The neurologic consultation: pointers and takeaways for intensivists

Wijdicks, Eelco F. M.

doi:10.1007/s00134-020-06055-w

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Moreover, the clinical examination can only assess the current functionality of the neurological systems, while it cannot predict which functions may be regained over time. Lastly, clinical examination can prove to be demanding for non-neurologists, potentially leading to an underestimation of ongoing brain damage [ 15 ].…”

Section: Which Are the Goals Of Treatment And How Monitoring Can Help?mentioning

confidence: 99%

“NeuroVanguard”: a contemporary strategy in neuromonitoring for severe adult brain injury patients

Rodriguez,

Zaccarelli,

Sterchele

et al. 2024

Crit Care

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Severe acute brain injuries, stemming from trauma, ischemia or hemorrhage, remain a significant global healthcare concern due to their association with high morbidity and mortality rates. Accurate assessment of secondary brain injuries severity is pivotal for tailor adequate therapies in such patients. Together with neurological examination and brain imaging, monitoring of systemic secondary brain injuries is relatively straightforward and should be implemented in all patients, according to local resources. Cerebral secondary injuries involve factors like brain compliance loss, tissue hypoxia, seizures, metabolic disturbances and neuroinflammation. In this viewpoint, we have considered the combination of specific noninvasive and invasive monitoring tools to better understand the mechanisms behind the occurrence of these events and enhance treatment customization, such as intracranial pressure monitoring, brain oxygenation assessment and metabolic monitoring. These tools enable precise intervention, contributing to improved care quality for severe brain injury patients. The future entails more sophisticated technologies, necessitating knowledge, interdisciplinary collaboration and resource allocation, with a focus on patient-centered care and rigorous validation through clinical trials.

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Section: Which Are the Goals Of Treatment And How Monitoring Can Help?mentioning

confidence: 99%

“NeuroVanguard”: a contemporary strategy in neuromonitoring for severe adult brain injury patients

Rodriguez,

Zaccarelli,

Sterchele

et al. 2024

Crit Care

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“…Pupillary assessment of the critically ill patient should include minimum and maximum pupil size, in addition to speed and changes in diameter. 1,2 Depending on suspected pathology, these parameters can play substantial roles. To accurately measure pupillary light reflexes (i.e., objective, reproducible, reliable), electronic devices were developed as early as the late 1950s, 3 with multiple devices being available on the market nowadays.…”

mentioning

confidence: 99%

Automated Quantitative Pupillometry in the Critically Ill

et al. 2021

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Objective:A systematic literature search has been performed to identify potential confounders for outcome prediction using pupillary light reflex in adult critically ill patients, as measured by handheld automated pupillometry devices.Methods:Three digital databases (PubMed, EmBase, Cochrane) were systematically searched. Articles published between 1990-2019 in adult patients, using monocular automated handheld devices were considered. Studies were classified according to the OCEBM classification (level 1 represents the highest, level 5 the lowest level of evidence). Case reports, original research and systematic reviews were included and cross-referenced.Results:Using 202 search terms, 58 eligible articles reporting on the use of handheld pupillometry in the critically ill could be identified, considering 3246 patients. The highest level of evidence came from 10 randomized trials and 19 prospective observational studies. The level of evidence was mostly 2 to 3 and highest with studies regarding the potential confounding effects of pain, the use of opioids and increased intracranial pressure. Additional potential confounders found are SSRIs, α2-adregenic receptor agonists and NMDA antagonists.Conclusions:The pupillary light reflex is susceptible to factors resulting from underlying comorbidities and effects of treatment regimes. Scenarios frequently encountered in critical care, such as pain, the use of opioids, and proof of increased intracranial pressure have potential confounding effects on outcome and pupillary reflexes. When treatment is guided by pupillary metrics, such confounders put patients at risk of over- or undertreatment. Future research should validate and identify additional confounders, as our review suggests that even more unexplored confounders may exist.

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The neurologic consultation: pointers and takeaways for intensivists

Cited by 2 publications

References 14 publications

“NeuroVanguard”: a contemporary strategy in neuromonitoring for severe adult brain injury patients

“NeuroVanguard”: a contemporary strategy in neuromonitoring for severe adult brain injury patients

Automated Quantitative Pupillometry in the Critically Ill

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