebral hemorrhage correlated with a greater risk of ischemic stroke and myocardial infarction, according to data from four population-based cohort studies. "These findings suggest that intracerebral hemorrhage may be a novel risk marker for arterial ischemic events," the researchers wrote. For the study, the team analyzed pooled data from four population-based, U.S. studies: the Atherosclerosis Risk in Communities (ARIC) study, the Cardiovascular Health Study (CHS), ...
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JAMA Network Open (05/11/21) DOI: 10.1001/jamanetworkopen.2021.12131 Chou, Sherry H.-Y.; Beghi, Ettore; Helbok, Raimund; et al. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779759 Neurological manifestations are common among patients hospitalized with COVID-19, according to new research, and are associated with an increased risk for in-hospital mortality. The cohort study — which involved 3,744 patients hospitalized with COVID-19 in 13 countries on four continents — sought to determine the neurological incidence of neurological manifestations of COVID-19 and investigate their relationship with in-hospital mortality. Patients were divided ...
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By Yingying Su, MD, Neuro ICU Professor, Xuanwu Hospital, Capital Medical University In 1998, when the neuro ICU of Xuanwu Hospital of Capital Medical University was established, we initiated a research project with the Beijing Municipal Science and Technology Commission—a study of bedside brain injury monitoring, evaluation, and brain protection treatment. Since then, with the support of nine scientific research projects, we have carried out studies of neuro-electrophysiology (EEG, EPs and ERPs), neuro-biochemical markers (S-100 and NSE), cerebral blood flow and cerebral perfusion (TCD, ICP and CPP), brain tissue oxygen technology (SjvO2, AVDO 2 and OEF), ...
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Reviewed by Sanjeev Sivakumar, MD Read the Article* *Article access requires subscription/login  Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage. Maximilian I. Sprügel, Joji B. Kuramatsu et al. Stroke 2021 Mar;52(3):975-984. doi: 10.1161/STROKEAHA.120.029345  Background : Statins play an important role in the treatment and prevention of ischemic cerebrovascular and cardiovascular disease. The debate on statin therapy and ICH risk is one that is ongoing, ever since the Stroke prevention by aggressive reduction in cholesterol levels (SPARCL) study published in 2006 showed ...
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Reviewed by Shannon Hextrum, MD Read the Article Ammar AA, Ammar MA, Owusu KA, et al. Andexanet Alfa Versus 4-Factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage [published online ahead of print, 2021 Jan 6].  Neurocrit Care . 2021;10.1007/s12028-020-01161-5. doi:10.1007/s12028-020-01161-5 Background: Andexanet alfa is FDA-approved for reversal of life-threatening bleeding related to oral factor Xa inhibitors (FXi). Trial data from ANNEXA-4 has shown that andexanet administration in life-threatening bleeds is associated with decreased anti-factor Xa activity and a high rate of good or excellent ...
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