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Marek Czosnyka - One of the best experts on this subject based on the ideXlab platform.

  • plateau waves of intracranial pressure and multimodal Brain Monitoring
    Acta Neurochirurgica, 2016
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Marek Czosnyka
    Abstract:

    The aim of this study was to describe multimodal Brain Monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5–20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, Brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and Brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal Brain Monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.

  • Intracranial Pressure and Brain Monitoring XII - Intracranial pressure and Brain Monitoring XIV
    Acta Neurochirurgica Supplement, 2016
    Co-Authors: Martin U. Schuhmann, Marek Czosnyka
    Abstract:

    Intracranial pressure and Brain Monitoring XIII : , Intracranial pressure and Brain Monitoring XIII : , کتابخانه دیجیتال جندی شاپور اهواز

  • pressures flow and Brain oxygenation during plateau waves of intracranial pressure
    Neurocritical Care, 2014
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Georgios V Varsos, Marek Czosnyka
    Abstract:

    Background Plateau waves are common in traumatic Brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal Brain Monitoring in head injured patients admitted in neurocritical care.

  • Brain Monitoring: Do We Need a Hole? An Update on Invasive and Noninvasive Brain Monitoring Modalities
    TheScientificWorldJournal, 2014
    Co-Authors: Damiano G. Barone, Marek Czosnyka
    Abstract:

    The ability to measure reliably the changes in the physical and biochemical environment after a Brain injury is of great value in the prevention, treatment, and understanding of the secondary injuries. Three categories of multimodal Brain Monitoring exist: direct signals which are monitored invasively; variables which may be monitored noninvasively; and variables describing Brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software. Intracranial pressure (ICP) Monitoring, either as stand-alone value or study of a dynamic trend, has become an important diagnostic tool in the diagnosis and management of multiple neurological conditions. Attempts have been made to measure ICP non-invasively, but this is not a clinical reality yet. There is contrasting evidence that Monitoring of ICP is associated with better outcome, and further RCTs based on management protocol are warranted. Computer bedside calculation of “secondary parameters” has shown to be potentially helpful, particularly in helping to optimize “CPP-guided therapy.” In this paper we describe the most popular invasive and non invasive Monitoring modalities, with great attention to their clinical interpretation based on the current published evidence.

  • Comprar Intracranial Pressure And Brain Monitoring XIV (Acta Neurochirurgica Supplementum 114) | Martín U. Schuhmann | 9783709109557 | Springer
    2012
    Co-Authors: Martin U. Schuhmann, Marek Czosnyka
    Abstract:

    Tienda online donde Comprar Intracranial Pressure And Brain Monitoring XIV (Acta Neurochirurgica Supplementum 114) al precio 218,45 € de Martin U. Schuhmann | Marek Czosnyka, tienda de Libros de Medicina, Libros de Neurologia - Neurologia general

Oddo M - One of the best experts on this subject based on the ideXlab platform.

  • Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis.
    Neurocritical care, 2019
    Co-Authors: Alexandre Simonin, Marco Rusca, Guillaume Saliou, Marc Levivier, Roy Thomas Daniel, Oddo M
    Abstract:

    BACKGROUND Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal Brain Monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature. METHODS We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), Brain tissue oximetry (PbtO2), and cerebral microdialysis (CMD). Therapy of CVT consisted of intravenous unfractionated heparin (UFH), followed by endovascular mechanical thrombectomy (EMT). EMT efficacy was assessed continuously at the bedside using MBM. RESULTS Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional Brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO2 (22.9 ± 7.5 vs. 30.1 ± 3.6 mmHg, p = 0.0003) and a decrease in CMD glutamate (12.69 ± 1.06 vs. 5.73 ± 1.76 μmol/L, p = 0.017) and intracranial pressure (ICP) (13 ± 4 vs. 11 ± 4 mmHg (p = 004). Patients did not require surgical decompression, regained consciousness, and were discharged from the hospital with a good neurological outcome (modified Rankin score 3 and 4). CONCLUSIONS This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe Brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO2 control, the presence of CMD signs of regional Brain cell ischemia triggered emergent EMT to treat CVT, which was associated with a significant and clinically relevant improvement of intracerebral physiology.

  • Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis.
    'Springer Science and Business Media LLC', 2019
    Co-Authors: Simonin A., Rusca M., Saliou G., Levivier M., Daniel R.t., Oddo M
    Abstract:

    Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal Brain Monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature. We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), Brain tissue oximetry (PbtO <sub>2</sub> ), and cerebral microdialysis (CMD). Therapy of CVT consisted of intravenous unfractionated heparin (UFH), followed by endovascular mechanical thrombectomy (EMT). EMT efficacy was assessed continuously at the bedside using MBM. Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional Brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO <sub>2</sub> (22.9 ± 7.5 vs. 30.1 ± 3.6 mmHg, p = 0.0003) and a decrease in CMD glutamate (12.69 ± 1.06 vs. 5.73 ± 1.76 μmol/L, p = 0.017) and intracranial pressure (ICP) (13 ± 4 vs. 11 ± 4 mmHg (p = 004). Patients did not require surgical decompression, regained consciousness, and were discharged from the hospital with a good neurological outcome (modified Rankin score 3 and 4). This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe Brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO <sub>2</sub> control, the presence of CMD signs of regional Brain cell ischemia triggered emergent EMT to treat CVT, which was associated with a significant and clinically relevant improvement of intracerebral physiology

Michael S. Avidan - One of the best experts on this subject based on the ideXlab platform.

  • Correction to: An updated introduction to electroencephalogram-based Brain Monitoring duringintended general anesthesia
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2021
    Co-Authors: Darren F. Hight, Heiko A. Kaiser, Jamie W. Sleigh, Michael S. Avidan
    Abstract:

    This article was updated to correct Heiko A. Kaiser’s name. It appeared incorrectly as Heiko K. Kaiser.

  • Correction to: An updated introduction to electroencephalogram-based Brain Monitoring during intended general anesthesia
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2021
    Co-Authors: Darren F. Hight, Heiko A. Kaiser, Jamie W. Sleigh, Michael S. Avidan
    Abstract:

    The original article was updated to correct the article title as “An updated introduction to electroencephalogram-based Brain Monitoring during intended general anesthesia” (instead of “Continuing professional development module”).

  • Monitoring the Brain: processed electroencephalogram and peri-operative outcomes.
    Anaesthesia, 2014
    Co-Authors: K. E. Escallier, M. R. Nadelson, D. Zhou, Michael S. Avidan
    Abstract:

    Summary Although the Brain is the target organ of general anaesthesia, the utility of intra-operative Brain Monitoring remains controversial. Ideally, the incorporation of Brain Monitoring into routine practice would promote the maintenance of an optimal depth of anaesthesia, with an ultimate goal of avoiding the negative outcomes that have been associated with inadequate or excessive anaesthesia. A variety of processed electroencephalogram devices exist, of which the bispectral index is the most widely used, particularly in the research setting. Whether such devices prove to be useful will depend not only on their ability to influence anaesthetic management but also on whether the changes they promote can actually affect clinically important outcomes. This review highlights the evidence for the role of bispectral index Monitoring, in particular, in guiding anaesthetic management and influencing clinical outcomes, specifically intra-operative awareness, measures of early recovery, mortality and neurocognitive outcomes.

  • Brain Monitoring during general anesthesia
    Trends in Anaesthesia and Critical Care, 2013
    Co-Authors: Nhila Jagadeesan, Maxim Wolfson, Yulong Chen, Mark D. Willingham, Michael S. Avidan
    Abstract:

    Summary Electroencephalography (EEG) offers utility as a surrogate monitor of anesthetic depth, potentially facilitating a "Goldilocks" anesthetic plan of "just right" patient centered dosing. Despite the proposed benefits, clinical incorporation has been slow, and there have been many conflicting results regarding the ability of EEG Monitoring to improve clinical outcomes. This review summarizes features of EEG waveforms during wakefulness, sedation and general anesthesia. The literature regarding the effectiveness of processed EEG Monitoring in preventing intraoperative awareness with recall is critically summarized; the strongest evidence for processed EEG Monitoring is in the setting of total intravenous anesthesia. Preliminary evidence regarding the utility of processed EEG Monitoring in preventing unnecessarily deep anesthesia and its hypothesized adverse effects is discussed. A provocative association has been noted between certain EEG features, such as burst suppression, and adverse early and intermediate term outcomes, such as delirium and death. However, whether such associations are causal or epiphenomenal is currently unknown. Finally, the limitations of current EEG monitors and the features of an ideal EEG monitor are described.

  • Brain Monitoring with electroencephalography and the electroencephalogram derived bispectral index during cardiac surgery
    Anesthesia & Analgesia, 2012
    Co-Authors: Miklos D Kertai, Elizabeth L Whitlock, Michael S. Avidan
    Abstract:

    Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider Monitoring the Brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG bispectral index (BIS) decreases the incidence intraoperative awareness in comparison with standard practice. However, there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves "fast-tracking," decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS Monitoring is not superior to a protocol based on end-tidal anesthetic concentration Monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG Monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG Monitoring in the cardiac surgical population.

Celeste Dias - One of the best experts on this subject based on the ideXlab platform.

  • plateau waves of intracranial pressure and multimodal Brain Monitoring
    Acta Neurochirurgica, 2016
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Marek Czosnyka
    Abstract:

    The aim of this study was to describe multimodal Brain Monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5–20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, Brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and Brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal Brain Monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.

  • pressures flow and Brain oxygenation during plateau waves of intracranial pressure
    Neurocritical Care, 2014
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Georgios V Varsos, Marek Czosnyka
    Abstract:

    Background Plateau waves are common in traumatic Brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal Brain Monitoring in head injured patients admitted in neurocritical care.

Joseartu Paiva - One of the best experts on this subject based on the ideXlab platform.

  • plateau waves of intracranial pressure and multimodal Brain Monitoring
    Acta Neurochirurgica, 2016
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Marek Czosnyka
    Abstract:

    The aim of this study was to describe multimodal Brain Monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5–20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, Brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and Brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal Brain Monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.

  • pressures flow and Brain oxygenation during plateau waves of intracranial pressure
    Neurocritical Care, 2014
    Co-Authors: Celeste Dias, Isabel Maia, Antonio Cerejo, Pete Smielewski, Joseartu Paiva, Georgios V Varsos, Marek Czosnyka
    Abstract:

    Background Plateau waves are common in traumatic Brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal Brain Monitoring in head injured patients admitted in neurocritical care.