Background: Elevated intraspinal pressure (ISP) driven by cord swelling is hypothesized to cause secondary injuries following trauma. We previously observed comparable ISP elevations in pigs undergoing traumatic spinal cord injury (TSCI) and sham operations (standalone laminectomy), suggesting the presence of other drivers. Methods: Using a porcine model, we assessed whether ISP elevation was compartment specific, related to cerebrospinal fluid (CSF) restoration, or driven by epidural pressure. In three corresponding sub-studies, the ISP was measured in the spinal cord, subdural, and epidural compartments after TSCI (n=5), and the effects of CSF drainage (n=3) and leaving the surgical wound open were tested (n=6).Results: The spinal cord and subdural ISP increased comparably, validating subdural ISP as a proxy for spinal cord pressure. CSF drainage attempts yielded no fluid and did not affect the subdural ISP. Correspondingly, magnetic resonance imaging revealed that the CSF was displaced by a higher degree of epidural compression than by spinal cord swelling. Leaving the wound open reduced ISP 2.5-fold more than the TSCI itself, further implicating epidural pressure from post-laminectomy swelling as a major driver of elevated ISP. Conclusion: Epidural pressure influences elevated ISP following TSCI and laminectomy, rather than spinal cord swelling alone or CSF reconstitution. These findings suggest caution against external compression after laminectomy and call for further investigation of elevated ISP in patients with TSCI.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 5% of strokes in the United States but imposes substantial economic burdens on healthcare systems, with hospitalization costs exceeding $90,000 per patient. This study evaluated the economic implications of incorporating transcutaneous auricular vagus nerve stimulation (taVNS) into standard aSAH management.Methods: This was a secondary analysis of the Non-invasive Auricular Vagus nerve stimulation for Subarachnoid Hemorrhage (NAVSaH) trial, a single-center trial enrolling adult patients with spontaneous SAH, randomized 1:1 to receive either taVNS or sham stimulation. Cost data were sourced from institutional accounting databases. The primary economic outcomes included total hospitalization costs, resource utilization across service lines, and 30-day readmission rates. Cost and utilization analyses were stratified by Hunt and Hess grades and compared between the treatment arms.Results: The taVNS group (n=13) had lower 30-day hospitalization costs than the sham group (n=14) ($82,632 vs. $103,998, P=0.003), representing a 20.54% reduction. Resource utilization was lower in the taVNS than the sham group for multiple service areas, including respiratory (17.00 vs. 64.60 charges per patient, P=0.003), laboratory (112.23 vs. 140.36 charges per patient, P<0.001), and pharmacy services (266.54 vs 313.29 charges per patient, P=0.004). Additionally, the taVNS group had lower 30-day readmission rates (7.7% vs. 28.6%) and readmission costs ($2,716 vs. $13,085).Conclusion: This study provides preliminary evidence that taVNS reduces hospital costs and service utilization in patients with aSAH. Multicenter validation is warranted; however, these findings suggest that taVNS offers a novel strategy for improving resource utilization and costs in critical care settings.

Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated disorder that leads to progressive muscular weakness, autonomic dysfunction, and potentially respiratory failure. Case Report: A 41-year-old Caucasian man presented with progressive bilateral ascending weakness, concerning for GBS, accompanied by rapidly worsening respiratory status. Chest imaging revealed multiple causes of acute hypoxemic respiratory failure. This is the first reported case of GBS supported by veno-venous extracorporeal membrane oxygenation (V-V ECMO) during recovery and discharge. Conclusion: GBS is typically associated with a high likelihood of recovery, but carries increased mortality in patients who develop sepsis, acute respiratory distress syndrome, or thromboembolic events. V-V ECMO support facilitated lung recovery and hospital discharge for rehabilitation.

Background: Extubation failure in neurocritical patients is strongly associated with poor outcomes; thus as physicians, identifying the neurocritical conditions prior to extubation is important. This increases the need for instruments that can accurately identify patients who are likely to undergo successful extubation. The objective of this study was to determine the predictive value of Extubation Predictive Score (ExPreS) and Visual pursuit, Swallowing attempt, Age, Glasgow Coma Scale (VISAGE) scores for successful extubation in neurocritical patients.Methods: This was a prospective observational cohort study of neurocritical patients admitted to the intensive care unit of Adam Malik Hospital between July and December 2024. The ExPreS and VISAGE scores were used to assess predictive scores for extubation success. Extubation success was defined as no reintubation or use of mechanical ventilation within 48 hours after a spontaneous breathing test.Results: There were 56 patients with most subjects being male, aged >40 years with a mean age of 48.9±16.5 years, with a diagnosis of head injury. Both predictive scores of extubation success in this study can be used to predict successful extubation in neurocritical patients (P<0.001), with an area under the curve (AUC) >0.8. The sensitivity value of ExPreS was 89.5%, specificity was 88.9%, and an AUC was 0.945, whereas the sensitivity value of VISAGE score was 63.2%, specificity was 94.4%, and the AUC was 0.876.Conclusion: Owing to their high sensitivity, specificity, and diagnostic accuracy, ExPreS and VISAGE scores can be used as reliable parameters in order to determine extubation success in neurocritical patients on mechanical ventilation.