Special Issue "Neuroprotection and Treatment in Intensive Care and Perioperative Medicine"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 30 September 2021.

Special Issue Editors

Prof. Dr. Łukasz J. Krzych
E-Mail Website
Guest Editor
Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
Interests: perioperative medicine; intensive care medicine; biomarkers; fluid therapy; hemodynamics; delirium
Dr. Mirosław Czuczwar
E-Mail Website
Assistant Guest Editor
Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-093 Lublin, Poland
Interests: perioperative medicine; intensive care medicine; pharmacology; fluid therapy; nutrition
Special Issues and Collections in MDPI journals
Dr. Izabela Duda
E-Mail Website
Assistant Guest Editor
Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
Interests: anesthesiology; neurosurgery; biomarkers; prognostication

Special Issue Information

Dear Colleagues,

Perioperative medicine covers a broad spectrum of pharmacological and nonpharmacological interventions needed to guarantee patients’ safety and to minimize the risk of complications. Both functional and structural neurologic injury represent a serious hazard of the compromised outcome in anesthesiology and intensive care medicine. In recent years, there has been a growing interest in preventive measures and treatment strategies that could be implemented to reduce insults to the brain. Goal-directed therapy is recommended to all subjects at risk of neurologic complications. However, effective neuroprotection and adequate treatment are still in question.

This Special Issue seeks high-quality manuscripts on neuroprotection and treatment of patients undergoing cardiac and noncardiac surgery, as well as in the critically ill. We welcome original papers, systematic reviews, and meta-analyses, and thorough reviews on this interesting topic. We would be happy if this Special Issue provides a complex source of up-to-date data used by anesthesiologists and intensive care specialists worldwide to improve perioperative care.

Prof. Łukasz J. Krzych
Ass. Prof. Mirosław Czuczwar
Dr. Izabela Duda
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 papers will be 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. International Journal of Environmental Research and Public Health 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 2300 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

  • Cognitive dysfunction and postoperative delirium in cardiac and noncardiac surgery
  • Potentially deleterious exposition on volatile agents in children and elderly patients
  • Biomarkers of neurological injury in anesthesiology and intensive care medicine
  • Perioperative stroke
  • Preventive strategies in neurosurgery and non-neurosurgery patients
  • Treatment of brain edema
  • Neurocognitive sequelae of critical illness

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

Article
Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients
Int. J. Environ. Res. Public Health 2020, 17(22), 8653; https://doi.org/10.3390/ijerph17228653 - 21 Nov 2020
Cited by 1 | Viewed by 624
Abstract
Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. [...] Read more.
Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC. Full article
Show Figures

Figure 1

Article
Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(12), 4573; https://doi.org/10.3390/ijerph17124573 - 25 Jun 2020
Cited by 1 | Viewed by 779
Abstract
Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the [...] Read more.
Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered patients hospitalized in an intensive care unit (ICU) from January 2017 to June 2019 with presumed increased ICP or considered to be at risk of it, treated with 15% mannitol (G1, n = 27), a combination of 15% mannitol and 10% hypertonic saline (HTS) (G2, n = 33) or 10% HTS only (G3, n = 13). Coefficients of variation (Cv) and arithmetic means (mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e., sodium (NaCv/NaMean), chloride (ClCv/ClMean) and osmolality (mOsmCv/mOsmMean). In-hospital mortality was also analyzed. The study group comprised 73 individuals (36 men, 49%). Mortality was 67% (n = 49). Median NaCv (G1: p = 0.002, G3: p = 0.03), ClCv (G1: p = 0.02, G3: p = 0.04) and mOsmCv (G1: p = 0.001, G3: p = 0.02) were higher in deceased patients. NaMean (p = 0.004), ClMean (p = 0.04), mOsmMean (p = 0.003) were higher in deceased patients in G3. In G1: NaCv (AUC = 0.929, p < 0.0001), ClCv (AUC = 0.817, p = 0.0005), mOsmCv (AUC = 0.937, p < 0.0001) and in G3: NaMean (AUC = 0.976, p < 0.001), mOsmCv (AUC = 0.881, p = 0.002), mOsmMean (AUC = 1.00, p < 0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC = 0.886 (p = 0.0002). The mortality of critically ill patients treated with osmotic agents is high. Electrolyte disequilibrium is the independent predictor of mortality regardless of the treatment method used. Variations of plasma sodium, chloride and osmolality are the most deleterious factors regardless of the absolute values of these parameters Full article
Show Figures

Graphical abstract

Article
Biomarkers Facilitate the Assessment of Prognosis in Critically Ill Patients with Primary Brain Injury: A Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(12), 4458; https://doi.org/10.3390/ijerph17124458 - 21 Jun 2020
Viewed by 710
Abstract
Primary injuries to the brain are common causes of hospitalization of patients in intensive care units (ICU). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is widely used for prognostication among critically ill subjects. Biomarkers help to monitor the severity [...] Read more.
Primary injuries to the brain are common causes of hospitalization of patients in intensive care units (ICU). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is widely used for prognostication among critically ill subjects. Biomarkers help to monitor the severity of neurological status. This study aimed to identify the best biomarker, along with APACHE II score, in mortality prediction among patients admitted to the ICU with the primary brain injury. This cohort study covered 58 patients. APACHE II scores were assessed 24 h post ICU admission. The concentrations of six biomarkers were determined, including the C-reactive protein (CRP), the S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase 9 (MMP-9), and tissue inhibitor of metalloproteinase 1 (TIMP-1), using commercially available ELISA kits. The biomarkers were specifically chosen for this study due to their established connection to the pathophysiology of brain injury. In-hospital mortality was the outcome. Median APACHE II was 18 (IQR 13–22). Mortality reached 40%. Median concentrations of the CRP, NGAL, S100B, and NSE were significantly higher in deceased patients. S100B (AUC = 0.854), NGAL (AUC = 0.833), NSE (AUC = 0.777), and APACHE II (AUC = 0.766) were the best independent predictors of mortality. Combination of APACHE II with S100B, NSE, NGAL, and CRP increased the diagnostic accuracy of mortality prediction. MMP and TIMP-1 were impractical in prognostication, even after adjustment for APACHE II score. S100B protein and NSE seem to be the best predictors of compromised outcome among critically ill patients with primary brain injuries and should be assessed along with the APACHE II calculation after ICU admission. Full article
Show Figures

Figure 1

Article
A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland
Int. J. Environ. Res. Public Health 2020, 17(11), 4161; https://doi.org/10.3390/ijerph17114161 - 11 Jun 2020
Cited by 1 | Viewed by 719
Abstract
Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire [...] Read more.
Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n = 29). One response from each hospital was recorded. Results: In three (10.4%) centres, there was no clear protocol for an interventional treatment plan. Endovascular embolisation was predominantly used in 11 (37.9%) hospitals, and microsurgical clipping, in 10 (34.5%). A written protocol for standard anaesthetic management was established only in six (20.7%) centres for coiling and in five (17.2%) for microsurgical clipping. The diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in seven (24.1%) units. “3-H therapy” was applied by 15 (51.8%) respondents, and “2-H therapy”, by four (13.8%) respondents. In only eight (27.6%) centres were all patients with aSAH being admitted to the ICU. Conclusion: Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardised. Means must be undertaken to improve patient-oriented treatment and care. Full article
Article
Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report
Int. J. Environ. Res. Public Health 2020, 17(10), 3656; https://doi.org/10.3390/ijerph17103656 - 22 May 2020
Cited by 2 | Viewed by 757
Abstract
Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as [...] Read more.
Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50–78 years). ONSD was measured bilaterally from day 1 to 10 (n = 1), until discharge (n = 3) or death (n = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was calculated on a daily basis as a surrogate formulti-organ failure due to sepsis in the study population. On day 1, the medians of right and left ONSD were 5.56 (IQR 5.35–6.30) mm and 5.68 (IQR 5.50–6.10) mm, respectively, and four subjects had bilaterally elevated ONSD. Forty-nine out of 80 total measurements performed (61%) exceeded 5.7 mm during the study period. We found no correlations between ONSD and sequential organ failure assessment (SOFA) during the study period (right: R = −0.13–0.63; left R = −0.24–0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients. Full article
Show Figures

Figure 1

Review

Jump to: Research

Review
Intranasal Insulin Administration to Prevent Delayed Neurocognitive Recovery and Postoperative Neurocognitive Disorder: A Narrative Review
Int. J. Environ. Res. Public Health 2021, 18(5), 2681; https://doi.org/10.3390/ijerph18052681 - 07 Mar 2021
Viewed by 677
Abstract
Delayed neurocognitive recovery and postoperative neurocognitive disorders are major complications of surgery, hospitalization, and anesthesia that are receiving increasing attention. Their incidence is reported to be 10–80% after cardiac surgery and 10–26% after non-cardiac surgery. Some of the risk factors include advanced age, [...] Read more.
Delayed neurocognitive recovery and postoperative neurocognitive disorders are major complications of surgery, hospitalization, and anesthesia that are receiving increasing attention. Their incidence is reported to be 10–80% after cardiac surgery and 10–26% after non-cardiac surgery. Some of the risk factors include advanced age, level of education, history of diabetes mellitus, malnutrition, perioperative hyperglycemia, depth of anesthesia, blood pressure fluctuation during surgery, chronic respiratory diseases, etc. Scientific evidence suggests a causal association between anesthesia and delayed neurocognitive recovery or postoperative neurocognitive disorders, and various pathophysiological mechanisms have been proposed: mitochondrial dysfunction, neuroinflammation, increase in tau protein phosphorylation, accumulation of amyloid-β protein, etc. Insulin receptors in the central nervous system have a non-metabolic role and act through a neuromodulator-like action, while an interaction between anesthetics and central nervous system insulin receptors might contribute to anesthesia-induced delayed neurocognitive recovery or postoperative neurocognitive disorders. Acute or chronic intranasal insulin administration, which has no influence on the blood glucose concentration, appears to improve working memory, verbal fluency, attention, recognition of objects, etc., in animal models, cognitively healthy humans, and memory-impaired patients by restoring the insulin receptor signaling pathway, attenuating anesthesia-induced tau protein hyperphosphorylation, etc. The aim of this review is to report preclinical and clinical evidence of the implication of intranasal insulin for preventing changes in the brain molecular pattern and/or neurobehavioral impairment, which influence anesthesia-induced delayed neurocognitive recovery or postoperative neurocognitive disorders. Full article
Show Figures

Figure 1

Review
Postoperative Neurocognitive Disorders in Cardiac Surgery: Investigating the Role of Intraoperative Hypotension. A Systematic Review
Int. J. Environ. Res. Public Health 2021, 18(2), 786; https://doi.org/10.3390/ijerph18020786 - 18 Jan 2021
Cited by 1 | Viewed by 758
Abstract
Perioperative neurocognitive disorders remain a challenging obstacle in patients after cardiac surgery, as they significantly contribute to postoperative morbidity and mortality. Identifying the modifiable risk factors and mechanisms for postoperative cognitive decline (POCD) and delirium (POD) would be an important step forward in [...] Read more.
Perioperative neurocognitive disorders remain a challenging obstacle in patients after cardiac surgery, as they significantly contribute to postoperative morbidity and mortality. Identifying the modifiable risk factors and mechanisms for postoperative cognitive decline (POCD) and delirium (POD) would be an important step forward in preventing such adverse events and thus improving patients’ outcome. Intraoperative hypotension is frequently discussed as a potential risk factor for neurocognitive decline, due to its significant impact on blood flow and tissue perfusion, however the studies exploring its association with POCD and POD are very heterogeneous and present divergent results. This review demonstrates 13 studies found after structured systematic search strategy and discusses the possible relationship between intraoperative hypotension and postoperative neuropsychiatric dysfunction. Full article
Show Figures

Figure 1

Review
Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?
Int. J. Environ. Res. Public Health 2020, 17(17), 6069; https://doi.org/10.3390/ijerph17176069 - 20 Aug 2020
Cited by 4 | Viewed by 1013
Abstract
Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization [...] Read more.
Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used. Full article
Show Figures

Figure 1

Review
Sepsis-Associated Brain Dysfunction: A Review of Current Literature
Int. J. Environ. Res. Public Health 2020, 17(16), 5852; https://doi.org/10.3390/ijerph17165852 - 12 Aug 2020
Cited by 2 | Viewed by 789
Abstract
Sepsis-associated brain dysfunction (SABD) may be the most common type of encephalopathy in critically ill patients. SABD develops in up to 70% of septic patients and represents the most frequent organ insufficiency associated with sepsis. It presents with a plethora of acute neurological [...] Read more.
Sepsis-associated brain dysfunction (SABD) may be the most common type of encephalopathy in critically ill patients. SABD develops in up to 70% of septic patients and represents the most frequent organ insufficiency associated with sepsis. It presents with a plethora of acute neurological features and may have several serious long-term psychiatric consequences. SABD might cause various pathological changes in the brain through numerous mechanisms. Clinical neurological examination is the basic screening method for SABD, although it may be challenging in subjects receiving with opioids and sedative agents. As electrographic seizures and periodic discharges might be present in 20% of septic patients, screening with electroencephalography (EEG) might be useful. Several imaging techniques have been suggested for non-invasive assessment of structure and function of the brain in SABD patients; however, their usefulness is rather limited. Although several experimental therapies have been postulated, at the moment, no specific treatment exists. Clinicians should focus on preventive measures and optimal management of sepsis. This review discusses epidemiology, clinical presentation, pathology, pathophysiology, diagnosis, management, and prevention of SABD. Full article
Show Figures

Figure 1

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Is hyperosmolar therapy the best treatment for patients at risk for increased intracranial pressure? A single-centre cohort study
Authors: Agnieszka Wiórek; Tomasz Jaworski; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia in Katowice
Abstract: Therapy with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in the CNS disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered 73 patients hospitalized in the ICU from 01.2017 to 06.2019 with presumed or at risk of increased ICP treated with a 15% mannitol (G1, n=27), combination of 15% mannitol and 10% HTS (G2, n=33) or 10% HTS only (G3, n=13). The coefficients of variation (Cv) and arithmetic means (Mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e sodium (NaCv/NaMean), chloride(ClCv/ClMean), osmolality (mOsmCv/mOsmMean). In-hospital mortality was analysed. The study group comprised 73 patients (36 men, 49%). Median NaCv (G1:p=0.002, G3:p=0.03), ClCv (G1:p=0.02, G3:p=0.04) and mOsmCv (G1:p=0.001, G3:p=0.02) were higher in deceased patients. NaMean (p=0.004), ClMean (p=0.04), mOsmMean (p=0.003) were higher in deceased patients in G3. In G1: NaCv (AUC=0.929, p<0.0001), ClCv (AUC=0.817,p=0.0005), mOsmCv (AUC=0.937,p<0.0001) and in G3: NaMean (AUC=0.976,p<0.001), mOsmCv (AUC=0.881,p=0.002), mOsmMean (AUC=1.00,p<0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC=0.886 (p=0.0002). Treatment of increased ICP with mannitol or hypertonic saline solutions may cause fatal uncontrolled increase and lability of sodium, chloride and plasma osmolality values jeopardizing the patients’ outcome.

Title: Biomarkers facilitate the assessment of prognosis in critically ill patients with primary brain injury: a cohort study
Authors: Izabela Duda; Agnieszka Wiórek; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, Medical University of Silesia in Katowice
Abstract: Primary injuries to the brain are common causes of hospitalization of patients in intensive care units (ICU). APACHE II scoring system is widely used for prognostication among critically ill subjects. Biomarkers help to monitor the severity of neurological status. The study aimed to identify the best biomarker, along with APACHE II score, in mortality prediction among patients admitted to the ICU with the primary brain injury. This cohort study covered 58 patients. APACHE II score was assessed 24 hours post ICU admission. The concentrations of six biomarkers were determined, including the C-reactive protein (CRP), the S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1), using commercially available ELISA kits. In-hospital mortality was the outcome. Median APACHE II was 18 (IQR 13-22). Mortality reached 40%. Median concentrations of the CRP (p=0.003), NGAL (p=0.002), S100B (p<0.001) and NSE (p=0.009) were significantly higher in deceased patients. S100B (AUC=0.854), NGAL (AUC=0.833), NSE (AUC=0.777) and APACHE II (AUC=0.766) were the best independent predictors of mortality (p<0.05 for all). Combination of APACHE II with S100B, NSE, NGAL and CRP essentially increased diagnostic accuracy of mortality prediction, with AUCs of 0.947, 0.909, 0.0.886 and 0.821, respectively (p<0.0001 for all). MMP and TIMP-1 were impractical in prognostication, even after adjustment for APACHE II score. S100B protein and NSE are the best predictors of the compromised outcome among critically ill patients with the primary brain injury and should be assessed along with APACHE II calculation after ICU admission.

Title: Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report
Authors: Piotr F. Czempik; Jakub Gąsiorek; Aleksandra Bąk; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Abstract: Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that might lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective pilot study covered 10 septic shock patients (5 men; aged 65, IQR 50-78 years). ONSD was measured bilaterally from day ‘1’ to ‘10’ (n=1), until discharge (n=3) or death (n=6). The upper limit for ONSD was set at 5.7mm. Sequential Organ Failure Assessment score was calculated on a daily basis as a surrogate of multi-organ failure in the study population. On day ‘1’, the medians of right and left ONSD were 5.56 (IQR 5.35-6.30) mm and 5.68 (IQR 5.50-6.10) mm, respectively, 4 subjects had bilaterally elevated ONSD. Forty-nine out of the total 80 measurements performed (61%) exceeded 5.7mm during the study. We found no correlations between ONSD and SOFA during the study period (right: R= -0.13-0.63; left R= -0.24-0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients.

Title: A questionnaire survey of management of patients with aneurysmal subarachnoid haemorrhage in Poland
Authors: Mariusz Hofman; Norbert Hajder; Izabela Duda; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Abstract: Backgrounds: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with serious impact on mortality and morbidity. We attempted to investigate correspondence between current guidelines of aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n=29). One response from each hospital was recorded. Results: In 3 (10.4%) centres there was no clear protocol of interventional treatment plan. Endovascular embolization was predominantly used in 11 (37.9%) hospitals and microsurgical clipping in 10 (34.5%). Written protocol of standard anaesthetic management was established only in 6 (20.7%) centres for coiling and in 5 (17.2%) for microsurgical clipping. Diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in 7 (24.1%) units. ‘3-H therapy’ was applied by 15 (51.8%) and ‘2-H therapy’ by 4 (13.8%) respondents. In only 8 (27.6%) centres all patients with aSAH were being admitted to the ICU. Conclusion: Many discrepancies exist between available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardized. Means must be undertaken to improve patient-oriented treatment and care.

Title: Sepsis-associated brain dysfunction: a review of current literature
Authors: Piotr F. Czempik; Michał P. Pluta; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Abstract: Sepsis-associated brain dysfunction (SABD) constitutes probably the most common type of encephalopathy in critically ill patients. SABD might develop in up to 70% of septic patients and represent the most frequent organ insufficiency associated with sepsis. It presents with a plethora of acute neurological features and may have several serious long-term psychiatric consequences. SABD might cause various pathological changes in the brain through numerous mechanisms. Clinical neurological examination is the basic screening method for SABD, although it may be challenging in subjects treated with opioids and sedative agents. As electrographic seizures and periodic discharges might be present in 20% of septic patients, screening with EEG might be useful. Several imaging techniques have been suggested for non-invasive assessment of the brain structure and function in SABD patients but their usefulness is rather limited. Although several experimental therapies have been postulated, at the moment no specific treatment for SABD exist. Clinicians should focus on preventive measures and optimal management of sepsis. This review discusses epidemiology, clinical presentation, pathology, pathophysiology, diagnosis, management and prevention of SABD.

Title: Antipsychotic Drugs in Prevention of Postoperative Delirium – What is known in 2020?
Authors: Michał P. Pluta; Magdalena Dziech; Piotr F. Czempik; Anna J. Szczepańska; Łukasz J. Krzych
Affiliation: Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
Abstract: Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay and cost of treatment. An episode of delirium in acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research shifted towards developing preventive strategies. We aimed to perform review of the topic based on the most recent literature. We conclude that based on available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what patients if any benefit from the pharmacological prevention of delirium, which agents should be used.

Back to TopTop