Timing is everything: Combining EEG and MRI to predict neurological recovery after cardiac arrest

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Acetozolamide induced hyperammonaemia: a case report and review of the literature

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Changes in cerebral blood flow and oxygen extraction during the post-resuscitation syndrome.

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Effects of prolonged mild hypothermia on cerebral blood flow after cardiac arrest.

Item does not contain fulltextOBJECTIVE: : The aim of the present study was to assess the cerebral blood flow and cerebral oxygen extraction in adult patients after pulseless electrical activity/asystole or resistant ventricular fibrillation who were treated with mild therapeutic hypothermia for 72 hrs. DESIGN: : Observational study. SETTING: : Tertiary care university hospital. PATIENTS: : Ten comatose patients with return of spontaneous circulation after pulseless electrical activity/asystole or prolonged ventricular fibrillation. INTERVENTION: : Treatment with mild therapeutic hypothermia for 72 hrs. MEASUREMENTS AND MAIN RESULTS: : Mean flow velocity in the middle cerebral artery was measured by transcranial Doppler at 12, 24, 36, 48, 60, 72, 84, 96, and 108 hrs after admission. Jugular bulb oxygenation was measured at the same intervals. Mean flow velocity in the middle cerebral artery was low (26.5 (18.7-48.0) cm/sec) at admission and significantly increased to 63.9 (45.6-65.6) cm/sec at 72 hrs (p = .002). Upon rewarming, the mean flow velocity in the middle cerebral artery remained relatively constant with a mean flow velocity in the middle cerebral artery of 71.5 (56.0-78.5) at 108 hrs (p = .381). Jugular bulb oxygenation at the start of the study was 57.0 (51.0-61.3)% and gradually increased to 81.0 (78.5-88.0)% at 72 hrs (p = .003). Upon rewarming, the jugular bulb oxygenation remained constant with a jugular bulb oxygenation of 84.0 (77.3-86.3)% at 108 hrs (p = .919). There were no differences in mean flow velocity in the middle cerebral artery, pulsatility index, and jugular bulb oxygenation between survivors and nonsurvivors. CONCLUSIONS: : Temperature by itself is probably not a major determinant in regulation of cerebral blood flow after cardiac arrest. The relatively low mean flow velocity in the middle cerebral artery in combination with normal jugular bulb oxygenation values suggests a reduction in cerebral metabolic activity that may contribute to the neuroprotective effect of (prolonged) mild therapeutic hypothermia in the delayed hypoperfusion phase.1 augustus 201

Complement activation after cardiac surgery follows a biphasic pattern.

Contains fulltext : 71269.pdf (publisher's version ) (Closed access

Point-of-care glucose measurement systems should be used with great caution in critically ill intensive care unit patients.

Contains fulltext : 89711.pdf (publisher's version ) (Closed access)1 januari 201

Preserved metabolic coupling and cerebrovascular reactivity during mild hypothermia after cardiac arrest.

Contains fulltext : 89670.pdf (publisher's version ) (Closed access)OBJECTIVE: Although mild hypothermia improves outcome in patients after out-of-hospital cardiac arrest, the cardiodepressive effects of hypothermia may lead to secondary brain damage. This study was performed to assess the cerebral blood flow, cerebral oxygen extraction, and cerebrovascular reactivity to changes in partial pressure of carbon dioxide in the arterial blood in comatose patients after out-of-hospital cardiac arrest treated with mild hypothermia. DESIGN: Observational study. SETTING: Tertiary care university hospital. PATIENTS: Ten comatose patients after out-of-hospital cardiac arrest. INTERVENTIONS: All patients were cooled to 32-34 degrees C for 24 hrs. Cerebrovascular reactivity to changes in carbon dioxide in the arterial blood was measured after increasing or decreasing the minute ventilation by 20%. MEASUREMENTS AND MAIN RESULTS: Mean flow velocity in the middle cerebral artery and pulsatility index were measured by transcranial Doppler at 0, 3, 6, 9, 12, 18, 24, and 48 hrs after admission. Jugular bulb oxygenation was measured at the same intervals. Cerebrovascular reactivity to changes in carbon dioxide in the arterial blood was studied on admission to the intensive care unit and at 6, 12, 18, and 24 hrs by measurement of mean flow velocity in the middle cerebral artery and jugular bulb oxygenation. Mean flow velocity in the middle cerebral artery was low (30.3+/-9.5 cm/sec) on admission and remained relatively stable for the first 24 hrs. After rewarming, it increased to 67.5+/-33.0 cm/sec at 48 hrs after admission from 30.3+/-9.5 at admission (p=.009). Jugular bulb oxygenation at the start of the study was 66.2+/-8.5% and gradually increased to 82.9+/-4.9% at 48 hrs (p<.001). Regression analysis showed a significant correlation between changes in carbon dioxide in the arterial blood, mean flow velocity in the middle cerebral artery (p<.001) and jugular bulb oxygenation (p<.001). The mean percentage change in mean flow velocity in the middle cerebral artery was 3.6+/-2.9% per 1-mm Hg change of carbon dioxide in the arterial blood. CONCLUSIONS: The mean flow velocity in the middle cerebral artery, as a parameter of cerebral blood flow, was low during mild hypothermia, whereas cerebral oxygen extraction remained normal, suggesting decreased cerebral metabolic activity. We demonstrated that CO2 reactivity is preserved during hypothermia in these patients.1 juli 201