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Acute Brain Injury in Intensive Care Unit
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Acute Brain Injury in Intensive Care Unit

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 (31 May 2023) | Viewed by 6120

Special Issue Editors

Prof. Dr. Rafael Badenes

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Guest Editor
Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Universitat de València, Valencia, Spain
Interests: traumatic brain injury; brain oxygenation; sedation; ICP; delirium; mechanical ventilation; organ donation
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Federico Bilotta

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Guest Editor
Neuroanesthesia and Neurocritical Care department of the Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
Interests: traumatic brain injury; brain oxygenation; sedation; ICP; delirium; mechanical ventilation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As many of you already know, acute brain injury (ABI) is a growing public health problem of substantial proportions. ABI includes traumatic brain injury, intracranial hemorrhage, subarachnoid hemorrhage, ischemic stroke, delirium, hypoxic–ischemic brain injury, neuroanesthesia, etc.

More than 150 million ABIs occur internationally each year. Across all ages, ABI represents 30–40% of all intensive care unit (ICU) admissions, and neurological injury is projected to remain the most important cause of disability from neurological disease until 2030. Severe ABI has a high mortality rate, estimated at 30–40% in observational studies on unselected populations.

Survivors experience a substantial burden of physical, psychiatric, emotional, and cognitive disabilities, which disrupt the lives of individuals and their families, and impose huge costs on society. Wide variations in the clinical manifestations of ABI are attributable to the complexity of the brain and to the pattern and extent of damage.

Over the past few years, a number of multicenter studies on the topic have emerged, helping to provide a better understanding of the condition. However, it is also clear that much remains to be learned.

With this Special Issue, we hope to encourage submissions that discuss the current state of the art, address ongoing knowledge gaps, and focus on ongoing controversies related to acute brain injury

Prof. Dr. Rafael Badenes
Prof. Dr. Federico Bilotta
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

  • acute brain injury
  • traumatic brain injury
  • subarachnoid hemorrhage
  • intracranial hemorrhage
  • ischemic stroke
  • delirium
  • hypoxic–ischemic brain injury
  • neuroanesthesia

Published Papers (3 papers)

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11 pages, 1433 KiB  
Article
Use of Prognostication Instruments in Prognostication Procedures of Postanoxic Coma Patients over Time: A Retrospective Study
by Charlotte Daun, Anne Ebert, Vesile Sandikci, Simone Britsch, Kristina Szabo and Angelika Alonso
J. Clin. Med. 2023, 12(10), 3357; https://doi.org/10.3390/jcm12103357 - 9 May 2023
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Abstract
Background: Many survivors of cardiovascular arrest remain in a postanoxic coma. The neurologist’s task is to provide the most accurate assessment of the patient’s neurologic prognosis through a multimodal approach of clinical and technical tests. The aim of this study is to analyze [...] Read more.
Background: Many survivors of cardiovascular arrest remain in a postanoxic coma. The neurologist’s task is to provide the most accurate assessment of the patient’s neurologic prognosis through a multimodal approach of clinical and technical tests. The aim of this study is to analyze differences and developments in the concept of neurological prognosis assessment and in-hospital outcome of patients over a five year-period. Methods: This retrospective observational study included 227 patients with postanoxic coma treated in the medical intensive care unit of the University Hospital, Mannheim from January 2016 to May 2021. We retrospectively analyzed patient characteristics, post-cardiac arrest care, and the use of clinical and technical tests for neurological prognosis assessment and patient outcome. Results: Over the observation period, 215 patients received a completed neurological prognosis assessment. Regarding the multimodal prognostic assessment, patients with poor prognosis (54%) received significantly fewer diagnostic modalities than patients with very likely poor (20.5%), indeterminate (24.2%), or good prognosis (1.4%; p = 0.001). The update of the DGN guidelines in 2017 had no effect on the number of performed prognostic parameters per patient. The finding of bilaterally absent pupillary light reflexes or severe anoxic injury on CT contributed most to a poor prognosis category (OR 8.38, 95%CI 4.01–7.51 and 12.93, 95%CI 5.55–30.13, respectively), whereas a malignant EEG pattern and NSE > 90 µg/L at 72 h resulted in the lowest OR (5.11, 95%CI 2.32–11.25, and 5.89, 95%CI 3.14–11.06, respectively) for a poor prognosis category. Assessment of baseline NSE significantly increased over the years (OR 1.76, 95%CI 1.4–2.22, p < 0.001), and assessment of follow-up NSE at 72 h trended to increase (OR 1.19, 95%CI 0.99–1.43, p = 0.06). In-hospital mortality was high (82.8%), remained unchanged over the observation period, and corresponded to the number of patients in whom life-sustaining measures were discontinued. Conclusions: Among comatose survivors of cardiac arrest, the prognosis remains poor. Prognostication of a poor outcome led nearly exclusively to withdrawal of care. Prognostic modalities varied considerably with regard to their contribution to a poor prognosis category. Increasing enforcement of a standardized prognosis assessment and standardized evaluation of diagnostic modalities are needed to avoid false–positive prognostication of poor outcomes. Full article
(This article belongs to the Special Issue Acute Brain Injury in Intensive Care Unit)
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15 pages, 1246 KiB  
Article
Repetitive Electroencephalography as Biomarker for the Prediction of Survival in Patients with Post-Hypoxic Encephalopathy
by Laurent M. Willems, Felix Rosenow, Susanne Knake, Isabelle Beuchat, Kai Siebenbrodt, Michael Strüber, Bernhard Schieffer, Konstantinos Karatolios and Adam Strzelczyk
J. Clin. Med. 2022, 11(21), 6253; https://doi.org/10.3390/jcm11216253 - 23 Oct 2022
Cited by 1 | Viewed by 1170
Abstract
Predicting survival in patients with post-hypoxic encephalopathy (HE) after cardiopulmonary resuscitation is a challenging aspect of modern neurocritical care. Here, continuous electroencephalography (cEEG) has been established as the gold standard for neurophysiological outcome prediction. Unfortunately, cEEG is not comprehensively available, especially in rural [...] Read more.
Predicting survival in patients with post-hypoxic encephalopathy (HE) after cardiopulmonary resuscitation is a challenging aspect of modern neurocritical care. Here, continuous electroencephalography (cEEG) has been established as the gold standard for neurophysiological outcome prediction. Unfortunately, cEEG is not comprehensively available, especially in rural regions and developing countries. The objective of this monocentric study was to investigate the predictive properties of repetitive EEGs (rEEGs) with respect to 12-month survival based on data for 199 adult patients with HE, using log-rank and multivariate Cox regression analysis (MCRA). A total number of 59 patients (29.6%) received more than one EEG during the first 14 days of acute neurocritical care. These patients were analyzed for the presence of and changes in specific EEG patterns that have been shown to be associated with favorable or poor outcomes in HE. Based on MCRA, an initially normal amplitude with secondary low-voltage EEG remained as the only significant predictor for an unfavorable outcome, whereas all other relevant parameters identified by univariate analysis remained non-significant in the model. In conclusion, rEEG during early neurocritical care may help to assess the prognosis of HE patients if cEEG is not available. Full article
(This article belongs to the Special Issue Acute Brain Injury in Intensive Care Unit)
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Systematic Review
Cocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence
by Luis F. Rendon, Stephanie Malta, Jacob Leung, Rafael Badenes, Ala Nozari and Federico Bilotta
J. Clin. Med. 2023, 12(16), 5207; https://doi.org/10.3390/jcm12165207 - 10 Aug 2023
Cited by 1 | Viewed by 3300
Abstract
Cocaine consumption has increased over the last decade. The potent sympathomimetic effects of the drug can lead to serious neurovascular complications in the form of ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). This systematic review and meta-analysis were designed to [...] Read more.
Cocaine consumption has increased over the last decade. The potent sympathomimetic effects of the drug can lead to serious neurovascular complications in the form of ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). This systematic review and meta-analysis were designed to describe the clinical features and outcomes of patients suffering from IS, ICH, or SAH occurring in the context of cocaine use. The PubMed, Embase, Cochrane, and Web of Science libraries were queried in December 2022. Studies were included if they provided information regarding the epidemiology, clinical presentation, or outcomes in cocaine-associated strokes. Odds ratios (OR) were pooled using a random-effects model. A total of 36 papers were included. Strokes associated with cocaine use were more prevalent in younger populations and those of African American descent. Cocaine use increased the odds of IS, ICH, or SAH (OR = 5.05, p < 0.001). The odds of mortality (OR = 1.77, p = 0.0021), vasospasm (OR = 2.25, p = 0.0037), and seizures (OR = 1.61, p < 0.001) were also worse when strokes were associated with cocaine use. In addition to counseling patients on the benefits of drug cessation, clinicians should remain vigilant of the potential complications in patients who are hospitalized with cocaine-associated strokes. Full article
(This article belongs to the Special Issue Acute Brain Injury in Intensive Care Unit)
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