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The co-primary endpoints were the differences in average and maximum hourly dexmedetomidine rates (microgram per kilogram per hour [mcg/kg/hr]) when comparing those on chronic clonidine versus those not on chronic clonidine. B Introduction/Hypothesis: b Chronic use of clonidine, a central alpha-2a agonist, may lead to downregulation of receptors. B Results: b A total of 273 patients were screened, and 75 patients met inclusion criteria (clonidine = 25, no clonidine = 50). [Extracted from the article]

Secondary outcomes included the incidence of PR interval prolongation (greater than 200 milliseconds) after administration and administration efficiency (time from order verification to administration). B Introduction: b Lacosamide is an antiepileptic medication used in the management of status epilepticus. Previous retrospective analyses have demonstrated safety and efficiency in intravenous (IV) push administration at rates up to 80 mg per minute. [Extracted from the article]

Given this, we aimed to evaluate rates of CTH in patients undergoing EVD placement following treatment with PCC for FXa inhibitor-related ICrH. However, there are no evaluations of CTH rates in patients following factor Xa (FXa) inhibitor-associated intracranial hemorrhage (ICrH) in those treated with prothrombin complex concentrate (PCC). [Extracted from the article]

B Learning Objectives: b Growing evidence amongst those with severe neurologic injuries has established an association between hyperchloremia and worsened clinical outcomes, such as acute kidney injury (AKI) and mortality. This study aims to determine the relationship between moderate hyperchloremia (serum chloride >=115 mmol/L) and clinical outcomes in AIS patients. B Conclusions: b In our study, AIS patients that developed moderate hyperchloremia experienced increased rates of AKI, higher mortality, were more likely to be admitted to the ICU, and had longer hospital lengths of stay. [Extracted from the article]

B Learning Objectives: b Hyperchloremia in the critically ill population is associated with increased morbidity and mortality. This study aimed to determine risk factors for developing hyperchloremia (serum chloride >115 mmol/L) and quantify the rate of associated complications in intracerebral hemorrhage (ICH) patients. Hyperchloremic patients had a higher rate of AKI (50% vs 16.7%; p<0.001), longer hospital LOS (18 vs 11.2 days; p<0.001) and ICU LOS (10.4 vs 4 days; p<0.001), and a higher rate of in-hospital mortality (29.2% vs 9.9%; p<0.001). [Extracted from the article]

B Learning Objectives: b A recent study of patients with intracerebral hemorrhage (ICH) demonstrated an association between the development of moderate hyperchloremia and mortality. The primary objective was to determine if the development of moderate hyperchloremia (serum chloride >115 mmol/L) independently predicted mortality in ICH patients treated with and without CIV HTS. Mortality was defined as death during hospital stay or hospice discharge. [Extracted from the article]

B Learning Objectives: b According to the Surviving Sepsis Campaign guidelines, norepinephrine is the first-line vasoactive agent recommended in septic shock due to its intrinsically low effect on heart rate and cardiac output. Analysis of risk factors for dysrhythmia development showed duration of norepinephrine infusion and maximum norepinephrine doses to be independently associated with increased rates of dysrhythmia (p<0.05). Dysrhythmia development is independently associated with longer duration of norepinephrine infusion and higher norepinephrine doses. [Extracted from the article]

Due to the lack of literature in this area, we aimed to determine the benefits of implementing a standard protocol for use of CIV anesthetic agents in the treatment of RSE. Adherence to a standardized treatment protocol for general treatment of SE has been associated with better seizure control and shorter intensive care unit and hospital length of stay, but no literature exists evaluating protocols aimed at treating patients for RSE with CIV anesthetic agents. B Introduction: b When status epilepticus (SE) persists despite emergent and urgent treatment with antiepileptic drugs (AED), it is referred to as refractory SE (RSE). [Extracted from the article]

Objectives: Hyperchloremia has been associated with increased morbidity and mortality in critically ill patients. While previous research has demonstrated an association between hypertonic saline and hyperchloremia, limited data exist in neurocritical care patients. The objective of this study is to determine the impact of moderate hyperchloremia (chloride ≥ 115 mmol/L) on clinical outcomes in intracerebral hemorrhage patients treated with continuous IV infusion 3% hypertonic saline.Design: Multicenter, retrospective, propensity-matched cohort study.Setting: Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and comprehensive stroke center designation.Patients: Intracerebral hemorrhage patients discharged between September 2011 and September 2015 were evaluated and matched 1:1 based on propensity scoring.Interventions: Continuous IV infusion 3% hypertonic saline.Measurements and Main Results: A total of 219 patients were included in the unmatched cohort (143 moderate hyperchloremia and 76 nonhyperchloremia) and 100 patients in the propensity-matched cohort. In-hospital mortality was significantly higher in those who developed moderate hyperchloremia in a propensity-matched cohort (34% vs 14%; p = 0.02). Moderate hyperchloremia independently predicted in-hospital mortality in multivariable logistic regression analysis (odds ratio, 4.4 [95% CI, 1.4-13.5]; p = 0.01).Conclusions: We observed higher rates of in-hospital mortality in patients who developed moderate hyperchloremia during treatment with continuous IV infusion 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality. These results suggest that chloride values should be monitored closely during hypertonic saline treatment as moderate elevations may impact outcomes in intracerebral hemorrhage patients. [ABSTRACT FROM AUTHOR]

Objective: Dexmedetomidine and propofol are commonly used sedatives in neurocritical care as they allow for frequent neurologic examinations. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the prevalence of severe hemodynamic effects in neurocritical care patients receiving dexmedetomidine and propofol. Design: Multicenter, retrospective, propensity-matched cohort study. Setting: Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and board-certified neu-rointensivists. Patients: Neurocritical care patients admitted between July 2009 and September 2012 were evaluated and then matched 1:1 based on propensity scoring of baseline characteristics. Interventions: Continuous sedation with dexmedetomidine or propofol. Measurements and Main Results: A total of 342 patients (105 dexmedetomidine and 237 propofol) were included in the analysis, with 190 matched (95 in each group) by propensity score. The primary outcome of this study was a composite of severe hypotension (mean arterial pressure < 60 mm Hg) and bradycardia (heart rate < 50 beats/min) during sedative infusion. No difference in the primary composite outcome in both the unmatched (30% vs 30%, p = 0.94) or matched cohorts (28% vs 34%, p = 0.35) could be found. When analyzed separately, no differences could be found in the prevalence of severe hypotension or bradycardia in either the unmatched or matched cohorts. Conclusions: Severe hypotension and bradycardia occur at similar prevalence in neurocritical care patients who receive dexmedetomidine or propofol. Providers should similarly consider the likelihood of hypotension or bradycardia before starting either sedative. [ABSTRACT FROM AUTHOR]

Analysis based on admission diagnosis showed both duration and maximum dose of DEX after initiation of atypical antipsychotics were statistically significantly higher in the medical compared to the neurological cohort. B Methodology: b We conducted a retrospective analysis of adult ICU patients receiving DEX concurrently with at least two doses of atypical antipsychotics. B Introduction/Hypothesis: b Dexmedetomidine (DEX) is commonly used the intensive care unit (ICU). [Extracted from the article]