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Neurocritical Care: New Insights and Challenges
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Neurocritical Care: New Insights and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 4842

Special Issue Editors

Dr. Konstantinos Dimitriadis

E-Mail Website
Guest Editor
Department of Neurology, University Hospital LMU Munich, 81377 Munich, Germany
Interests: neurointensive care medicine; postoperative delirium
Prof. Dr. Julian Bösel

E-Mail Website
Guest Editor
Department of Neurology, University Hospital Heidelberg, 69120 Heidelberg, Germany
Interests: acute brain injury; acute ischemic stroke; intracranial hemorrhage

Special Issue Information

Dear Colleagues,

In recent years, specialized neurocritical care with early recognition and prevention of secondary brain injury has resulted in superior patient outcomes. Although the overall low number of patients per unit and ethical considerations regarding RCTs make meaningful research difficult, the community has generated a substantial body of evidence for the treatment strategies in neurointensive care units in recent decades.

Given the multidisciplinary and multiprofessional teams and the data- and resource-intensive environments, management aspects, including health care policy, as well as strategies applying advanced technology, may play an important role. Furthermore, biomarkers to allow personalized treatment and insights into the management of complications and of neurocritical care are warranted.

This Special Issue provides insights into novel advances and challenges in neurocritical care with an emphasis on monitoring, treatment strategies, prognosis and cost-effectiveness.

Dr. Konstantinos Dimitriadis
Prof. Dr. Julian Bösel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neurocritical care
  • acute brain injury
  • monitoring
  • treatment
  • cost-effectiveness

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Published Papers (4 papers)

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Research

13 pages, 774 KiB  
Article
Routine ICU Surveillance after Brain Tumor Surgery: Patient Selection Using Machine Learning
by Jan-Oliver Neumann, Stephanie Schmidt, Amin Nohman, Paul Naser, Martin Jakobs and Andreas Unterberg
J. Clin. Med. 2024, 13(19), 5747; https://doi.org/10.3390/jcm13195747 - 26 Sep 2024
Viewed by 578
Abstract
Background/Objectives: Routine postoperative ICU admission following brain tumor surgery may not benefit selected patients. The objective of this study was to develop a risk prediction instrument for early (within 24 h) postoperative adverse events using machine learning techniques. Methods: Retrospective cohort of 1000 [...] Read more.
Background/Objectives: Routine postoperative ICU admission following brain tumor surgery may not benefit selected patients. The objective of this study was to develop a risk prediction instrument for early (within 24 h) postoperative adverse events using machine learning techniques. Methods: Retrospective cohort of 1000 consecutive adult patients undergoing elective brain tumor resection. Nine events/interventions (CPR, reintubation, return to OR, mechanical ventilation, vasopressors, impaired consciousness, intracranial hypertension, swallowing disorders, and death) were chosen as target variables. Potential prognostic features (n = 27) from five categories were chosen and a gradient boosting algorithm (XGBoost) was trained and cross-validated in a 5 × 5 fashion. Prognostic performance, potential clinical impact, and relative feature importance were analyzed. Results: Adverse events requiring ICU intervention occurred in 9.2% of cases. Other events not requiring ICU treatment were more frequent (35% of cases). The boosted decision trees yielded a cross-validated ROC-AUC of 0.81 ± 0.02 (mean ± CI95) when using pre- and post-op data. Using only pre-op data (scheduling decisions), ROC-AUC was 0.76 ± 0.02. PR-AUC was 0.38 ± 0.04 and 0.27 ± 0.03 for pre- and post-op data, respectively, compared to a baseline value (random classifier) of 0.092. Targeting a NPV of at least 95% would require ICU admission in just 15% (pre- and post-op data) or 30% (only pre-op data) of cases when using the prediction algorithm. Conclusions: Adoption of a risk prediction instrument based on boosted trees can support decision-makers to optimize ICU resource utilization while maintaining adequate patient safety. This may lead to a relevant reduction in ICU admissions for surveillance purposes. Full article
(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)
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9 pages, 513 KiB  
Article
No Harmful Effect of Endovascular Treatment before Decompressive Surgery—Implications for Handling Patients with Space-Occupying Brain Infarction
by Johann Otto Pelz, Simone Engelmann, Cordula Scherlach, Peggy Bungert-Kahl, Alhuda Dabbagh, Dirk Lindner and Dominik Michalski
J. Clin. Med. 2024, 13(3), 918; https://doi.org/10.3390/jcm13030918 - 5 Feb 2024
Viewed by 1016
Abstract
This study explored short- and mid-term functional outcomes in patients undergoing decompressive hemicraniectomy (DHC) due to space-occupying cerebral infarction and asked whether there is a potentially harmful effect of a priorly performed endovascular treatment (EVT). Medical records were screened for patients requiring DHC [...] Read more.
This study explored short- and mid-term functional outcomes in patients undergoing decompressive hemicraniectomy (DHC) due to space-occupying cerebral infarction and asked whether there is a potentially harmful effect of a priorly performed endovascular treatment (EVT). Medical records were screened for patients requiring DHC due to space-occupying cerebral infarction between January 2016 and July 2021. Functional outcomes at hospital discharge and at 3 months were assessed by the modified Rankin Scale (mRS). Out of 65 patients with DHC, 39 underwent EVT before DHC. Both groups, i.e., EVT + DHC and DHC alone, had similar volumes (280 ± 90 mL vs. 269 ± 73 mL, t-test, p = 0.633) and proportions of edema and infarction (22.1 ± 6.5% vs. 22.1 ± 6.1%, t-test, p = 0.989) before the surgical intervention. Patients undergoing EVT + DHC tended to have a better functional outcome at hospital discharge compared to DHC alone (mRS 4.8 ± 0.8 vs. 5.2 ± 0.7, Mann–Whitney-U, p = 0.061), while the functional outcome after 3 months was similar (mRS 4.6 ± 1.1 vs. 4.8 ± 0.9, Mann–Whitney-U, p = 0.352). In patients initially presenting with a relevant infarct demarcation (Alberta Stroke Program Early CT Score ≤ 5), the outcome was similar at hospital discharge and after 3 months between patients with EVT + DHC and DHC alone. This study provided no evidence for a harmful effect of EVT before DHC in patients with space-occupying brain infarction. Full article
(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)
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14 pages, 797 KiB  
Article
Intrahospital Transport of Critically Ill Patients with Subarachnoid Hemorrhage—Frequency, Timing, Complications, and Clinical Consequences
by Moritz L. Schmidbauer, Tim L. T. Wiegand, Linus Keidel, Julia Zibold and Konstantinos Dimitriadis
J. Clin. Med. 2023, 12(24), 7666; https://doi.org/10.3390/jcm12247666 - 13 Dec 2023
Viewed by 1329
Abstract
Background: Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical [...] Read more.
Background: Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical in these patients. Methods: In this retrospective, single-center cohort study, a total of 108 IHTs were analyzed for demographics, transport rationale, clinical outcomes, and pre/post-IHT monitoring parameters. After establishing clinical thresholds, the frequency of complications was calculated, and predictors of thresholds violations were determined. Results: The mean age was 55.7 (+/−15.3) years, with 68.0% showing severe SAH (World Federation of Neurosurgical Societies Scale 5). IHTs with an emergency indication made up 30.8% of all transports. Direct therapeutic consequences from IHT were observed in 38.5%. On average, the first IHT occurred 1.5 (+/−2.0) days post-admission and patients were transported 4.3 (+/−1.8) times during their stay in the NICU. Significant parameter changes from pre- to post-IHT included mean arterial pressure, systolic blood pressure, oxygen saturation, blood glucose levels, temperature, dosages of propofol and ketamine, tidal volume, inspired oxygen concentration, Horovitz index, glucose, pH, intracranial pressure, and cerebral perfusion pressure. Relevant hemodynamic thresholds were violated in 31.5% of cases, while respiratory complications occurred in 63.9%, and neurological complications in 20.4%. For hemodynamic complications, a low heart rate with a threshold of 61/min (OR 0.96, 95% CI 0.93–0.99, p = 0.0165) and low doses of midazolam with a threshold of 17.5 mg/h (OR 0.97, 95% CI 0.95–1.00, p = 0.0232) significantly predicted adverse events. However, the model did not identify significant predictors for respiratory and neurological outcomes. Conclusions: Conclusively, IHTs in SAH patients are associated with relevant changes in hemodynamic, respiratory, and neurological monitoring parameters, with direct therapeutic consequences in 4/10 IHTs. These findings underscore the importance of further studies on the clinical impact of IHTs. Full article
(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)
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11 pages, 1040 KiB  
Article
Usage of Inhalative Sedative for Sedation and Treatment of Patient with Severe Brain Injury in Germany, a Nationwide Survey
by Svea Roxana Roggenbuck, André Worm, Martin Juenemann, Christian Claudi, Omar Alhaj Omar, Marlene Tschernatsch, Hagen B. Huttner and Patrick Schramm
J. Clin. Med. 2023, 12(19), 6401; https://doi.org/10.3390/jcm12196401 - 8 Oct 2023
Cited by 2 | Viewed by 1254
Abstract
Brain injured patients often need deep sedation to prevent or treat increased intracranial pressure. The mainly used IV sedatives have side effects and/or high context-sensitive half-lives, limiting their use. Inhalative sedatives have comparatively minor side effects and a brief context-sensitive half-life. Despite the [...] Read more.
Brain injured patients often need deep sedation to prevent or treat increased intracranial pressure. The mainly used IV sedatives have side effects and/or high context-sensitive half-lives, limiting their use. Inhalative sedatives have comparatively minor side effects and a brief context-sensitive half-life. Despite the theoretical advantages, evidence in this patient group is lacking. A Germany-wide survey with 21 questions was conducted to find out how widespread the use of inhaled sedation is. An invitation for the survey was sent to 226 leaders of intensive care units (ICU) treating patients with brain injury as listed by the German Society for Neurointensive Care. Eighty-nine participants answered the questionnaire, but not all items were responded to, which resulted in different absolute counts. Most of them (88%) were university or high-level hospital ICU leaders and (67%) were leaders of specialized neuro-ICUs. Of these, 53/81 (65%) use inhalative sedation, and of the remaining 28, 17 reported interest in using this kind of sedation. Isoflurane is used by 43/53 (81%), sevoflurane by 15/53 (28%), and desflurane by 2. Hypotension and mydriasis are the most common reported side effects (25%). The presented survey showed that inhalative sedatives were used in a significant number of intensive care units in Germany to treat severely brain-injured patients. Full article
(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)
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