Reorganization and Stability for Motor and Language Areas Using Cortical Stimulation: Case Example and Review of the Literature

The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures

sj-docx-1-jic-10.1177_08850666221139223 - Supplemental material for Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States

Supplemental material, sj-docx-1-jic-10.1177_08850666221139223 for Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States by Jordan Hatfield, Tetsu Ohnuma, Alexandria L. Soto, Jordan M. Komisarow, Monica S. Vavilala, Daniel T. Laskowitz, Michael L. James, Joseph P. Mathew, Adrian F. Hernandez, Benjamin A. Goldstein, Miriam Treggiari, Karthik Raghunathan, and Vijay Krishnamoorthy in Journal of Intensive Care Medicine</p

Variation in Early Management Practices in&nbsp;Moderate-to-Severe ARDS in the United&nbsp;States: The Severe ARDS: Generating Evidence Study.

BackgroundAlthough specific interventions previously demonstrated benefit in patients with ARDS, use of these interventions is inconsistent, and patient mortality remains high. The impact of variability in center management practices on ARDS mortality rates remains unknown.Research questionWhat is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States?Study design and methodsWe conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and Pao2 to Fio2 ratio of&nbsp;≤ 150 with positive end-expiratory pressure of&nbsp;≥ 5&nbsp;cm H2O, who were admitted to 29 US centers between October 1, 2016, and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality also were assessed.ResultsA total of 2,466 patients were enrolled. Median baseline Pao2 to Fio2 ratio was 105 (interquartile range, 78.0-129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (LPV; tidal volume,&nbsp;≤ 6.5&nbsp;mL/kg predicted body weight; plateau pressure, or when unavailable, peak inspiratory pressure,&nbsp;≤ 30&nbsp;mm H2O) was 31.4%&nbsp;and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), methods used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7%-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early LPV was correlated with SMR.InterpretationSubstantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes.Trial registryClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov