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The article comments on the paper "Systemic inflammatory response syndrome increases immobility-induced neuromuscular weakness," by H. Fink and colleagues. According to the authors, the findings of the study allow for a direct extrapolation to human critical care medicine. The authors claim that critical illness polyneuromyopathy is a vital cause for difficulties in weaning from the ventilator and for persisting muscle weakness and disability after intensive care unit discharge.

Background and Purpose: Spontaneous subarachnoid hemorrhage (SAH) still has a high risk for poor outcome that is frequently attributable to symptomatic cerebral vasospasm (CVS). We hypothesize that cellular microparticles (MP) play a role in the pathogenesis of CVS and may serve as biomarkers for CVS., Methods: In 20 consecutive SAH patients, endothelial, leukocyte, platelet, and erythrocyte MP were measured during 15 days after ictus. CVS was detected by transcranial Doppler sonography. Twenty matched volunteers served as healthy controls., Results: Endothelial, leukocyte, and erythrocyte MP were elevated in SAH patients compared to healthy controls. CD105(+) and CD62e(+) endothelial MP were significantly higher in SAH patients with Doppler sonographic CVS. CD105(+) endothelial MP were especially increased on the days of Doppler sonographic CVS onset. In patients experiencing cerebral infarction attributable to vasospasm, CD41(+) platelet MP were elevated in addition to endothelial MP. CD41(+) platelet MP were significantly higher in patients with any level of disability (modified Rankin Scale score ≥1) compared to those who made a full recovery (modified Rankin Scale score=0) on discharge from hospital., Conclusions: Endothelial MP were elevated in patients with SAH. This elevation coincided with the occurrence of Doppler sonographic CVS and therefore could be a novel biomarker for CVS. Platelet MP might be involved in the pathogenesis of cerebral infarction attributable to vasospasm, resulting in neurological morbidity.

Purpose of Review: To provide an overview of infectious intracranial complications secondary to invasive procedures or trauma in the neuro-ICU patient population. Nosocomial infections of the central nervous system are a serious complication contributing to morbidity, prolonged length of stay in the ICU and/or hospital, and mortality of neurocritical care patients., Recent Findings: Any type of neurosurgical interventions, specifically ventriculostomy/external ventricular drainage, constitutes a major risk factor for infectious intracranial complications. Other predisposing factors are comorbidities with immunocompromised state and the presence of a distant focus of infection. The emergence of multiresistant pathogens adds to the complexity of the management of infectious intracranial complications. In recent years, several antimicrobial agents suitable for the treatment of nosocomial central nervous system infections have been extensively studied with respect to pharmacodynamics and pharmacokinetics in serum and - of special importance in the neurocritical care setting - cerebrospinal fluid., Summary: Despite recent advances in prevention and treatment, the management of nosocomial intracranial infections still poses a challenge to the neuro-ICU specialist and must consider timely diagnosis and prompt initiation of appropriate antibiotic therapy. This review focuses on the definition, epidemiology, clinical features, and therapeutical approach to this distinct complication of neurocritical care.