Neurology Critical Care

Coma/Anoxic Brain Injury

Levy DE, Caronna JJ, Singer BH, et al. Predicting outcome from hypoxic-ischemia coma. JAMA 1985;253:1420-6.  Oft-cited landmark study of the prognostic information provided by physical examination. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3968772

Wijdicks EF, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 ;67:203-10. Excellent, practical review from the AAN. http://www.ncbi.nlm.nih.gov/pubmed/16864809?ordinalpos=90&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-6. Prospective cohort study found patients with "delayed" extubation had increased incidence of nosocomial pneumonia, longer ICU and hospital stays, and greater hospital charges. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10806150

Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).  JAMA  2001;286:2703-10.  This early study helped establish the methodology for studying ICU delirium while documenting the immense scope of the problem.  Over 80% of patients experienced delirium during their ICU stay, 10% of whom were still delirious at hospital discharge.  Nearly 40% of patients who were alert or easily aroused and followed commands were delirious, suggesting delirium is easily overlooked. Training manuals and other downloadable materials in 12 languages are available at: www.icudelirium.org . http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11730446&query_hl=16&itool=pubmed_DocSum 

Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004;291:1753-62. This study confirmed a high prevalence of ICU delirium and was the first to show delirium is an independent risk factor for mortality.  Specifically, ICU delirium was associated with 3-fold higher 6-month mortality.  After adjusting for co-morbidities, illness severity, coma, and use of sedatives and analgesics, delirium was also associated with prolonged ICU and hospital stays, as well as cognitive impairment at hospital discharge. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15082703&query_hl=16&itool=pubmed_DocSum

***See also Sedation and Analgesia

Spinal cord injury

Mansel JK, Norman JR. Respiratory complications and management of spinal cord injuries. Chest 1990; 97:1446-52. Summarizes the impact of cervical injuries on pulmonary mechanics over time and interventions to minimize pulmonary morbidity and mortality and optimize chances of successful weaning from the ventilator. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2189697

Acute stroke

van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet 2007;27;369:306-18.  Review of the evaluation, treatment, and complications of vasospasm and rebleeding.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17258671

Adams HP Jr, del Zoppo G, Alberts MJ, et al.  Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: Most recent guidelines for the management of ischemic stroke. Circulation. 2007;115:e478-534. http://www.ncbi.nlm.nih.gov/pubmed/17515473?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2

Other

DeGans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347:1549-56.  High quality RCT including 301 patients found early administration of 10 mg dexamethasone q 6 hrs for 4 days reduced the risk of poor outcome (score of 5 vs. score of 1-4 on Glasgow Outcome Scale) [relative risk 0.59] and was associated with a relative risk of death of 0.48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12432041

Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007; 131:1541-9. This review offers a particularly nice discussion of the controversies surrounding the diagnostic approach to neuromuscular complications of critical illness. http://www.ncbi.nlm.nih.gov/pubmed/17494803?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

*See also Noninvasive Ventilatory Support for pulmonary complications of neuromuscular weakness.