scholarly journals The Endothelium, A Protagonist in the Pathophysiology of Critical Illness: Focus on Cellular Markers

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Sabrina H. van Ierssel ◽  
Philippe G. Jorens ◽  
Emeline M. Van Craenenbroeck ◽  
Viviane M. Conraads
Keyword(s):  
Brain Injury ◽  
Critically Ill ◽  
Prognostic Markers ◽  
Acute Brain Injury ◽  
Tissue Homeostasis ◽  
Endothelial Repair ◽  
Cellular Markers ◽  
Near Future ◽  
Secondary Ischemia ◽  
Intense Research

The endotheliumis key in the pathophysiology of numerous diseases as a result of its precarious function in the regulation of tissue homeostasis. Therefore, its clinical evaluation providing diagnostic and prognostic markers, as well as its role as a therapeutic target, is the focus of intense research in patientswith severe illnesses. In the critically ill with sepsis and acute brain injury, the endothelium has a cardinal function in the development of organ failure and secondary ischemia, respectively. Cellular markers of endothelial function such as endothelial progenitor cells (EPC) and endothelialmicroparticles (EMP) are gaining interest as biomarkers due to their accessibility, although the lack of standardization of EPC and EMP detection remains a drawback for their routine clinical use. In this paper we will review data available on EPC, as a general marker of endothelial repair, and EMP as an equivalent of damage in critical illnesses, in particular sepsis and acute brain injury. Their determination has resulted in new insights into endothelial dysfunction in the critically ill. It remains speculative whether their determination might guide therapy in these devastating acute disorders in the near future.

scholarly journals Energy Expenditure in Critically Ill Adult Patients With Acute Brain Injury: Indirect Calorimetry vs. Predictive Equations

2020 ◽  
Vol 10 ◽  
Author(s):  
Kathryn A. Morbitzer ◽  
William S. Wilson ◽  
Alex C. Chaben ◽  
Adrienne Darby ◽  
Kelly A. Dehne ◽  
...  
Keyword(s):  
Brain Injury ◽  
Energy Expenditure ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Acute Brain Injury ◽  
Adult Patients ◽  
Predictive Equations

Sedation algorithm in critically ill patients without acute brain injury

2005 ◽  
Vol 33 (1) ◽  
pp. 120-127 ◽  
Author(s):  
Bernard De Jonghe ◽  
Sylvie Bastuji-Garin ◽  
Pascal Fangio ◽  
Jean-Claude Lacherade ◽  
Julien Jabot ◽  
...  
Keyword(s):  
Brain Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Brain Injury

scholarly journals 1147 Sleep Correlates With Improved Functional Outcome In The Intensive Care Unit

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A437-A437
Author(s):  
L C Markun ◽  
A Sampat ◽  
R Dutta ◽  
G A Palchik ◽  
M Chow ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injury ◽  
Critical Illness ◽  
Functional Outcome ◽  
Critically Ill ◽  
Acute Brain Injury ◽  
Subdural Hemorrhage ◽  
Neurological Patients ◽  
Chi Square Analysis

Abstract Introduction Disruption of sleep may have significant implications in acute brain injury, functional recovery, and critical illness. Few data exist characterizing sleep architecture in patients admitted to an intensive care unit (ICU). We aim to describe sleep and clinical characteristics in patients with acute brain injury and critical illness. Methods Retrospective analysis was performed in ICU patients who underwent continuous electroencephalographic (EEG) monitoring from 2018-2019. Sleep was scored based on AASM-defined EEG criteria. Clinical variables, EEG characteristics, and modified Ranking Scale (mRS) were collected. Good outcome was defined as mRS<3. Differences were assessed using chi-square analysis and t-test. Results 205 patients were reviewed with a mean age of 57 years (range 18-91) and a majority (57%) were male. Patients carried a primary neurologic/neurosurgical (61%) or medical/surgical (39%) diagnosis. Status epilepticus, subdural hemorrhage, traumatic brain injury, encephalopathy and cardiac arrest accounted for the majority of diagnoses encountered. Only 58 patients (28%) achieved N1 sleep; of these 76.4% achieved N2, 2.8% N3, and none achieved REM. Of those achieving any sleep, 43% had good outcomes versus only 23% in those who did not (t=-7.45, p<0.001). Neurological patients were more likely to attain sleep compared to those with other primary diagnoses (χ 2 (1)=7.08, p=0.008). Centrally acting anesthetics did not account for sleep differences between neurologic and non-neurologic patients (χ² (1)=2.01, p=0.16). However, those with primary brain injury reached sleep more often in the absence of anesthetic use (χ 2 (1)=4.82, p=0.03). The overall mortality was 32% in this cohort. Conclusion Most critically ill patients do not achieve electrophysiologic sleep. Of those who do, N1/N2 stages are seen most often. Neurological patients were more likely to sleep, and achieving any sleep was associated with improved functional outcome. Further studies are needed to determine whether sleep augmentation in the critically ill impacts functional outcome. Support N/A.

scholarly journals Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 469
Author(s):  
Wojciech Dabrowski ◽  
Dorota Siwicka-Gieroba ◽  
Malgorzata Gasinska-Blotniak ◽  
Sami Zaid ◽  
Maja Jezierska ◽  
...  
Keyword(s):  
Brain Injury ◽  
Gut Microbiota ◽  
Hospital Stay ◽  
Critically Ill ◽  
Mental Status ◽  
Critically Ill Patients ◽  
Acute Brain Injury ◽  
Effective Prevention ◽  
Prevention And Treatment ◽  
Tryptophan Pathway

Delirium, an acute alteration in mental status characterized by confusion, inattention and a fluctuating level of arousal, is a common problem in critically ill patients. Delirium prolongs hospital stay and is associated with higher mortality. The pathophysiology of delirium has not been fully elucidated. Neuroinflammation and neurotransmitter imbalance seem to be the most important factors for delirium development. In this review, we present the most important pathomechanisms of delirium in critically ill patients, such as neuroinflammation, neurotransmitter imbalance, hypoxia and hyperoxia, tryptophan pathway disorders, and gut microbiota imbalance. A thorough understanding of delirium pathomechanisms is essential for effective prevention and treatment of this underestimated pathology in critically ill patients.

Effect of Early Versus Late Tracheostomy or Prolonged Intubation in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 26 (1) ◽  
pp. 14-25 ◽  
Author(s):  
Victoria A. McCredie ◽  
Aziz S. Alali ◽  
Damon C. Scales ◽  
Neill K. J. Adhikari ◽  
Gordon D. Rubenfeld ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Acute Brain Injury ◽  
Prolonged Intubation

scholarly journals Cefepime Use and Acute Brain Injury in Critically Ill Patients

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
John O'Horo ◽  
Dereddi Raja Reddy ◽  
Tarun Singh ◽  
Rahul Kashyap ◽  
James Steckelberg ◽  
...  
Keyword(s):  
Brain Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Brain Injury
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