| 书目名称 | Textbook of Neurointensive Care: Volume 2 | | 副标题 | Perioperative Manage | | 编辑 | Elizabeth Mahanna Gabrielli,Kristine H. O‘Phelan,A | | 视频video | | | 概述 | Reviews all monitoring, pharmacological and perioperative strategies used in neurointensive care.Provides evidence-based data and includes algorithms to facilitate decision making and key points in ea | | 图书封面 |  | | 描述 | .This extensively updated edition provides a comprehensive review of intensive care for neurologically injured patients from the emergency room and ICU through the operating room and post-surgical period in two comprehensive volumes. The Editors of this second volume present a comprehensive textbook that incorporates best practice/evidence-based medicine and performance improvement, while it champions the three characteristics needed in our neuro–ICUs: patient and family centered high-quality care, education, and discovery. This volume concentrates on perioperative management, monitoring and pharmacotherapy, examining the neurological problems most frequently seen in intensive care, and describes the various types of neurosurgery and critical features of the management of patients. General issues are discussed across the textbook, such as cardiac care, fluids and electrolytes, nutrition, and monitoring as well as more specific conditions and complications including elevated intracranial pressure, seizures, and altered mental states...Listening to an injured brain is not easy. It takes knowledge, dedication, and understanding of the critically ill patient and their family. .Textboo | | 出版日期 | Textbook 2024Latest edition | | 关键词 | Neurointensive; Neuroradiology; Neurosurgery; CNS Trauma; Ventilation; Sepsis; Neuroanesthesia; Monitoring; | | 版次 | 3 | | doi | https://doi.org/10.1007/978-3-031-62224-3 | | isbn_softcover | 978-3-031-62226-7 | | isbn_ebook | 978-3-031-62224-3 | | copyright | The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerl |
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Intraoperative Neuroanesthesia |
Elizabeth Mahanna Gabrielli,Steven A. Robicsek,Dietrich Gravenstein,Nikolaus Gravenstein,David L. McDonagh |
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Abstract
This chapter broadly describes the formulation of a neuroanesthetic management plan. There are unique intraoperative issues for all neurosurgical procedures as anesthetic agents and technique may significantly affect cerebral oxygen consumption (CMRO.), cerebral oxygen delivery (CDO.), cerebral blood flow (CBF), intracranial tissue volume, intracranial pressure (ICP), arterial oxygen content (CaO.), and the autoregulation of spinal and cerebral blood flow. Management of concurrent comorbidities, optimization of the surgical exposure, and anticipation of surgery-related events in the operating room and during the perioperative period broadly define secondary objectives of an anesthetic intervention..A selection of representative clinical scenarios including surgeries for mass lesions, lesions in the posterior fossa, transsphenoidal hypophysectomies, open and endovascular surgeries for aneurysms and other vascular malformations, surgical treatment of stroke, spine surgery, and functional neurosurgery are presented. Unique considerations and complications such as positioning, postoperative visual loss, venous air embolism (VAE), neuroprotection, and neuromonitoring are reviewed in detail.
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Postoperative Care for the Neurosurgical Patient: Cranial Procedures |
Lucas R. Philipp,Caio M. Matias,Peter Le Roux,Jack Jallo |
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Abstract
Those undergoing cranial procedures are among the most challenging patients in the intensive care unit (ICU) given their complex primary neurosurgical pathology and represent the most systemically ill patients in the hospital—the neurointensivist integrates all aspects of neurological and medical management into a single care plan. This chapter provides an overview of the key considerations for the medical management of these patients, including preoperative assessment, anesthesia management, postoperative monitoring, and management of complications. Optimization of therapy during the acute postoperative care phase is critical given the heightened sensitivity of the postoperative central nervous system (CNS) and vulnerability to secondary insult. The mitigation of these complications and avoidance of secondary neurological insult is contingent upon a thorough understanding of the interplay between multiple body systems, and a focus on systemic, CNS-directed therapy is essential.
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Complex Spine Surgery |
Ken Porche,Daniel J. Hoh,Basma Mohamed,Adam Polifka,Matthew Decker |
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Abstract
This chapter provides a comprehensive exploration of complex spine surgery, tracing the evolution of surgical techniques and the implementation of advanced instrumentation that has transformed patient outcomes. Focused on addressing severe spinal pathologies such as trauma, tumors, infections, and deformities, the text delineates the progression from traditional posterior approaches to more innovative anterior and lateral methods. These developments facilitate enhanced access to spinal structures, allowing for improved stabilization and alignment. Moreover, the chapter emphasizes the crucial interplay between neurosurgical and critical care teams in managing complex cases, highlighting the importance of a multidisciplinary approach. With detailed descriptions of surgical approaches, instrumentation, and potential complications, the chapter serves as an essential resource for clinicians aiming to expand their surgical repertoire and improve patient care in complex spinal conditions.
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Airway Management in the Neurointensive Care Unit |
Felipe Urdaneta,Ya-Chu May Tsai,Matteo Parotto |
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Abstract
Airway management in the critically ill can be very challenging. The pathophysiology of underlying conditions, disparities in equipment, providers’ skills, and availability of adequately trained staff are essential issues and play a pivotal role in patient outcomes..Neuro-critically ill patients require special considerations. Optimization of oxygenation before and during attempts of airway management, monitoring pulse oximetry, electrocardiogram, blood pressure monitoring, and capnography should be available. Peri-intubation cardiovascular instability occurs frequently and is associated with severe complications and death. Hemodynamic stability maintains adequate cerebral perfusion pressure; extreme blood pressure fluctuation during instrumentation attempts should be avoided..Management of airway emergencies should focus on coordinated team efforts to reestablish airway patency, oxygenation, and ventilation restoration.
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Critical Care Procedures |
Brad R. Withers,Kevin W. Hatton |
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Abstract
Neurocritical care patients undergo frequent bedside invasive procedures during their acute critical illness to aid in the diagnosis and treatment of central nervous system (CNS) and other organ system injuries that may critically effect survival or long-term organ system function. These procedures have specific indications, contraindications, and complications that affect the balance between risk and benefit. In this chapter, we describe these features and highlight the recommended techniques for the most commonly performed procedures.
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Echocardiography and Ultrasound Applications |
Nawar Al-Rawas,Ron Leong,Eric Feduska,Ettore Crimi |
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Abstract
Echocardiography and ultrasound (US) use is essential in patients admitted to the neurointensive care unit (NICU), allowing real-time diagnosis and assisting in bedside procedures..Brain US can help to evaluate cerebral anatomy, pathology, and cerebral circulation and vasospasm by analyzing blood flow velocities by using transcranial Doppler (TCD), transcranial color-coded duplex sonography (TCCD), or other bedside US modalities..Bedside cardiac US is an essential tool in critically ill patients to evaluate cardiac function and abnormalities and assess volume status by using transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), or cardiac point-of-care ultrasound (POCUS)..Vascular access with US guidance has been implemented successfully in critical care practices for decades to assess with bedside peripheral venous, central venous, and intra-arterial cannulation..US can provide a quick and essential assessment in shock and trauma patients by using dedicated protocols including ultrasound in shock (RUSH), abdominal and cardiac evaluation with sonography in shock (ACES), focused assessment with sonography for trauma (FAST), or focused cardiac ultrasound (FOCUS)..Bedside US in critical care units is safe, accurate, rapid, and repeatable at the bedside. Data obtained with bedside US are essential and can provide useful tools and skillset that can assist and guide critical care practices in NICU.
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Invasive Neurological and Multimodality Monitoring in the Neuro-ICU |
Omer Doron,Guy Rosenthal,Peter Le Roux |
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Abstract
Patients admitted to the neurocritical care unit (NCCU) are at risk for secondary brain injury that frequently can exacerbate outcomes. Consequently, current NCCU management strategies focus on the identification, prevention, and management of secondary brain injury since there are few pharmacological agents that demonstrate efficacy in these patients. In the last decade, techniques to monitor brain function have evolved and, in the modern NCCU, play an important role in patient care and, in particular, in a patient-specific targeted approach. Monitors include radiologic techniques that provide information about a specific point in time or bedside monitors that provide continuous or noncontinuous physiologic information. In turn, these bedside techniques may be subdivided into invasive or noninvasive monitors. In this review, we will discuss invasive intracranial monitors, including (1) intracranial pressure; (2) monitors of cerebral oxygenation (direct measurement of brain oxygen [PbtO.] and jugular venous catheters); (3) metabolic monitors, i.e., cerebral microdialysis; (4) cerebral blood flow monitors such as thermal diffusion flowmetry and laser Doppler flowmetry; (5) invasive electroencephalography.
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Noninvasive Neuromonitoring |
Kathryn R. Rosenblatt,Vishank A. Shah,Mariyam Humayun,Veronika Solnicky,Ozan Akça |
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Abstract
All neuromonitoring tools were initially developed to either augment or supplant the neurological exam when the effects of treatment or the brain insult itself mask clinical findings. Some monitoring tools have become as essential as the clinical exam in the care of neurocritically ill patients and are used routinely to assess cerebral hemodynamics and function, such as transcranial Doppler ultrasonography and evoked potential monitoring. Other tools, such as near-infrared spectroscopy, processed electroencephalography, and point-of-care electroencephalography, are not yet standards of practice in the management of patients with critical neurological illness. Yet, all three represent systems that can be rapidly applied at the bedside without the need for specialized technicians or complex procedures to operate the equipment. The ongoing development of integrated multimodality neuromonitoring drives the evolution of neurocritical care toward individualized therapeutic decision-making to improve neurological recovery.
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Integrated Approaches to Multimodality Monitoring of Cerebral Physiology |
Ramani Balu |
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Abstract
Delayed secondary brain injury occurs in the hours, days, and weeks after acute brain insults and can markedly worsen neurologic outcomes. A multitude of pathophysiological processes, both systemic and neurologic, can trigger secondary brain injury. Physiological monitoring at the bedside can help identify these processes in real time so that therapies that potentially reduce the burden of secondary injury can be deployed. Multimodality monitoring (MMM) refers to any strategy where multiple indices of brain and systemic physiology are simultaneously and continuously monitored. While MMM may allow for a more nuanced picture of brain function during critical illness, it produces a plethora of data that can be confusing to interpret. This chapter will provide a systematic approach for MMM data interpretation during the clinical care of a critically ill, brain-injured patient.
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Neurological Applications of Hemodynamics and Pulmonary Monitoring |
Krupa Savalia,Atul Kalanuria,W. Andrew Kofke |
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Abstract
The elaborate heart-brain axis was historically highlighted by French physiologist, Claude Bernard, in the early twentieth century. The nervous system controls cardio-pulmonary function through a network of neuronal loops and feedback systems. Sensory feedback, such as inadequate neural tissue blood flow, results in signals to increase blood pressure, largely via autonomic output which may lead to variable effects in hemodynamic augmentation or attenuation depending on the clinical scenario. Moreover, the brain has important effects on pulmonary function, largely through control of respiratory patterns (see below), but also indirectly via hemodynamic input. Moreover, neurologic processes can affect pulmonary function on virtually all axes of neurologic function; more specifically, from the intracranial CNS to the spinal cord and peripheral nervous system, to the neuromuscular junction. The impacts produce oxygenation and carbon dioxide abnormalities due to issues with neurogenic pulmonary parenchymal issues, control of breathing, airway dysfunction, and disordered respiratory muscle function. Numerous disease states alter brain-heart and brain-lung interactions. Monitoring for such interactions can provide insight as to neural function and such monitors are reviewed.
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Systemic Illness and Multisystem Organ Failure |
Aaron N. LacKamp,Robert D. Stevens,Peggy A. White |
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Abstract
Critical illness has consequences for the nervous system. Patients experiencing critical illness are at risk for common global neurologic disturbances, such as delirium, long-term cognitive dysfunction, ICU-acquired weakness, sleep disturbances, recurrent seizures, and coma. In addition, complications related to specific organ dysfunction may be anticipated. Cardiovascular disease presents the possibility for CNS injury after cardiac arrest, sequelae of endocarditis, aberrancies of blood flow autoregulation, and malperfusion. Respiratory disease is known to cause short-term effects of hypoxia and long-term effects after ARDS. Sepsis encephalopathy and sickness behavior syndrome are early signs of infection in patients. In addition, commonly encountered organ dysfunction including uremia, hepatic failure, endocrine, and metabolic disturbances present with neurologic findings which may manifest in the critically ill patient as well.
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Environmental Injury: Toxins, Overdose, Drowning, Thermal Burns |
Jared Ham |
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Abstract
Working knowledge of toxins and environmental injuries is important to the intensivist in any ICU. This chapter focuses on the initial management of the poisoned, drowned, and burned patient with emphasis on resuscitation and the essential points of care following stabilization. The section on toxins and overdose provides information on general resuscitation as well as key toxin-specific points, illustrates a pattern-recognition based framework for dealing with undifferentiated toxidromes, discusses important antidotes, and outlines enhanced elimination and detoxification modalities. The section on drowning discusses epidemiology, the pathophysiology of drowning, and highlights the need to investigate for and treat medical conditions and injuries that frequently occur along with drowning. Finally, the section on thermal burns delves into the special considerations needed for airway assessment and management of burn patients, inhalation injuries, fluid resuscitation, wound care, and indications for transfer to a dedicated burn center.
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Consultative Neurocritical Care |
Chitra Venkatasubramanian,Kyle Lyman,Varun Shah |
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Abstract
Critically ill patients who are suffering from non-neurological illness and organ dysfunction in an ICU environment are prone to secondary injuries along the neuraxis. Structural and functional disturbances can manifest all the way from the brain to the peripheral nervous system. The most common neurological disorders seen in non-neurological ICUs include delirium, altered mentation, and critical illness neuromyopathy, but more acute conditions are encountered, such as ischemic and hemorrhagic strokes, as well as seizures. Besides providing consultation for management decisions, neurologists are also an integral part of neuroprognostication in critically ill patients. This chapter outlines the basic principles of consultative neurocritical care by describing prerequisites and techniques for performing an adequate and ICU-focused neurological exam. The chapter also addresses several common questions asked of the neurology consultant and provides a practical approach to adequately answer these. Fundamental aspects of neuroprognostication are also elaborated.
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Sedation, Analgesia and Muscle Relaxation in NICU |
Angelo Guglielmi,Marta Baggiani,Chiara Almondo,Giuseppe Citerio |
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Abstract
Sedation, analgesia, and muscle relaxation are crucial in the management of patients admitted to neurointensive care unit (NICU). In NICU, the aims of sedation analgesia and muscle relaxation are specific and encompass brain physiology and peculiar patterns of brain injury. Counterbalancing the positive aspects and side effects of each sedative is pivotal for clinicians. Monitoring is fundamental and sedation holds, defined as interruptions or de-escalation of sedatives, has the target of allowing the patient’s arousal, and clinically identifying any focal or global neurological impairment useful for subsequent patient management..Clinical scales and new delivery technologies will help the monitoring and the clinical evaluation of the patient..Status epilepticus and delirium represent complex situations in which sedation, analgesia, and muscle relaxation have a large role in the treatment or even in triggering the clinical picture.
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Anticoagulants and Reversal Agents |
Sulaiman Almohaish,Gretchen M. Brophy |
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Abstract
Neurocritical care patients are at an increased risk of developing thrombotic complications. Several anticoagulant agents are available to prevent patients from developing a thrombus or to treat patients when thrombosis occurs. Some of these agents are available as oral therapy and others are parenteral. Parenteral agents are preferred to be used in an unstable patient while in the hospital due to their short half-life and reliable absorption, while many oral agents are ideal for stabilized patients preparing to be discharged. When choosing appropriate anticoagulant therapy for a patient, healthcare professionals should consider individual patient characteristics, such as weight, renal and liver function, and concomitant medications. Anticoagulant use may also lead to unwanted bleeding adverse events that require the initiation of anticoagulation reversal strategies. This chapter will focus on anticoagulant pharmacology, pharmacotherapy, advantages and disadvantages, and reversal strategies when life-threatening bleeding occurs.
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发表于 2025-3-21 19:45:03
