Publications by authors named "Lavienraj Premraj"
Background: The aim of this study was to evaluate the association of arterial hyperoxemia with neurological outcomes and mortality in adults with acute brain injury (ABI).
Methods: Six electronic databases, including MEDLINE, Embase and online registers of clinical trials, were systematically searched from inception to June 1 st, 2024. Studies comparing the effects of hyperoxemia versus no hyperoxemia on outcomes of hospitalized adult patients with ABI-related conditions (e.
Article Synopsis
- The study analyzes sex differences in ICU outcomes for severe COVID-19 patients, focusing on mortality rates between males and females.
- It includes data from 10,259 patients admitted to ICUs worldwide between January 2020 and June 2022, revealing that males had a higher hazard of death (HR=1.14) despite adjustment for complications.
- Additionally, males exhibited more severe health issues, requiring greater interventions and showing higher risks for cardiac arrest and pulmonary embolism compared to females.
Article Synopsis
- Extracorporeal membrane oxygenation (ECMO) helps patients with severe heart and lung issues, and recent research aims to understand how seizures affect outcomes in adult ECMO patients through a systematic review of studies.
- The study analyzed 23 studies involving over 40,000 patients undergoing different types of ECMO, focusing on seizure occurrence and mortality rates.
- Findings showed a 3.0% overall seizure prevalence among ECMO patients, with higher mortality rates for those with seizures, particularly in VV-ECMO patients, suggesting seizures may increase risks in critically ill patients on ECMO.
Article Synopsis
- A study was conducted to compare stroke incidences and mortality rates in critically ill COVID-19 patients from low-and middle-income countries (LMICs) and high-income countries (HICs).
- The results showed that stroke incidence was significantly higher in LMICs (35.7 per 1000 admitted-days) compared to HICs (17.6 per 1000 admitted-days), with patients from LMICs also facing higher mortality rates (43.6% vs. 29.2%).
- The findings highlight the need for better stroke diagnosis and healthcare resource allocation in LMICs, as both higher income status and the presence of stroke are associated with increased risk of death
Article Synopsis
- The study examines the connection between initial neurological symptoms of COVID-19 and long-term neurological issues (PANSC) in hospitalized adults across 407 international sites from January 2020 to April 2022.
- It analyzes the prevalence and risk factors for PANSC, with a focus on how male and female patients experience symptom resolution over time.
- Results show that fatigue and muscle/joint pain were the most common symptoms post-hospitalization, with a higher prevalence in females compared to males, and highlights differences in ICU admission rates and mechanical ventilation usage between the sexes.
Article Synopsis
- - This review focuses on three main objectives: understanding factors affecting oxygen levels in patients on ECMO, examining how hyperoxia impacts patient outcomes, and offering practical guidance on adjusting oxygen levels during treatment.
- - Research included observational and interventional studies as well as guidelines from the Extracorporeal Life Support Organization to gather evidence about hyperoxia and clinical results.
- - Findings indicate that both the ECMO machine and a patient’s natural heart and lung function influence systemic oxygenation, with high risks of hyperoxia emerging during treatment, which can increase the chances of in-hospital mortality.
Plasma biomarkers for brain injury in extracorporeal membrane oxygenation.
Acute Crit Care
November 2023
Article Synopsis
- * Timely neuroimaging is often challenging during ECMO treatment, making it hard to diagnose neurological complications accurately.
- * This review highlights the importance of blood-based biomarkers as potential tools for quickly detecting brain injuries in ECMO patients, summarizing existing research on the topic.
Article Synopsis
- The study systematically reviewed the prevalence and outcomes of neurological complications in adult patients with sepsis, noting a variety of conditions such as septic encephalopathy and ischemic strokes.
- Of the 74 studies analyzed, neurologic complications were documented in 38, revealing notable statistics regarding their prevalence among sepsis patients.
- The research also highlighted the use of various neuromonitoring tools, particularly electroencephalograms, and linked certain factors like infection type and ICU stay length to increased risk of complications.
Neuromelanin: Its role in the pathogenesis of idiopathic Parkinson's disease and potential as a therapeutic target.
Parkinsonism Relat Disord
July 2023
Parkinson's disease is an increasingly prevalent condition that involves the marked loss of dopaminergic neurons in the substantia nigra pars compacta. These neurons pigmented with neuromelanin along with other regions of the brain are almost exclusively victims of neurodegeneration in the disease. The link between neuromelanin and Parkinson's disease has been widely studied for decades.
View Article and Find Full Text PDFBackground: Cardiac arrest (CA) is a sudden event that is often characterized by hypoxic-ischemic brain injury (HIBI), leading to significant mortality and long-term disability. Brain tissue oxygenation (PbtO) is an invasive tool for monitoring brain oxygen tension, but it is not routinely used in patients with CA because of the invasiveness and the absence of high-quality data on its effect on outcome. We conducted a systematic review of experimental and clinical evidence to understand the role of PbtO in monitoring brain oxygenation in HIBI after CA and the effect of targeted PbtO therapy on outcomes.
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- Stroke patients on mechanical ventilation often face poor outcomes, and the best timing for tracheostomy regarding mortality is unclear, prompting this systematic review and meta-analysis on the subject.* -
- The study searched through five databases for relevant research on tracheostomy timing in stroke patients, including criteria for inclusion and exclusion of specific types of strokes.* -
- Out of 17,346 patients analyzed, the average time to tracheostomy was about 9.7 days, with a reported all-cause mortality rate of 15.7%, indicating that only 20% achieved a good neurological outcome after a median follow-up of 180 days.*
Article Synopsis
- * The exact causes of these symptoms are not fully understood, but theories involve persistent viral presence, immune system dysfunction, and blood vessel issues that affect the brain and nervous system.
- * Current treatments aim to address these mechanisms by using antivirals, reducing inflammation, and supporting the recovery of sensory functions like smell.
Article Synopsis
- Acute brain injury (ABI) is a common complication following extracorporeal cardiopulmonary resuscitation (ECPR), prompting researchers to examine the effects of arterial oxygen (PaO) and carbon dioxide (PaCO) levels on ABI incidence.
- A study of over 3,100 adult ECPR patients revealed that 16% experienced ABI, with moderate to severe hyperoxia increasing the risk of ABI and associated complications like ischemic stroke and intracranial hemorrhage.
- The findings suggest that early severe hyperoxia during ECMO is linked to a higher risk of ABI and mortality, indicating the need for cautious management of oxygen delivery in ECPR patients to minimize reperfusion injury.
Mechanical ventilation in acute brain injury patients with acute respiratory distress syndrome.
Front Med (Lausanne)
October 2022
Article Synopsis
- Acute respiratory distress syndrome (ARDS) is prevalent in patients with acute brain injury (ABI), with rates up to 35%, and these patients often have additional risk factors compared to general critical care cases.
- Lung injury in ABI results from a surge of catecholamines and neuro-inflammation, requiring careful ventilation strategies to avoid hindering neurological recovery.
- While lung protective ventilation strategies like permissive hypercapnia and high PEEP are critical, they must be adjusted for ABI patients to prevent brain hypoxia, with specific monitoring of intracranial pressure necessary for optimal treatment.
Article Synopsis
- * Out of 9024 studies screened, 47 were included, covering 5268 patients, revealing high variability in outcomes and a pooled mortality rate of 22.1% with an average tracheostomy timing of 16.5 days post-ventilation.
- * No significant association was found between mortality and factors like tracheostomy timing or the method used, while mechanical ventilation duration was linked to longer ICU and hospital stays, averaging 29.6 and 38.8
Article Synopsis
- The study aimed to understand the prevalence and impact of neurological manifestations in hospitalized COVID-19 patients, comparing adults and children over a period spanning from January 2020 to May 2021.
- Among 161,239 hospitalized patients, common neurological symptoms included fatigue, altered consciousness, and seizures, with adults showing a higher occurrence of strokes and other complications in ICU settings.
- Key findings highlighted that stroke risk increased with age, while seizures and CNS infections were more prevalent in ICU among children; various health conditions also contributed to higher stroke risk in adults.
Article Synopsis
- The study investigates the frequency and impact of neurological complications in critically ill COVID-19 patients, recognizing their potential link to fatal outcomes and modifiable risk factors.* -
- It is a secondary analysis of data collected from the COVID-19 Critical Care Consortium, focusing on adult ICU patients with confirmed COVID-19 and assessing various health aspects, including comorbidities and outcomes.* -
- Ethical approval has been obtained for the main study, allowing this analysis to proceed without additional approvals, with data being relevant for understanding patient prognosis and management in ICU settings.*
The Use of Noninvasive Multimodal Neuromonitoring in Adult Critically Ill Patients With COVID-19 Infection.
J Neurosurg Anesthesiol
October 2023
Introduction: Noninvasive neuromonitoring could be a valuable option for bedside assessment of cerebral dysfunction in patients with coronavirus disease-2019 (COVID-19) admitted to intensive care units (ICUs). This systematic review aims to investigate the use of noninvasive multimodal neuromonitoring in critically ill adult patients with COVID-19 infection.
Methods: MEDLINE/PubMed, Scopus, Cochrane, and EMBASE databases were searched for studies investigating noninvasive neuromonitoring in patients with COVID-19 admitted to ICUs.
Introduction: Neurological complications are frequent in patients with coronavirus disease-2019 (COVID-19). The use of non-invasive neuromonitoring in subjects without primary brain injury but with potential neurological derangement is gaining attention outside the intensive care unit (ICU). This systematic review and meta-analysis investigates the use of non-invasive multimodal neuromonitoring of the brain in non-critically ill patients with COVID-19 outside the ICU and quantifies the prevalence of abnormal neuromonitoring findings in this population.
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- Neurological and neuropsychiatric symptoms often emerge or persist for three months or more after COVID-19, presenting a major challenge for healthcare systems worldwide, which requires better understanding through meta-analysis.
- The primary goal of the study was to assess the prevalence of these symptoms in adults at least 12 weeks after experiencing acute COVID-19.
- Out of 1,458 articles reviewed, 19 studies with 11,324 patients revealed that notable post-COVID-19 neurological symptoms included fatigue (37%) and brain fog (32%).
Article Synopsis
- * A total of 1,322 patients were analyzed, revealing that 5.9% experienced intracranial hemorrhage, while 1.1% had ischemic strokes and 0.3% suffered hypoxic ischemic brain injury during ECMO treatment.
- * The research emphasizes a concerning 92% mortality rate among ECMO patients who experienced neurological events, indicating the urgent need for further studies on this issue.
Article Synopsis
- Stroke is a rare complication in ICU patients with COVID-19, with only 2.2% experiencing acute stroke during their hospital stay.
- Hemorrhagic stroke was linked to higher mortality rates, while ischemic stroke did not show the same increased risk of death.
- Patients with ischemic strokes had higher rates of conditions like diabetes and hypertension, especially compared to those without strokes.