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  1. Article ; Online: Neurologic Complications in the Postoperative Neurosurgery Patient.

    Sarwal, Aarti

    Continuum (Minneapolis, Minn.)

    2021  Volume 27, Issue 5, Page(s) 1382–1404

    Abstract: Purpose of review: This article discusses neurologic complications encountered in the postoperative care of neurosurgical patients that are common or key to recognize in the immediate postoperative period. The major neurosurgical subspecialty procedures ...

    Abstract Purpose of review: This article discusses neurologic complications encountered in the postoperative care of neurosurgical patients that are common or key to recognize in the immediate postoperative period. The major neurosurgical subspecialty procedures (cerebrovascular neurosurgery, neuro-oncology, epilepsy neurosurgery, functional neurosurgery, CSF diversion, endovascular neurosurgery, and spinal surgery) are broadly included under craniotomy procedures, endovascular/vascular procedures, and spinal procedures. This article focuses on the range of complications inherent in these approaches with specific scenarios addressed as applicable.
    Recent findings: The morbidity and mortality related to neurosurgical procedures remains high, necessitating ongoing research and quality improvement efforts in perioperative screening, intraoperative management, surgical approaches, and postoperative care of these patients. Emerging research continues to investigate safer and newer options for routine neurosurgical approaches, such as coiling over clipping for amenable aneurysms, endoscopic techniques for transsphenoidal hypophysectomy, and minimally invasive spinal procedures; postoperative monitoring and care of patients after these procedures continues to be a key component in the continuum of care for improving outcomes.
    Summary: Postoperative care of patients undergoing major neurosurgical procedures is an integral part of many neurocritical care practices. Neurosurgeons often enlist help from neurologists to assist with evaluation, interpretation, and management of complications in routine inpatient settings. Awareness of the common neurologic complications of various neurosurgical procedures can help guide appropriate clinical monitoring algorithms and quality improvement processes for timely evaluation and management of these patients.
    MeSH term(s) Endovascular Procedures ; Humans ; Neurosurgery ; Neurosurgical Procedures/adverse effects ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Period
    Language English
    Publishing date 2021-10-07
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1538-6899
    ISSN (online) 1538-6899
    DOI 10.1212/CON.0000000000001039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Neurologic Complications of Critical Medical Illness.

    Morris, Nicholas A / Sarwal, Aarti

    Continuum (Minneapolis, Minn.)

    2023  Volume 29, Issue 3, Page(s) 848–886

    Abstract: Objective: This article reviews the neurologic complications encountered in patients admitted to non-neurologic intensive care units, outlines various scenarios in which a neurologic consultation can add to the diagnosis or management of a critically ... ...

    Abstract Objective: This article reviews the neurologic complications encountered in patients admitted to non-neurologic intensive care units, outlines various scenarios in which a neurologic consultation can add to the diagnosis or management of a critically ill patient, and provides advice on the best diagnostic approach in the evaluation of these patients.
    Latest developments: Increasing recognition of neurologic complications and their adverse impact on long-term outcomes has led to increased neurology involvement in non-neurologic intensive care units. The COVID-19 pandemic has highlighted the importance of having a structured clinical approach to neurologic complications of critical illness as well as the critical care management of patients with chronic neurologic disabilities.
    Essential points: Critical illness is often accompanied by neurologic complications. Neurologists need to be aware of the unique needs of critically ill patients, especially the nuances of the neurologic examination, challenges in diagnostic testing, and neuropharmacologic aspects of commonly used medications.
    MeSH term(s) Humans ; COVID-19/complications ; Critical Illness/therapy ; Pandemics ; Critical Care ; Hospitalization
    Language English
    Publishing date 2023-06-19
    Publishing country United States
    Document type Review ; Journal Article
    ISSN 1538-6899
    ISSN (online) 1538-6899
    DOI 10.1212/CON.0000000000001278
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The authors reply.

    Rajagopalan, Swarna / Sarwal, Aarti

    Critical care medicine

    2023  Volume 51, Issue 9, Page(s) e191–e192

    Language English
    Publishing date 2023-08-17
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005958
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Pulse Oximetry Con: Stop Living in the Cave.

    Winters, Bradford D / Sarwal, Aarti

    Critical care medicine

    2023  Volume 51, Issue 9, Page(s) 1249–1254

    MeSH term(s) Oximetry ; Oxygen ; Culturally Appropriate Technology
    Chemical Substances Oxygen (S88TT14065)
    Language English
    Publishing date 2023-04-12
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005892
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Neuromonitoring in Critically Ill Patients.

    Rajagopalan, Swarna / Sarwal, Aarti

    Critical care medicine

    2023  Volume 51, Issue 4, Page(s) 525–542

    Abstract: Objectives: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer ... ...

    Abstract Objectives: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities.
    Data sources: English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL.
    Study selection: Original research, review articles, commentaries, and guidelines.
    Data extraction: Syntheses of data retrieved from relevant publications are summarized into a narrative review.
    Data synthesis: A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients.
    Conclusions: Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.
    MeSH term(s) Humans ; Critical Illness/therapy ; Brain Injuries/diagnosis ; Brain Injuries/therapy ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/therapy ; Brain Injuries, Traumatic/complications ; Critical Care/methods ; Cerebrovascular Circulation/physiology ; Monitoring, Physiologic/methods
    Language English
    Publishing date 2023-02-17
    Publishing country United States
    Document type Review ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005809
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Neurovascular ultrasound in acute stroke: emergency department applications.

    Ostrovskiy, Grigory / Reynolds, Alexandra S / Sarwal, Aarti

    Emergency medicine practice

    2024  Volume 26, Issue Suppl 4, Page(s) 1–28

    Abstract: Acute stroke is one of the most common neurologic emergencies encountered by emergency clinicians. While point of care ultrasound has been a core part of emergency clinicians' training and practice for many years, the use of specialized ultrasound ... ...

    Abstract Acute stroke is one of the most common neurologic emergencies encountered by emergency clinicians. While point of care ultrasound has been a core part of emergency clinicians' training and practice for many years, the use of specialized ultrasound modalities in the care of acute ischemic stroke has not been as widely adopted. This review discusses the use of ultrasound in acute stroke, with a focus on applications of interest to emergency clinicians. Transcranial Doppler, carotid Doppler, microembolic signal detection, transthoracic echocardiography, evaluation for collateral circulation and optic nerve sheath diameter measurement are discussed in a case-based format, with a focus on practical applications for emergency clinicians.
    MeSH term(s) Humans ; Emergency Service, Hospital ; Stroke/diagnostic imaging ; Ultrasonography/methods ; Ultrasonography, Doppler, Transcranial/methods ; Point-of-Care Systems
    Language English
    Publishing date 2024-05-15
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1559-3908
    ISSN (online) 1559-3908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Neuro Point-of-Care Ultrasound.

    Sigman, Erika J / Laghari, Fahad J / Sarwal, Aarti

    Seminars in ultrasound, CT, and MR

    2023  Volume 45, Issue 1, Page(s) 29–45

    Abstract: As the scope of point-of-care ultrasound (POCUS) expands in clinical medicine, its application in neurological applications offers a non-invasive, bedside diagnostic tool. With historical insights, detailed techniques and clinical applications, the ... ...

    Abstract As the scope of point-of-care ultrasound (POCUS) expands in clinical medicine, its application in neurological applications offers a non-invasive, bedside diagnostic tool. With historical insights, detailed techniques and clinical applications, the chapter provides a comprehensive overview of neurology-based POCUS. It examines the applications, emphasizing its role when traditional neuroimaging is inaccessible or unsafe as well advocating for its use as an adjunctive tool, rather than a replacement of advanced imaging. The chapter covers a range of uses of neuro POCUS including assessment of midline shift, intracranial hemorrhage, hydrocephalus, vasospasm, intracranial pressure, cerebral circulatory arrest, and ultrasound-guided lumbar puncture.
    MeSH term(s) Humans ; Point-of-Care Systems ; Ultrasonography/methods ; Intracranial Hemorrhages
    Language English
    Publishing date 2023-12-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1353113-x
    ISSN 1558-5034 ; 0887-2171
    ISSN (online) 1558-5034
    ISSN 0887-2171
    DOI 10.1053/j.sult.2023.12.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Are We Ready for Clinical Therapy based on Cerebral Autoregulation? A Pro-con Debate.

    Sarwal, Aarti / Robba, Chiara / Venegas, Carla / Ziai, Wendy / Czosnyka, Marek / Sharma, Deepak

    Neurocritical care

    2023  Volume 39, Issue 2, Page(s) 269–283

    Abstract: Cerebral autoregulation (CA) is a physiological mechanism that maintains constant cerebral blood flow regardless of changes in cerebral perfusion pressure and prevents brain damage caused by hypoperfusion or hyperperfusion. In recent decades, researchers ...

    Abstract Cerebral autoregulation (CA) is a physiological mechanism that maintains constant cerebral blood flow regardless of changes in cerebral perfusion pressure and prevents brain damage caused by hypoperfusion or hyperperfusion. In recent decades, researchers have investigated the range of systemic blood pressures and clinical management strategies over which cerebral vasculature modifies intracranial hemodynamics to maintain cerebral perfusion. However, proposed clinical interventions to optimize autoregulation status have not demonstrated clear clinical benefit. As future trials are designed, it is crucial to comprehend the underlying cause of our inability to produce robust clinical evidence supporting the concept of CA-targeted management. This article examines the technological advances in monitoring techniques and the accuracy of continuous assessment of autoregulation techniques used in intraoperative and intensive care settings today. It also examines how increasing knowledge of CA from recent clinical trials contributes to a greater understanding of secondary brain injury in many disease processes, despite the fact that the lack of robust evidence influencing outcomes has prevented the translation of CA-guided algorithms into clinical practice.
    MeSH term(s) Humans ; Arterial Pressure ; Brain Injuries/therapy ; Hemodynamics ; Homeostasis/physiology ; Cerebrovascular Circulation/physiology ; Intracranial Pressure/physiology
    Language English
    Publishing date 2023-05-10
    Publishing country United States
    Document type Editorial
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1007/s12028-023-01741-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Cerebral Autoregulation: Igniting the Debate on Therapeutic Focus.

    Sarwal, Aarti / Robba, Chiara / Venegas, Carla / Ziai, Wendy / Czosnyka, Marek / Sharma, Deepak

    Neurocritical care

    2023  Volume 39, Issue 3, Page(s) 738–739

    MeSH term(s) Humans ; Brain ; Blood Pressure ; Homeostasis ; Cerebrovascular Circulation
    Language English
    Publishing date 2023-09-19
    Publishing country United States
    Document type Letter
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1007/s12028-023-01841-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Toxicology of Psychoactive Substances.

    Prisco, Lara / Sarwal, Aarti / Ganau, Mario / Rubulotta, Francesca

    Critical care clinics

    2021  Volume 37, Issue 3, Page(s) 517–541

    Abstract: A trend in the increasing use of prescription psychoactive drugs (PADs), including antidepressants, antipsychotics, and mood stabilizers, has been reported in the United States and globally. In addition, there has been an increase in the production and ... ...

    Abstract A trend in the increasing use of prescription psychoactive drugs (PADs), including antidepressants, antipsychotics, and mood stabilizers, has been reported in the United States and globally. In addition, there has been an increase in the production and usage of illicit PADs and emergence of new psychoactive substances (NPSs) all over the world. PADs pose unique challenges for critical care providers who may encounter toxicology issues due to drug interactions, side effects, or drug overdoses. This article provides a summary of the toxicologic features of commonly used and abused PADs: antidepressants, antipsychotics, mood stabilizers, hallucinogens, NPSs, caffeine, nicotine, and cannabis.
    MeSH term(s) Anticonvulsants/therapeutic use ; Antidepressive Agents ; Antimanic Agents ; Antipsychotic Agents/adverse effects ; Humans ; Psychotropic Drugs/toxicity ; United States
    Chemical Substances Anticonvulsants ; Antidepressive Agents ; Antimanic Agents ; Antipsychotic Agents ; Psychotropic Drugs
    Language English
    Publishing date 2021-05-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1006423-0
    ISSN 1557-8232 ; 0749-0704
    ISSN (online) 1557-8232
    ISSN 0749-0704
    DOI 10.1016/j.ccc.2021.03.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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