Critical care clinics
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Critical care clinics · Oct 2006
ReviewAdvances in the management of central nervous system infections in the ICU.
This chapter focuses on early aggressive management of common infections of the central nervous system that require monitoring in an ICU setting. These include meningitis, encephalitis, brain and epidural abscess, subdural empyema and ventriculitis. ⋯ The emergence of organisms resistant to penicillin and cephalosporins has also further complicated the early management of bacterial meningitis. Current antimicrobial guidelines are provided along with discussion of new diagnostic and therapeutic strategies and controversial aspects of management.
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Critical care clinics · Oct 2006
ReviewIntensive care for brain injury after cardiac arrest: therapeutic hypothermia and related neuroprotective strategies.
Neurologic injury is the predominant cause of poor functional outcome in patients who are resuscitated from cardiac arrest. The management of these patients in the ICU can be challenging because of the paucity of effective therapies and lack of readily available diagnostic and prognostic tools. ⋯ The American Academy of Neurology recently enhanced the delivery of care in survivors of cardiac arrest by providing evidence-based practice parameters on the prediction of poor outcome in comatose survivors of cardiac arrest, based on clinical evaluation and diagnostic tests. This article discusses these advances and their potential impact on the care provided in the ICU.
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Critical care clinics · Oct 2006
ReviewComa, delirium, and cognitive dysfunction in critical illness.
Syndromes of global cerebral dysfunction that are associated with critical illness include acute disorders (eg, coma, delirium) and chronic processes (ie, cognitive impairment). These syndromes can result from direct cerebral injury; however, many cases develop as a complication of a systemic insult. Coma frequently evolves into phenomenologically distinct disorders of consciousness; it must be differentiated from conditions in which consciousness is preserved, as in the locked-in state. Advances have been made in defining, scoring, and delineating the epidemiology of cerebral dysfunction in the ICU, but research is needed to elucidate underlying mechanisms, with the goal of identifying targets for prevention and therapy.
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Effective treatment of intracranial hypertension involves meticulous avoidance of factors that precipitate or aggravate increased intracranial pressure. When intracranial pressure becomes elevated, it is important to rule out new mass lesions that should be surgically evacuated. medical management of increased intracranial pressure should include sedation and paralysis, drainage of cerebrospinal fluid, and osmotherapy with either mannitol or hypertonic saline. For intracranial hypertension refractory to initial medical management, barbiturate coma, hypothermia, or decompressive craniectomy should be considered. Steroids are not indicated and may be harmful in the treatment of intracranial hypertension resulting from traumatic brain injury.
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Stroke is the third leading cause of death and the leading cause of disability in the United States. This article summarizes the critical care of acute ischemic stroke, including conventional and novel therapies. The article provided an overview of the initial management, diagnostic workup, treatment options, and supportive measures that need to be considered in the acute phase of ischemic stroke.