Rethink about the implement of enteral nutrition support in neurointensive care unit patients / 中国实用护理杂志

The viewpoint of early enteral nutrition support in neurointensive care unit patients has gradually developed.In order to enable patients to achieve the nutritional goal,it is very important to give neurointensive care unit patients early enteral nutrition support and prevent gastrointestinal complications. Standard practice of enteral nutrition support in neurointensive care unit patients is imperative to effectively carry out clinical practice guidelines,optimize the nursing process,solve the clinical problems and make sure the safety of implement of enteral nutrition support.

Risk factors of pulmonary embolism in patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia / 第二军医大学学报

Objective To explore the risk factors of pulmonary embolism (PE) in the patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia (NICUHAP) with increased D-dimer level. Methods A case-control study was taken to observe the clinical data from the patients with NICUHAP who were initially diagnosed in the Tenth People’s Hospital of Tongji University between Jan. 2007 and Jan.2018. According to the results of computed tomography pulmonary angiography (CTPA) examination, the patients were divided into PE group and non-PE group. The pulmonary artery occlusion index (PAOI) was calculated in the patients of the PE group. Univariate and multivariate logistic regression analyses were performed to explore the risk factors for PE. Results A total of 129 patients initially diagnosed as NICUHAP were included in this study and received CTPA examination. The median D-dimer levels of PE patients (n=75) and non-PE patients (n=54) were 3.97 mg/L and 0.88 mg/L, respectively, and the difference was significant (P38.5 °C), and elevated cardiac troponin I level were possible independent risk factors for PE. Conclusion The patients initially diagnosed as NICUHAP with PE have elevated D-dimer level compared with the patients without PE. There is no significant correlation between D-dimer level and PAOI. The patients initially diagnosed as NICUHAP, who are older than 60 years, or accompanied with coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, elevated cardiac troponin I level or with a body temperature below 38.5 °C, need CTPA examination to exclude PE.

Imitadores y camaleones de ictus, para tenerlos siempre en mente / Stroke mimics and chameleons, have them always on mind

INTRODUCCIÓN: Se denominan imitadores de ictus (falsos positivos, sobrediagnosticados) así como camaleones de ictus (falsos negativos, infradiagnosticados) a los casos que inducen a cometer errores en el diagnóstico y tratamiento del ictus. Los mismos deben ser considerados para aproximarse de una manera certera al diagnóstico y tratamiento más adecuados. El objetivo es relatar el caso de una paciente que se presenta con un imitador de ictus, afortunadamente con evolución favorable posterior. CASO CLÍNICO: Paciente de 17 años, procedente y residente de la ciudad de El Alto, segundigesta, sin antecedentes personales patológicos, cuadro clínico de 8 horas de evolución, caracterizado por alteración de la conciencia de manera progresiva así como crisis convulsivas tónico clónicas generalizadas; se realiza neuroprotección, tratamiento neurointensivo y se considera tratamiento trombolítico, el cual debido a una adecuada disquisición diagnóstica se decide evitar, orientándose el diagnóstico hacia epilepsia, realizándose el tratamiento respectivo con evolución favorable. DISCUSIÓN: El caso presenta varios datos importantes, tales como la edad de la paciente y la ausencia de crisis convulsivas con anterioridad, sin embargo debido a la urgencia del caso se consideró trombolisis, sin administrase la misma y decidiéndose por el tratamiento de epilepsia, evitando tanto el riesgo asociado a hemorragia intracerebral por la administración de trombolítico en un caso que no correspondía su utilización ya que como se pudo evidenciar la literatura cita como un importante imitador de ictus a las crisis convulsivas.

INTRODUCTION: Stroke mimics (false positives, over diagnosed) and stroke chameleons (false negative, underdiagnosed) are special cases that induce to commit mistakes on stroke diagnoses and treatment. They have to be considered to approximate an adequate treatment. The objective is report the case of a patient with stroke mimic, fortunately identified and treated with favorable evolution. CASE REPORT: Female 17 year-old patient, from El Alto city, without pathologic antecedents with 8 hours clinical manifestations with consciousness impairment and tonic-clonic seizures, neuroprotection is performed such as neurocritical care, thrombolysis is considered, but after an adequate diagnostic disquisition is avoided, the diagnoses of epilepsy is achieved and treatment is performed. DISCUSSION: Several important data are reviewed, such as the early age, lack of seizures antecedent, nevertheless thrombolysis is considered, throughout a careful literature review, epilepsy treatment is performed, avoiding intracraneal bleeding complications.

Brazilian neurointensive care: a brief history / Terapia intensiva neurológica no Brasil: uma análise histórica

Neurointensive care arose from the specific growth of the various therapeutic methods in neuroscience, similar to the formation of specific units in other specialties. The progress of the neurological intensive treatment is more recent and because of the high frequency of pathologies in this area it became necessary to structure this specialty in terms of theoretical and physical aspects. In this text, a commentary on the chronology of this development is set out briefly and objectively.

O neurointensivismo surgiu a partir do crescimento específico das diversas formas terapêuticas em neurociências, à semelhança da formação de unidades específicas em outras especialidades. O progresso do tratamento neurológico intensivo é mais recente e, em virtude da alta frequência das patologias nessa área, tornou-se necessária a estruturação dessa especialidade do ponto de vista teórico e físico. Neste texto, um comentário à cronologia desse desenvolvimento é exposto de maneira breve e objetiva.

Microdialysis and its application in neurointensive care / 医学研究生学报

Microdialysis, a technique for sampling the biochemical substances of extracellular fluid in vivo, has been widely utilized for physiological, pharmacological and pathological research. The principles and methodology of microdialysis and its applications in neurointensive care was reviewed.