It's wild that a single company managed to brainwash the entire specialty of neurocritical care into believing that NPi is the be-all and end-all of pupillometry.
It's not.
eg: for predicting DCI after SAH, trending CV is better 👇
More on NPi: emcrit.org/pulmcrit/npi/
🙏 Huge thanks to our 🇨🇭/🇩🇪 collaborative team
💧 Cisternal drainage (CD) can be considered during 🔪 surgical clipping when 🚫 LD isn’t feasible
🎯 Lumbar puncture (LP) may fit a carefully selected low-risk subgroup
🚨 EVD remains essential for urgent CSF diversion and 📈 ICP monitoring
🚰 Lumbar drainage (LD) is the only strategy backed by randomized trials showing ⬇️ delayed cerebral ischemia and ✅ better long-term functional outcome → ⭐ first-line option in suitable patients.
We propose a pragmatic algorithm to personalize drainage in everyday clinical practice 🩺
🔍 Key take-home messages ⬇️
CSF diversion is a cornerstone of acute aneurysmal SAH care, both to treat hydrocephalus and to support blood-product clearance 🧠
In our review 📚, we compare 4 modalities: LP/LD/EVD/CD
🔗 doi.org/10.1186/s130...
Reviewing a paper that was so bad that i had to ask myself if i just had a stroke and wasn't able to read anymore
The more one knows about the technical part of AI and the real world (clinics), and the gap between them, the more one becomes sceptical. As some days, we struggle to even get the basics right, i wonder what we are even trying to do with ai
The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension - Genecand - 2025 - Pulmonary Circulation - Wiley Online Library onlinelibrary.wiley.com/doi/10.1002/...
@pvrinstitute.bsky.social @atsblueeditor.bsky.social @pulmpeeps.bsky.social
New evidence showing that 🧠 brain networks become more resilient to subsequent lesions after a first ischemic stroke – fresh out in @braincomms.bsky.social from the #GenevaStrokeLab - doi.org/10.1093/brai...
👨💻 As always, we're committed to #opensource.
You can access all our code here: github.com/JulianKlug/n...
Questions? Let’s discuss ! ⬇️
Thanks to a great international team from 🇨🇭🇫🇷🇩🇪 !
Ultimately, clinicians must balance permissive PtO₂ variability to optimize fever control with diclofenac against the adverse effects of device-based interventions or the risks of sustained hyperthermia ⚖️
🧵(8/n)
This decrease in PtO2 is less pronounced than with short infusion protocols and the clinical relevance of such a small decrease is questionable 🤷♂️
🧵(7/n)
We found:
- Effective decrease in core T°C
- Small decrease in PtO2, without signs of ischemia
- Maintained cerebral perfusion pressure
- Decrease in heart rate associated with the decrease in PtO2
🧵(7/n)
We thus investigated 39 administrations of 12h diclofenac infusions in 18 febrile patients with acute brain injury AND brain tissue oxygenation monitoring 🫧 - comparing pre vs. post 🧠-status
🧵(6/n)
This has lead to the use of extended (12h ⏰) or continuous (days 🗓️) diclofenac infusion protocols -
but their effect on cerebral oxygenation has never been verified
🧵(5/n)
IV diclofenac bolus infusions have been shown to reduce temperature ⬇️, but have been associated with a decrease in brain oxygenation and CPP
ccforum.biomedcentral.com/articles/10....
🧵(4/n)
💊Pharmacological options are limited and depend on the country, but include: paracetamol, metamizole and NSAIDs
If all else fails, device based cooling is the way to go 🥶
🧵(3/n)
Fever 🔥 occurs frequently after acute brain injury, such as intracranial haemorrhage, stroke or traumatic brain injury 🤯 - but even small temperature elevations are associated with worse prognosis!
Guidelines therefore recommend targeting < 37.5°C
🧵(2/n)
Can extended diclofenac infusions be used to treat hyperthermia 🔥 in patients with acute brain injury 🧠 and do they affect brain oxygenation 🫧?
A thread on our latest work in @icmexperimental.bsky.social : icm-experimental.springeropen.com/articles/10....
#neuroskyence #Medsky #Critsaresky
🧵(1/n)
But then again probably the right population to test it in, as anymore severe than that ie stage D/E, more flow would be required
Mostly stage B and C is probably just not severe enough
No place for "Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock" - The ALTSHOCK-2 Randomized Clinical Trial www.jacc.org/doi/10.1016/...
#emimcc #cccsky #foamcc #foamed #medsky
Up to date epidemiology and outcomes of ischemic stroke, ICH and SAH in the #Geneva cohort fresh out in #Neurology 🧠 - www.neurology.org/doi/10.1212/...
Great thread and summary of current state of the evidence! Any idea why they only did a dichotomized analysis of the mrs though?
