Why you may need a neurologist to see a comatose patient in the ICU

Abstract

This commentary summarizes the value of a neurologist in the diagnosis and prognostication of coma. Evaluating coma is inherently complex, and neurologic consultation and management can be useful. We often find that management changes after a neurologic consultation.

Cytokine removal in human septic shock: Where are we and where are we going?

“…Although there is a significant body of experimental evidence supporting the potential use of haemoadsorption with CytoSorb in septic shock, there is far less evidence from human studies. There are over 100 case studies describing the use of CytoSorb in many clinical scenarios, and in general, the treatment is well tolerated, but clinical studies in general are small case series [70–72]. The largest study to date, a randomized controlled, open-label study enrolled patients from 10 German study sites over the period 2008–2011 [73, 74].…”

“…Intraoperative CytoSorb treatment was associated with reduced vasopressor demand and less frequent RRT with no difference in length of mechanical ventilation and ICU stay [78]. Other case series in sepsis patients do point to a reduction in vasopressor dose, which may be considered a relevant endpoint, although these are not randomized studies [68–70]. The third interim analysis of the CytoSorb Registry [75] of 135 patients with septic shock and an acute physiology and chronic health evaluation II (APACHE-II) predicted mortality of 78% had an observed mortality of 65% with a marked reduction in both PCT and IL-6 levels after 24 h [75].…”

Myoclonus Status and Prognostication of Postresuscitation Coma: The Bigger Picture

“…3 After much thought about giving prognostic information and decades of practice, we strongly believe this determination is still the territory of neurology. 4,5 Persistent coma after acute circulatory standstill and successful return of circulation has been broadly and correctly considered an ominous situation. Awakening, when it occurs, is usually quick and sustained, although some of those patients have had focal injuries to the brain (eg, postarrest amnesia).…”

“…Reliable analysis must include an unconfounded expert neurologic examination, detailed cardiac assessment, evaluation of other serious organ damage, and consideration of the patient's prior functionality and advance directives . After much thought about giving prognostic information and decades of practice, we strongly believe this determination is still the territory of neurology …”

Erratum to: Why you may need a neurologist to see a comatose patient in the ICU

“…Unfortunately, the original version of this article [ 1 ] contained several typographical and grammatical errors, none of which affected the scientific content of the article. These have now been corrected in the original article.…”