Intensive Care Unit Ventilation and Brain Damage

2014 ◽  
Vol 39 (1) ◽  
pp. 13-14
Author(s):  
&NA;
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Damage

scholarly journals The role of indirect calorimetry in the treatment and rehabilitation of patients in long-term unconsciousness after brain damage

2020 ◽  
Vol 1 (1) ◽  
pp. 10-16
Author(s):  
Kirill Yu. Krylov ◽  
Ivan V. Sergeev ◽  
Alexandra V. Yakovleva ◽  
Ruben S. Yagubyan ◽  
Alexey A. Yakovlev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Energy Expenditure ◽  
Brain Damage ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Nutritional Support ◽  
Nitrogen Loss ◽  
Energy Requirements

Background. Nutritional support is an important part of the treatment of critically ill patients. However, there are no specific recommendations for patients in a long unconscious state after brain damage to determine their energy needs. Aim. To determine the role of indirect calorimetry in assessing the energy expenditure of patients in prolonged unconsciousness after brain damage. Methods. Prospective cohort study included 81 patients with brain damage who were treated in the intensive care unit. All patients with prolonged unconsciousness had stayed in the intensive care unit for more than 30 days. Mean age of patients was 48.4 16.3 years. Men were predominant (58%). Almost all patients had normal body mass index (BMI) (mean 22.8 6.2 kg/m2). The main cause of brain damage was severe traumatic injury (42%). There were also patients with consequences of subarachnoid hemorrhage (35%), stroke (19%) and hypoxic damage (4%). Results. According to indirect calorimetry, mean energy requirements in patients in prolonged unconsciousness was 25.12 8.8 kcal/kg/day (1595.3 560 kcal/day). Variability of this value was high in this sample (10.661.6 kcal/kg/day, 6733514 kcal/day). According to urine nitrogen loss, mean protein requirement was 0.83 0.46 g/kg/day that was lower than the recommended values for critically ill patients. Variability of data obtained by indirect calorimetry was higher than that of the calculated values despite statistically similar energy requirements of patients. Variability of data obtained by Harris-Benedict equation ranged from 15.4 kcal/kg/day (1023 kcal/day) to 37.3 kcal/kg/day (2065 kcal/day). There was no relationship between energy expenditure and causes of brain damage. Moreover, significant correlation between metabolic rate, urine nitrogen loss and outcomes of disease was also absent. Conclusion. Indirect calorimetry alone is not enough to prescribe optimal nutritional support in patients with prolonged unconsciousness if function of the gastrointestinal tract and other factors affecting energy expenditure are not considered.

scholarly journals Management of Status Epilepticus

1998 ◽  
Vol 25 (S1) ◽  
pp. S4-S6 ◽  
Author(s):  
Michael J. Aminoff
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
General Anesthesia ◽  
Brain Damage ◽  
Response To Treatment ◽  
Motor Activities ◽  
Pharmacologic Management ◽  
Convulsive Seizures ◽  
Electroencephalogram Eeg

AbstractThe pharmacologic management of major motor status epilepticus is summarized. When general anesthesia is required, the electroencephalogram (EEG) is used for monitoring the adequacy of treatment. The EEG findings may also be important in recognizing status epilepticus and monitoring its response to treatment when this is clinically difficult, as when it occurs in comatose or pharmacologically paralyzed patients or in the context of severe brain damage. Finally, the EEG helps to clarify the nature of motor activities of uncertain basis in patients in the intensive care unit and has indicated that non-convulsive seizures or status are more common than clinically suspected in such patients.

scholarly journals Features of electrophysiological activity in a neonate with severe post-hypoxic brain damage (post-hypoxic cerebral depression)

2020 ◽  
Vol 11 (6) ◽  
pp. 13-20
Author(s):  
Tatiana V. Melashenko ◽  
Maria Y. Fomina ◽  
Alexander B. Palchik ◽  
Olga I. Pavlova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Damage ◽  
Neonatal Intensive Care ◽  
Hypoxic Brain Damage ◽  
Hypoxic Brain ◽  
Central Nervous System Depression ◽  
Neuroimaging Data ◽  
Alpha Coma ◽  
Visual Diagnosis

The article briefly presents the literature data and a description of the clinical dynamic observation of a patient with severe hypoxic brain damage (from the neonatal period to 4 months of life), in the conditions of the neonatal intensive care unit. The article describes the clinical picture, features of paroxysmal states and antiepileptic therapy, dynamics of neuroimaging data, electroencephalographic phenomena recorded in a patient with cerebral depression and structural cerebral injuries. The significance of electroencephalographic examination in the intensive care unit as an informative method for assessing cerebral activity in young children with central nervous system depression syndrome is shown. Disorganization of background activity, indicating structural cerebral damage, long-term persistence of slow-wave activity, detection of epileptic changes in the form of generalized flashes of pointed waves in the theta range, alpha-coma pattern, subsequently replaced by suppression of the background pattern in the patient, are typical electrophysiological disorders recorded in severe hypoxic encephalopathy. In conditions of limited opportunities for visual diagnosis of a patient with impaired consciousness, EEG remains the only method of obtaining information about the functional state of the brain, the data obtained during the study are an important prognostic criterion.

scholarly journals Monitoring of the Effectiveness of Intensive Care and Rehabilitation by Evaluating the Functional Activity of the Autonomic Nervous System in Patients with Brain Damage

2018 ◽  
Vol 14 (4) ◽  
pp. 21-34 ◽  
Author(s):  
Yu. Yu. Kiryachkov ◽  
A. V. Grechko ◽  
D. L. Kolesov ◽  
A. A. Loginov ◽  
M. V. Petrova ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Brain Damage ◽  
Functional State ◽  
Functional Activity ◽  
Intensive Therapy ◽  
Sympathetic Hyperactivity ◽  
Normal Functional

Purpose: evaluation of the clinical significance of parametric monitoring of the effectiveness of intensive care and rehabilitation based on the analysis of the functional state of the autonomous nervous system in patients with brain damage of different genesis.Materials and methods. The study included 66 patients on day 20—50 after the traumatic brain injury; anoxic damage; and stroke consequences. The isolation of clinical groups and subsequent analysis of clinical status is based on the analysis of the functional state of the autonomic nervous system based on the dynamics of the heart rate variability (HRV) parameters. Findings obtained in studies of 500 patients in the postoperative period with a 5-minute HRV were tested as normal and abnormal ANS parameters [1]. Parasympathetic hyperactivity was measured within the limits for SDNN (standard deviation of all normal-to-normal R-R intervals) > 41.5 ms; for rMSSD (root-meansquare of the successive normal sinus R-R interval difference) > 42.4 ms; for pNN50% (the percentage of interval differences in successive NN intervals greater than 50 ms (NN50) / total number of NN intervals) > 8.1%; for SI (Baevsky stress index, in normalized units) < 80 n. u.; for TP (total power of variance of all NN intervals) > 2000 ms2. Sympathetic hyperactivity was determined within the limits for following parameters: SDNN, < 4.54 ms; rMSSD, < 2.25 ms; pNN50%, < 0.109%; SI, > 900 n. u.; TP < 200 ms2. Normal HRV parameters were selected within the limits of the values for: SDNN [13.31-41.4ms]; rMSSD [5.78—42.3 ms]; pNN50% [0.110—8.1%]; SI [80—900 nu]; for TP [200—2000 ms2]. To verify the parasympathetic or sympathetic hyperactivity within these limits, 3 of 5 parameters were chosen [1].Results. Based on the dynamics of the HRV parameters before the intensive care and on days 30—60 of the intensive therapy and rehabilitation of patients with traumatic and non-traumatic brain injuries, 5 main clinical groups of patients were identified. Group 1 (n=27) consisted of patients with normal parameters of the ANS functional activity (both at the time of admission to the hospital and on the 30—60th day of the intensive therapy and rehabilitation). Group 2 (n=9) included patients with the baseline sympathetic hyperactivity of the ANS at admission to the intensive care unit and normal functional activity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 3 (n=8) included patients with baseline normal functional state of the ANS and the signs of sympathetic hyperactivity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 4 (n=15) consisted of patients with signs of sympathetic hyperactivity of the ANS both initially and on the 30—60th day of the intensive care and rehabilitation. Group 5 (n=7) included patients with signs of parasympathetic hyperactivity of the ANS (according to the parameters of HRV) both at baseline, at admission to the intensive care unit, and on the 30—60th day of the intensive care and rehabilitation.Conclusion: The normalization of HRV parameters is accompanied by patients’ recovery from the vegetative state and coma to minimal consciousness or normal consciousness; the index of disability rate decreases, the social reintegration grows, according to the DRS scale (M. Rappaport, 1982); dependence on mechanical ventilation reduces, and the muscle tone normalizes.

Donor Action Program in the Emilia-Romagna Region of Italy

2002 ◽  
Vol 12 (4) ◽  
pp. 275-279 ◽  
Author(s):  
Maria Rosa Pugliese ◽  
Daniela Degli Esposti ◽  
Ada Dormi ◽  
Nicola Venturoli ◽  
Paolo Mazzetti Gaito ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Brain Damage ◽  
Organ Procurement ◽  
Action Program ◽  
Critical Areas ◽  
Donation Process ◽  
Emilia Romagna Region ◽  
Study Population

Context The high demand for organs for transplantation necessitates enhancement of organ procurement activity worldwide. Objective To detect critical areas in the organ donation process and to assess whether careful monitoring of deaths in each intensive care unit could improve rates of identification of brain death. Design Records of patients who died in intensive care units in the Emilia-Romagna region between July 1, 1998 and June 30, 2000 were reviewed through the Donor Action program. Results Of the 2469 patients who died during the period studied, 1010 (40.9%) had severe brain damage, as indicated by a score of 3 on the Glasgow coma scale. A total of 857 patients with severe brain damage who had spent more than 6 hours in the intensive care unit (34.7% of all deaths) were considered as potential donors. Signs of brain death were observed in 383 (44.7%) of the 857 patients who died. Rates of identification of brain death increased from 36% to 55% during the study period. Conclusion Considering that the characteristics of the study population had not changed, we believe that the Donor Action program was an important factor leading to the observed improvement in identification of brain death.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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