This official textbook of the Society of Neurocritical Care (SNCC) comprises a comprehensive review of all possible neurologic conditions that one may encounter in the practice of neuro-intensive care. It covers various topics, from the history and origin of neuro-intensive care to psychological and nursing care. Neurocritical care is the intensive care management of patients with life-threatening neurological and neurosurgical illnesses such as massive stroke, bleeding in or around the brain (subarachnoid hemorrhage, intracerebral hemorrhage, subdural hemorrhage, intraventricular hemorrhage), brain tumors, brain trauma, status epilepticus, nerve and muscle diseases (myasthenia gravis, Guillain-Barre Syndrome), spinal cord disorders and the cardiopulmonary complications of brain injury. Neurocritical care units specialize in managing the unique needs of such critically ill patients. The textbook is divided into many sections. Chapters discuss issues related to palliative care and describe some of the commonly performed procedures in the neuro-intensive care unit as well. It provides a straightforward and systematic approach to various clinical problems encountered during intensive care management of neurologic patients. It includes a separate section on special considerations in neurocritical care. The book includes ample figures, flowcharts and algorithms. The textbook is a valuable resource for residents, fellows and trainees in neuroanesthesia, neurointensive care, critical care, and anesthesia. It serves as a quick guide to all intensivists managing neurosurgical patients. It is also helpful for general intensivists who occasionally manages neurologic patients.

lgrsnf/Principles and Practice of Neurocritical Care (Jul 2, 2024)_(9819980585)_(Springer).pdf

zlib/no-category/Hemanshu Prabhakar, Vasudha Singhal, Kapil G Zirpe, Harsh Sapra/Principles and Practice of Neurocritical Care (Jul 2, 2024)_(9819980585)_(Springer)_28775506.pdf

1st ed. 2024, US, 2024

Singapore, Singapore

Preface
Acknowledgments
Contents
Part I: History of Neurocritical Care
1: Introduction to Neurocritical Care
References
Part II: Basic Principles of Neurocritical Care
2: Neurological Examination in Neurocritical Care
2.1 Introduction
2.2 The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) Approach and the ABCGS (Airway, Breathing, Circulation, Glucose, or Seizures) Approach
2.2.1 Initial Assessment
2.2.2 History and General Examination
2.2.3 Neurological Examination of a Conscious Patient
Neurological Examination of a Patient with an Altered Sensorium
2.2.4 Neurological Examination of a Patient in a Coma
2.3 Examination of Cranial Nerves (CNs) [5, 11]
2.3.1 Motor Functions and Assessment
2.3.2 Reflex Examination
Upper Motor vs. Lower Motor Neuron Disease
2.3.3 Motor Examination in an Unconscious Patient
2.3.4 Sensory Testing
2.3.5 Pupillary Size and Reflex
2.3.6 Brainstem Reflexes
2.3.7 Neuroexamination in Pediatrics
References
3: Cerebrospinal Fluid Dynamics
3.1 Introduction
3.2 CSF-Containing Spaces [4]
3.3 CSF Production
3.3.1 From the Choroid Plexus (CP)
The Role of Ion Channels in CSF Secretion from the CP
Ion Transport
3.3.2 Extra-Choroidal CSF Formation
Movement of Glucose
Movement of Proteins
3.4 CSF Composition
3.5 Continuity between the Ventricular CSF and the Brain ECS
3.6 The Role of the Glymphatic System
3.7 CSF Flow
3.8 CSF Reabsorption
3.8.1 Meningeal Lymphatics
3.8.2 Continuous Fluid Exchange [13]
3.9 CSF Dynamics and ICP Elevation
3.10 Hydrocephalus
3.11 Idiopathic Intracranial Hypertension (IIH)
3.12 Traumatic Brain Injury
3.13 Intracerebral Hemorrhage
3.14 Subarachnoid Hemorrhage
3.15 Ischemic Stroke [13]
3.16 Conclusions
References
4: Cerebral Hemodynamics
4.1 Introduction
4.1.1 Special Needs of the Brain
4.1.2 Unique Features of Cerebral Circulation
4.1.3 Determinants of Cerebral Blood Flow
4.2 Regulation of Cerebral Blood Flow
4.2.1 Regulation of Cerebral Blood Flow Can Be Divided into Four Categories (Fig. 4.4)
4.3 Alterations of Cerebral Blood Flow Regulation in Health and Disease
4.3.1 Effect of Aging
4.3.2 Effect of Posture
4.3.3 Effect of Exercise
4.3.4 Effect of Hypertension
4.3.5 Effect of Stroke
4.3.6 Effect of Anesthesia
References
Part III: Monitoring in Neurocritical Care
5: Intracranial Pressure Monitoring
5.1 Introduction
5.2 ICP Waveform: Physiological and Pathological Trends
5.3 Intracranial Pressure–Volume Relationship: Intracranial Compliance
5.4 ICP Interplay with Cerebral Perfusion Pressure (CPP)
5.5 ICP Measurement
5.5.1 Historical Perspective
5.5.2 Current Practice
5.5.3 Invasive ICP Monitoring
5.5.4 Noninvasive Techniques
5.6 Future Avenues for ICP Monitoring
References
6: Cerebral Blood Flow Monitoring
6.1 Introduction
6.2 Arterial Supply of the Brain
6.3 The Physiological Aspects of Cerebral Blood Flow
6.3.1 Cerebral Physiology and CBF
6.3.2 Factors Affecting CBF [9]
Intrinsic Factors
Extrinsic Factors Affecting CBF
6.3.3 Cerebral Autoregulation (CA)
6.4 Cerebral Blood Flow Monitoring
6.4.1 General Concepts
Fick’s Principle
The Central Volume Principle [37]
Doppler Effect and Intensity Fluctuations [37]
6.4.2 Cerebral Blood Flow Monitoring Techniques
Direct Techniques
6.4.3 Imaging-Based CBF Techniques
X-Ray-Based Techniques
MRI-Based Techniques
Ultrasonography (USG)-Based Techniques
6.4.4 Optical Techniques
6.4.5 Nuclear Medicine-Based Techniques
6.4.6 Monitoring Cerebral Autoregulation
6.4.7 Newer Advances
Microwave-Based CBF Analysis
Ultrasound-Tagged (UT)-NIRS
6.5 Conclusion
References
7: Jugular Venous Oximetry
7.1 Introduction
7.2 History
7.3 Relevant Anatomy
7.4 Site of Monitoring
7.5 Insertion of a Jugular Bulb Catheter
7.6 Avoidance of Extracranial Contamination
7.7 Intermittent and Continuous Monitoring
7.8 Complications
7.9 The Fundamental Concepts of Jugular Venous Oximetry
7.10 Clinical Applications of SjVO2
7.10.1 Traumatic Brain Injury
7.10.2 Subarachnoid Hemorrhage
7.10.3 Cardiac Surgeries
7.10.4 Neuroprognostication after Cardiac Arrest
7.10.5 Effect of Anesthetics on SjVO2
7.11 Limitations
7.12 Conclusions
References
8: EEG for the Intensivist: Basics
8.1 Introduction
8.2 Basics of EEG
8.3 Important Terminology
8.4 Various Patterns Seen in EEG
8.4.1 Normal Adult EEG
8.5 Pattern 3: Periodic Epileptiform Discharges (PEDs)
8.5.1 Periodic Lateralized Epileptiform Discharges or Lateralized Periodic Discharges
8.5.2 Bilateral Independent Periodic Lateralized Epileptiform Discharges
8.5.3 Generalized Periodic Discharges
8.5.4 Stimulus-Induced Periodic, Rhythmic, or Ictal Discharges (SIRPIDs)
8.5.5 Triphasic Waves
8.6 Pattern 4: Burst-Suppression Pattern (BSP)
8.7 Pattern 5: Electrographic Seizures
8.7.1 Focal Electrographic Seizures
8.7.2 Generalized Electrographic Seizures
8.8 Continuous EEG
References
9: Transcranial Doppler
9.1 Introduction
9.2 Physical Principle
9.3 Transcranial Doppler (TCD) Versus Transcranial Color-Coded Duplex Sonography (TCCD)
9.4 Technique of TCD
9.5 Spectral Waveform Analysis
9.6 TCD Indices
9.7 Assessment of Cerebral Hemodynamics by TCD
9.8 Clinical Uses
9.9 Limitations of TCD
9.10 Summary
References
10: Evoked Response Monitoring
10.1 Introduction
10.2 Applied Anatomy
10.3 Basics of Recording
10.3.1 Montages
10.3.2 Nearfield and Far-Field Potentials [3, 5]
10.3.3 Nomenclature, Amplitude, and Latency
10.4 Recording Technique
10.4.1 Upper Limb
10.4.2 Lower Limb
10.5 Interpretation
10.6 Prolongation of Latency
10.7 Changes in Amplitude
10.8 Absence of Waves
10.8.1 Upper Limb (Table 10.3)
10.8.2 Lower Limb (Table 10.4)
10.9 Factors Affecting SSEPs
10.10 Indications and Common Applications in Critical Care
10.10.1 Prognostication After Cardiac Arrest [12–18]
10.10.2 Prognostication After Traumatic Brain Injury [1, 19–21]
10.11 Other Uses
10.12 Multimodal Monitoring [23, 24]
10.13 Other Evoked Responses in Critical Care [25]
References
11: Near Infrared Spectroscopy
11.1 Introduction
11.2 Factors Affecting NIRS-Based Cerebral Oximetry Readings
11.3 Clinical Application of NIRS-Based Cerebral Oximetry in NICU
References
12: Brain Tissue Oxygenation
12.1 Introduction: The Physiology of Brain Oxygen
12.1.1 Systemic Determinants of Brain Oxygen
12.1.2 Arterial Oxygen Content
12.1.3 Cerebral Blood Flow
12.1.4 Capillary Oxygen Delivery
12.1.5 Oxygen Diffusion
12.2 Brain Tissue Oxygen Monitoring
12.2.1 Normal Values for Brain Oxygen Levels
12.3 Methodological Issues with Clinical Monitoring of pbtO2
12.3.1 Systemic Determinants of PbtO2
12.3.2 The Balance of Supply and Demand
12.3.3 Local Tissue Factors Influencing PbtO2 Readings
12.4 Brain Tissue Oxygen Monitoring in TBI
12.4.1 Ischemia as a Component of Secondary Brain Injury in TBI
12.4.2 Mechanisms of Brain Hypoxia and Dysoxia
12.4.3 Identification of Brain Hypoxia with PbtO2
12.4.4 Outcomes Associated with Low PbtO2
12.4.5 Protocolized Approach to Brain Hypoxia
12.4.6 Randomized Trials of PbtO2-Based Management in TBI
12.5 Brain Tissue Oxygen Monitoring in SAH
12.5.1 Mechanisms of Brain Injury in SAH
12.6 PbtO2 Monitoring in SAH
12.6.1 Evidence for PbtO2 Use in SAH
12.7 The Future of Brain Oxygen Monitoring in Acute Brain Injury
12.7.1 Indices of Auto-regulation
12.7.2 Use of PbtO2 Monitoring in CSD
12.8 Conclusions
References
13: Brain Microdialysis
13.1 Introduction
13.2 The Principle of Microdialysis
13.3 Factors Affecting Solute Recovery
13.3.1 Flow Rate of Perfusate
13.3.2 Characteristics of Semipermeable Membrane
13.3.3 Characteristics of Analyte
13.3.4 Temperature
13.3.5 Tissue Factors
13.4 Clinical Applications of Microdialysis in Brain Injury
13.4.1 Aneurysmal Subarachnoid Hemorrhage
13.4.2 Traumatic Brain Injury
13.4.3 Acute Ischemic Stroke
13.4.4 Brain Tumor
13.4.5 Epilepsy
13.5 Other Applications of Cerebral Microdialysis
13.6 Future Applications
References
14: Neuroimaging: CT Scan and MRI
14.1 Introduction
14.2 Imaging Modalities
14.2.1 Computed Tomography
14.2.2 Magnetic Resonance Imaging
14.2.3 Basic Sequences of MRI
14.2.4 Digital Subtraction Angiography
14.3 Different Spectrum of Pathology
14.4 Summary
References
15: Brain Ultrasonography
15.1 Introduction
15.2 Principles of Brain Ultrasound
15.3 Clinical Applications
15.3.1 Midline Shift
15.3.2 Intraparenchymal Hemorrhage
15.3.3 Extra-axial Hemorrhage
15.3.4 Hydrocephalus
15.3.5 Post-surgical Applications
15.3.6 Limitations of Brain Ultrasound
15.3.7 Orbital Ultrasound
15.3.8 Optic Nerve Sheath Diameter
15.3.9 Papilledema
15.3.10 Eye Movements and Pupillary Light Reflex
15.4 Conclusions
References
Part IV: Neuropharmacology in Neurocritical Care
16: Sedation and Analgesia
16.1 Introduction
16.2 Indications
16.2.1 General Indication
16.2.2 Brain-Specific Indications
16.3 Selection of Sedatives and Analgesics in the NCCU [6, 10, 11]
16.4 Assessing Patients While on Sedation in the NCCU
16.5 Monitoring of Sedation and Analgesia in the NCCU
16.6 A Practical Approach for the Use of Sedation and Analgesia in the NCCU
16.7 Withdrawal of Sedation in NCCU Patients
16.8 Conclusion
References
17: Antiseizure Medications
17.1 Introduction
17.2 Seizure Prophylaxis
17.3 Acute Treatment of Seizures
17.3.1 Benzodiazepines
17.3.2 Antiseizure Medications
First-Generation Antiseizure Medications
Second-Generation Antiseizure Medications
Third-Generation Antiseizure Medications
17.4 Treatment of Medical Emergencies with Antiseizure Medications (ASMs)
17.4.1 Emergent Therapy for Status Epilepticus
17.4.2 Urgent Therapy for Status Epilepticus
17.4.3 Refractory Status Epilepticus Treatment
Anesthesia Weaning
17.4.4 Super-Refractory Status Epilepticus
17.5 ICU Interventions Which Impact Pharmacotherapy
17.5.1 Renal Replacement Therapy
17.5.2 Plasmapheresis
17.5.3 Therapeutic Hypothermia
17.6 Summary
References
18: Antibiotic Drugs
18.1 Introduction
18.2 Pharmacokinetics (PK) and Pharmacodynamics (PD)
18.2.1 PK–PD Parameters of the Major Classes of Antimicrobials
18.2.2 Alterations in the PK Parameters in ICU Patients
18.3 PK–PD Parameters of the Major Classes of Antimicrobials
18.3.1 Beta-lactams
18.3.2 Linezolid
18.3.3 Vancomycin
18.4 Antibiotic Prophylaxis for Neurosurgical Patients
18.5 Principles of Surgical Prophylaxis
18.6 Antimicrobial Therapy for Community Acquired Meningitis
18.6.1 Repeat Lumbar Puncture
18.6.2 Duration of Therapy
18.7 Healthcare-Associated Meningitis
18.8 Antimicrobial Considerations
18.9 Management of Healthcare-Associated Meningitis/Ventriculitis
18.10 Shunt and Reservoir Infections
18.10.1 Shunt Reimplantation
18.11 Intrathecal/Intraventricular Antibiotics
18.11.1 Factors Affecting CSF Concentration
18.11.2 Infectious Disease Society of America (IDSA) Recommendations Includes
18.11.3 Adjunctive Therapy Along with Intrathecal Administration
18.12 Drug to Drug Interactions (DDI)
18.12.1 Pharmacokinetics (PK) and Pharmacodynamics (PD) in Drug–Drug Interaction
18.12.2 Carbapenems
18.12.3 Erythromycin
18.12.4 Linezolid
18.12.5 AAE (Antibiotic-Associated Encephalopathy)
18.13 Conclusion
References
19: Antiviral Drugs
19.1 Introduction
19.2 Viruses Causing Encephalitis/Myelitis
19.3 Antivirals Practiced in Encephalitis
19.3.1 Acyclovir and Valacyclovir
19.3.2 Ganciclovir and Valganciclovir
19.3.3 Foscarnet
19.3.4 Cidofovir
19.3.5 Leteromovir
19.4 HIV and Antiretroviral Drugs
19.4.1 HIV Encephalitis
Diagnosis
Management
HIV-Associated CD8 Encephalitis
19.4.2 Opportunistic Infections
19.4.3 IRIS
19.4.4 Antiretroviral Drugs Related Neuropsychiatric Complications
19.5 Antiretroviral Drugs
19.5.1 Nucleoside Reverse Transcriptase Inhibitor
19.5.2 Nonnucleoside Reverse Transcriptase Inhibitors
19.5.3 Protease Inhibitors
19.5.4 Integrase Inhibitors
19.5.5 Entry and Fusion Inhibitors
19.6 Neuropsychiatry Effects of Other Antivirals
19.6.1 Antiviral Drugs in Influenza
19.6.2 Antivirals in Chronic Hepatitis B
19.6.3 Antivirals in Hepatitis C
19.7 Newer/Investigational Antivirals
19.7.1 Brincidofovir
19.7.2 Maribavir
19.7.3 Pritelivir
19.8 Conclusion
References
20: Antifungal Drugs
20.1 Introduction and Epidemiology
20.2 Classification of Fungi
20.3 Classification of Antifungal Agents
20.4 Mechanism of Action
20.5 Drug Toxicities
20.5.1 Polyenes
20.5.2 Azoles
20.6 Recommendations of Recent Guidelines
20.6.1 Regarding Invasive Candidiasis
20.6.2 For Invasive Aspergillosis
20.7 Conclusion
References
21: Antihypertensive Therapy
21.1 Introduction
21.2 Definitions of Hypertension
21.2.1 Causes of Hypertension
21.2.2 Blood Pressure Goals in Neurocritical Care
21.2.3 Pharmacology of Antihypertensive Drugs
21.2.4 RAS Inhibitors
21.2.5 Angiotensin-Converting Enzyme (ACE) Inhibitors
21.2.6 Angiotensin Receptor Blocker (ARB) Drugs
21.2.7 Direct Renin Inhibitors
21.3 Adrenoceptor Antagonists
21.3.1 Beta-Blockers (BBs)
21.3.2 Alpha-Blockers
21.3.3 Calcium Channel Blockers (CCBs)
21.3.4 Diuretics
21.3.5 Vasodilators
21.3.6 Centrally Acting Agents
21.4 Conclusions
References
22: Hypoglycaemic Drugs
22.1 Introduction
22.2 Classification of Hypoglycaemic Drugs
22.3 Insulin
22.3.1 Chemistry
22.3.2 Mechanism of Action
22.3.3 Types of Insulin
Rapid-Acting Insulins
Short-Acting Insulin
Intermediate-Acting Insulins
Long-Acting Insulins
Ultra-Long Acting Insulin
22.3.4 Insulin Strengths
22.3.5 Insulin Administration
22.3.6 Insulin Delivery Devices
22.3.7 Monitoring During Insulin Therapy
22.3.8 Adverse Effects of Insulin
22.3.9 Literature Support for Insulin Use in ICU Patients
22.4 Hypoglycaemic Agents for Type 2 DM
22.4.1 Introduction
22.4.2 Mechanism of Action
22.4.3 Types
22.5 Parenteral Hypoglycaemic Agents
22.6 Advantages and Disadvantages of Hypoglycemics
22.7 Clinical Implications in Neurocritical Care
22.8 Future Prospects
22.9 Conclusions
References
23: Vasopressor Drugs
23.1 Introduction
23.2 Function of Adrenergic and Dopaminergic Receptors
23.2.1 Norepinephrine (Noradrenaline)
23.2.2 Epinephrine (Adrenaline)
23.2.3 Dobutamine
23.2.4 Vasopressin
23.3 Exogenous Vasopressors and Inotropes
23.3.1 Dopexamine
23.4 Sympathomimetics
23.4.1 Ephedrine
23.4.2 Phenylephrine
23.4.3 Angiotensin II
23.5 Role of Vasopressors in Neurological Conditions
23.5.1 Subarachnoid Hemorrhage
23.5.2 Traumatic Brain Injury (TBI)
23.5.3 Spinal Cord Injury
23.5.4 Vasopressors in Acute Ischemic Stroke
23.6 Sepsis and the Brain
23.7 Conclusion
References
24: Steroids
24.1 Introduction
24.2 Fundamental Concepts Regarding CS Therapy in NICU
24.3 Synthetic CSs
24.4 CSs in Critical Neurological/Neurosurgical Disorders
24.4.1 Brain Neoplasms
24.4.2 CNS Infections
Bacterial Meningitis (BM)
Tubercular Meningitis (TBM)
Tuberculomas, Spinal Cord Tuberculosis
Brain Abscess
Herpes Simplex Encephalitis (HSVE)
Neurocysticercosis (NCC)
Cerebral Toxoplasmosis, Neurolisteriosis, Cryptococcal Meningitis (CM)
Immune Reconstitution Syndrome (IRIS)
24.4.3 Autoimmune Neurological Disorders
MS
MG
SRE
24.4.4 CNS Trauma
SCI
24.5 CS in Critical Non-Neurological Illnesses
24.5.1 CIRCI: Septic Shock, ARDS
24.5.2 Endocrine Failure
24.5.3 Airway Crisies, Obstructive Airway Disease, Anaphylaxis, Graft Donor Management
24.6 NICU Disorders in Which CSs Are Not Indicated
24.6.1 TBI
24.6.2 Acute Ischemic Stroke (AIS), ICH, Aneurysmal Subarachnoid Hemorrhage (aSAH), Guillian Barre Syndrome (GBS)
24.7 Role of Mineralocorticoids in the NICU
24.8 Conclusions
References
25: Antipsychotic Drugs
25.1 Introduction
25.2 Classification
25.3 Mechanism of Action
25.3.1 Indication [13–20]
25.3.2 Side Effects
25.3.3 Contraindications
Anti-Psychotics Related Problems in ICU
25.4 Neuroleptic Malignant Syndrome
25.5 Conclusion
References
26: Anticoagulants Antiplatelets and Antifibrinolytics
26.1 Introduction
26.2 Physiology of Hemostasis
26.3 Anticoagulants
26.3.1 Unfractionated Heparin (UFH)
Mechanism of Action
Route of Administration
Pharmacologic Properties
Adverse Effects
Monitoring Test
Neurocritical Care Indications
Contraindications
Interactions
Reversal Agent
26.3.2 Low-Molecular-Weight Heparins (LMWH)
Mechanism of Action
Route of Administration
Therapeutic Dose
Pharmacologic Properties
Reversal Agent
Monitoring Test
26.3.3 Fondaparinaux
26.3.4 Warfarin
Mechanism of Action
Route of Administration
Pharmacologic Properties
Dosing and Administration
Monitoring Test
Adverse Effects
Indications of Warfarin in Neurocritical Care Setting
26.3.5 Novel Oral Anticoagulants (NOAC)
Dabigatran Etexilate
Pharmacologic Properties
Dose
Contraindications
Adverse Effects
Reversal
Rivaroxaban
Pharmacologic Properties
Dose
Contraindications
Reversal
Apixaban
Pharmacologic Properties
Interactions
Side Effects
Antidote
26.4 Antifibrinolytics
26.4.1 Aprotinin
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Clinical Indications
Adverse Effects
Precautions
26.4.2 Tranexamic Acid
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Clinical Indications
Adverse Effects
Precautions
Contraindications
26.4.3 Epsilon Amino Caproic Acid
Dose and Route of Administration
Pharmacokinetics
Side Effects
26.4.4 Monitoring Antifibrinolytics
26.4.5 Antifibrinolytics in Neurocritical Care
Traumatic Brain Injury
Spontaneous Intracranial Hemorrhage (ICH)
Aneurysmal Subarachnoid Hemorrhage (SAH)
26.5 Antiplatelet Agents
26.5.1 Role of Platelets
26.5.2 Aspirin
Chemical Properties
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Pharmacodynamics
Indications
Side Effects
Precautions
26.5.3 Clopidogrel
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Clinical Indications
Side Effects and Contraindications
Drug Interactions and Precautions
26.5.4 Prasugrel
Mechanism of Action
Pharmacokinetics
Uses
Adverse Effects
Contraindications
26.6 ADP Receptor Antagonists
26.6.1 Ticagrelor
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Indications
Contraindications
Side Effects
Drug Interactions
26.6.2 Cangrelor
Mechanism of Action
Dose
Pharmacokinetics
Pharmacodynamics
Side Effects
26.7 Phosphodiesterase Inhibitors
26.7.1 Dipyridamole
Mechanism of Action
Dose
Pharmacokinetics
Side Effects
26.7.2 Cilostazol
Dose and Route of Administration
Pharmacokinetics
Pharmacodynamics
Indications
Adverse Effects
26.8 Glycoprotein (GP) IIb/IIIa Inhibitors
26.8.1 Abciximab
Mechanism of Action
Dose and Route
Pharmacokinetics
Clinical Indications
Contraindications
Side Effects
Monitoring
Management of Toxicity
26.8.2 Eptifibatide
Mechanism of Action
Dose and Route of Administration
Pharmacokinetics
Indications
Adverse Effects
Contraindications
26.8.3 Tirofiban
Mechanism of Action
Dose
Pharmacokinetics
26.8.4 Monitoring Antiplatelet Agents
26.8.5 Antiplatelets in Neurocritical Care
Stroke
Spontaneous Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Periprocedural Antiplatelets in Neuroendovascular Interventions
26.8.6 Resistance to Antiplatelet Therapy
26.9 Summary
26.10 Conclusion
References
27: Osmotherapy
27.1 Introduction
27.2 Principles Behind the Use of Osmotherapy
27.3 What Are the Options?
27.3.1 Pharmacology of the Agents
Mannitol
Hypertonic Saline
Sodium Bicarbonate
Hypertonic Sodium Lactate
Glycerol
27.4 Practical Pearls
27.4.1 Indications
Evidence in Different Pathologies
27.4.2 Routes of Administration (Peripheral vs Central)
27.4.3 Combination of Therapy (Mannitol and HTS)
27.4.4 How Long to Be Given
27.4.5 Hyperosmolar Agents and Acute Kidney Injury
27.5 Conclusion
References
Part V: Systemic Neurocritical Care
28: Cardiac Problems in Neurocritical Care
28.1 Introduction
28.2 Pathophysiology of Cardiac Injury in Brain Injury
28.2.1 Neurogenic Stunned Myocardium (NSM)
28.2.2 Stress Cardiomyopathy
28.2.3 Neurogenic Pulmonary Edema (NPE)
28.3 Cardiac Complications in Traumatic Brain Injury (TBI)
28.3.1 Cardiac Complications in Acute Ischemic Stroke (AIS)
28.3.2 Cardiac Complications in Subarachnoid Hemorrhage (SAH)
28.3.3 Cardiac Complications in Intracerebral Hemorrhage (ICH)
28.4 Cardiac Complications in Spinal Cord Injury
28.5 Cardiac Complications in Potential Brain Death Organ Donors
28.6 Cardiac Complications in Epilepsy
28.7 Cardiac Dysfunction in Guillain Barre Syndrome (GBS)
28.8 Cardiac Complications in Myasthenia Gravis (MG)
28.9 Cardiac Issues in Neuromuscular Disorders (NMD)
28.10 Management of Cardiac Complications in Neurocritical Care
References
29: Respiratory Problems in Neurocritical Care
29.1 Introduction
29.2 Neurological Diseases
29.3 Neurosurgical Procedures
29.4 Neurotrauma
29.5 Brain–lung Cross Talk
References
30: Renal Problems in Neurocritical Care
30.1 Introduction
30.2 Defining Acute Kidney Injury
30.3 Burden of AKI in Neurocritically Ill Patients
30.4 Pathophysiology of AKI in Neurocritically Ill Patients
30.4.1 Brain–Kidney Organ Crosstalk
30.4.2 Osmo-Diuretics in AKI
30.4.3 Loop Diuretics in AKI
30.4.4 Vasopressors in AKI
30.5 Diagnosis of AKI IN Neurocritically Ill Patients
30.5.1 History and Clinical Evaluation
30.5.2 Diagnostic Testing
Functional Biomarkers
Damage and Stress Biomarkers
Additional Tests
30.6 Management of AKI in Neurocritically Ill Patients
30.6.1 AKI Risk-Prediction
30.6.2 Minimizing Secondary Injury
30.6.3 Management Strategies
Hemodynamic Management
Nephrotoxic Drug Management
Ventilatory Management
Anemia Management
Glycemic Control
Nutritional Support
30.7 Contrast-Induced Acute Kidney Injury
30.7.1 Incidence in Neurocritically Ill
30.7.2 Pathogenesis
30.7.3 Periprocedural Management
30.8 Gadolinium-Based Contrast Agents and Nephrotoxicity
30.9 Renal Replacement Therapies in Neurocritically Ill Patients
30.9.1 Techniques
30.9.2 Mechanism of Worsening Cerebral Edema
30.9.3 Timing of Initiation of RRT
30.9.4 Treatment Modifications in Neurocritically Ill
30.10 Future Directives
References
31: Endocrine Dysfunction in Acute Brain Injury
31.1 Introduction
31.2 Physiology of the Brain–Endocrine Axis
31.3 Endocrine Dysfunction in Traumatic Brain Injury
31.4 Endocrine Dysfunction Following Acute Stroke
31.5 Endocrine Dysfunction in Aneurysmal SAH
31.6 Summary
Appendix
References
32: Myopathies in Neurocritical Care
32.1 Introduction
32.2 Epidemiology and Risk Factors
32.3 Pathophysiology
32.3.1 Functional Aberrations in the Involved Muscle
32.4 Classification of ICUAW
32.5 Clinical Presentation
32.6 Evaluation and Diagnosis
32.6.1 Functional Assessment
Volitional Functional Testing for Peripheral Muscle Assessment
Volitional Functional Testing for Respiratory Muscles
Non-Volitional Functional Testing for Respiratory Muscles
32.6.2 Imaging
32.7 Diagnostic Criteria for ICUAW Based on Electrodiagnostic Testing [43]
32.8 Preventive and Therapeutic Interventions for ICUAW
32.8.1 Role of Pharmacological Interventions
32.8.2 Role of Physiotherapy in ICUAW
Respiratory Muscle Training
Physical Training
32.8.3 Prognosis
32.8.4 Complications
32.9 Management
32.9.1 Rehabilitation During the ICU Stay
32.9.2 Barriers to Successful Mobilization
32.9.3 Safety Concerns During Mobilization
32.9.4 Newer Horizons in Rehabilitation
32.9.5 Rehabilitation and Care after ICU Discharge
32.10 Summary and Conclusion
References
33: Gastrointestinal Problems in Neurocritical Care
33.1 Introduction
33.2 Erosive Gastritis and Duodenitis
33.3 Increased Intestinal Permeability and Bacterial Translocation
33.4 Gastrointestinal Motility Disorders
33.5 Systemic Immune Reactions in Lesions of the Gastrointestinal System
33.6 Microbiota Disorder
33.7 Antibiotic-Associated Diarrhea
References
34: Role of Clinical Neuropsychology
34.1 Introduction
34.2 What
34.3 Why
34.4 How
34.5 Three Stages of Neuropsychological Psycho-diagnostics
34.5.1 Clinical Interview
34.5.2 Psychometric Testing
34.5.3 Cognitive Rehabilitation and Interventions
34.6 Whom
34.7 Conclusion
References
Part VI: Supportive Neurocritical Care
35: Mechanical Ventilation in Traumatic/Acute Brain Injury
35.1 Introduction
35.2 Epidemiology and Risk Factors of ARDS in Acute Brain Injury
35.2.1 Milestone of MV in Neurologically Diseased Patients
35.3 Pathophysiology of Lung Injury in Acute Brain Injury: Brain Lung Cross Talk
35.4 Ventilatory Strategies
35.5 Putting It All Together from Intubation to Extubation and Finally Indications for Tracheostomy [2]
35.6 Conclusion
References
36: Fluid Management in Neurocritical Care
36.1 Introduction
36.2 Pathophysiology
36.2.1 Tonicity of Administered Fluids
36.2.2 Cerebral Edema
36.2.3 Autoregulation
36.3 Fluid Management in NCC: Quantity of Maintenance Fluids: How Much to Give?
36.4 Type of Maintenance Fluids: Which Fluids to Give?
36.5 Fluid Administration Based on Assessment of Circulation
36.6 Conclusions
References
37: Nutrition in Neurocritical Care
37.1 Introduction
37.2 Nutritional Assessment in Patients Admitted to Neurocritical ICUs
37.3 Estimation of Nutritional Requirements
37.4 Initiation and Monitoring of Nutrition
37.5 Special Nutritional Considerations in NCC
37.6 Conclusions
References
38: Fever in Neurocritical Care
38.1 Introduction
38.2 What Is Fever? Why Is It Harmful for Neurological Disease-Affected Patients?
38.3 Why Treat a Fever?
38.4 Pathophysiology of Fever in Neuro ICU
38.5 Manifestations of Fever on the Brain
38.6 Causes of Fever in Neuro ICU
38.6.1 Infectious
38.6.2 Non-infectious
38.6.3 Hyperthermia Syndromes in Neuro-intensive Care
38.7 Investigations and Treatment
38.8 Conclusion
References
39: Sepsis in Neurocritical Care
39.1 Introduction
39.2 Definitions
39.3 Primary Brain Injury and Secondary Sepsis
39.4 Primary Sepsis and Secondary Brain Injury
39.5 Conclusions
References
40: Cerebral Resuscitation in Neurocritical Care
40.1 Introduction
40.2 Optimizing Perfusion Pressures
40.2.1 Ischemic Stroke
40.2.2 Hemorrhagic Stroke
40.2.3 Traumatic Brain Injury
40.2.4 Sepsis and Septic Shock
40.2.5 Promoting Macrocirculation
40.3 Optimizing Brain Volume
40.3.1 Nonpharmacological Management
Surgical Decompression
40.4 Optimizing Glycemic Control
40.4.1 Optimizing Oxygenation and Ventilation
40.4.2 Control of Fever
40.4.3 Optimizing Nutrition
40.4.4 Analgosedation
40.4.5 Optimizing Hemoglobin
40.4.6 Electrolyte Abnormalities
40.4.7 Seizure Control
40.5 Conclusion
References
41: Coma in Neurocritical Care
41.1 Introduction
41.2 Consciousness Level and Content
41.3 Pathophysiological Basis of Disorders of Consciousness
41.4 Causes of DoC at Emergency Department
41.5 Neurologic Complications of Critical Medical Illnesses
41.6 Diagnostic Step at Emergency Department
41.7 Determination of the Depth of the DoC
41.8 Non-convulsive Status Epilepticus (NCSE)
41.9 Diagnostic Bedside Tools and Devices in the Critically Ill Update
41.10 Therapeutic Interventions in Prolonged DoC
41.11 Personal View on the Therapeutic Interventions for Refractory Prolonged DoC
41.12 Curing Coma Campaign
References
42: Physiotherapeutic Management in Neurocritical Care
42.1 Introduction
42.2 Physiotherapy in Respiratory Impairments
42.2.1 Chest Physiotherapy
42.2.2 Techniques of Chest Physiotherapy
Therapeutic Body Positioning
Percussion
Vibrations
42.2.3 Manual Hyperinflation
42.2.4 Active Cycle of Breathing Technique (ACBT)
42.2.5 Autogenic Drainage (AD)
42.2.6 Positive Airway Pressure Techniques
42.2.7 Respiratory Muscle Training
42.3 Prevention and Management of ICUAW
42.4 Prevention and Management of Deep Vein Thrombosis
42.5 Physiotherapy Management of Altered State of Consciousness
42.5.1 Brain-Computer Interface (BCI)
42.6 Management of Spasticity, Muscle Tightness, and Contractures
42.7 Conclusion
References
43: Palliative Care in Neurocritical Care
43.1 Introduction
43.2 Palliative Care in Neuro-critical Care: Is There a Need?
43.2.1 Issues of Palliative Care in Neuro-intensive Care
43.2.2 Unique Issues for Palliative Care in Neuro-intensive Care Unit: [6] See Table 43.2
43.3 WHO Should Be Offered Palliative Care in Neuro-intensive Care
43.3.1 Advanced Directive [14, 15]
43.4 Palliative Care Plan: How to Communicate?
43.5 Treatment Domains of Palliative Care in Neuro-ICU (See Fig. 43.2)
43.6 Strategies to Help Ensure the Delivery of Appropriate and Optimal Patient-Centered Care for Patients at High Risk of Death or Severe Disability [23] (See Fig. 43.3)
43.6.1 Barriers of Palliative Care
43.6.2 Precision Palliative Care Plan
43.7 Conclusion
References
44: Neurocritical Care Nursing
44.1 Introduction
44.2 Neuro-critical Care Nurse
44.3 Features of Neuro-critical Care Nursing
44.4 Familiarity with Neuro-disease Processes and Diagnostics
44.5 Communication
44.6 Teamwork, Confidence and Attitude
44.7 Attention to Detail
44.8 Decision-Making
44.9 Focus and Dedication
44.10 Technical Proficiency
44.11 Compassion and Patience
44.12 Reporting/Handover
44.12.1 Assessment
44.12.2 Codes
44.12.3 Physicians Round
44.12.4 Nursing Care
44.12.5 Documentation
44.12.6 Furthering the Care Plan: Working Towards a Transfer
44.12.7 Patient Flow
44.12.8 Dealing with Death
44.12.9 Finishing Up
44.13 Conclusion
References
Part VII: Case-Based Neurocritical Care
45: Traumatic Brain Injury and Neurocritical Care
Case
45.1 Introduction
45.2 Classification of TBI
45.3 Pathophysiology of TBI
45.3.1 Primary Traumatic Brain Damage
45.3.2 Secondary Brain Damage
Cellular Metabolism and Cell Death
Cerebral Blood Flow
Cerebral Autoregulation and Carbon Dioxide (CO2) Reactivity
Post-Traumatic Vasospasm
Cerebral Oxygenation
Edema
Inflammation and Cell Death
45.4 Monitoring of Brain Trauma Patient
45.4.1 Intracranial Pressure Monitoring
45.4.2 Brain Oxygen Tension (PtiO2)
45.4.3 Transcranial Doppler (TCD)
45.4.4 Cerebral Microdialysis (MD)
45.4.5 Continuous Electroencephalography (cEEG)
45.5 Principles of Management of Head Injured Patient
45.5.1 Management of Mild TBI (GCS 13–15)

2024-06-01