Journal of critical care
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Journal of critical care · Aug 2014
Review Historical ArticleHistory of brain death as death: 1968 to the present.
The concept of brain death was formulated in 1968 in the landmark report A Definition of Irreversible Coma. While brain death has been widely accepted as a determination of death throughout the world, many of the controversies that surround it have not been settled. Some may be rooted in a misconstruction about the history of brain death. ⋯ Since 1968, the concept of brain death has been extensively analyzed, debated, and reworked. Still there remains much misunderstanding and confusion, especially in the general public. In this comprehensive review, I will trace the evolution of the definition of brain death as death from 1968 to the present, providing background, history and context.
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Journal of critical care · Aug 2014
ReviewAutomated pupillometer for monitoring the critically ill patient: A critical appraisal.
Abnormalities in the pupillary light reflex are an important prognostic indicator for patients in the intensive care unit (ICU). Manual pupillary examination is confounded by interobserver discrepancies and errors in detecting a reflex under certain conditions. The automated pupillometer is a computer-based infrared digital video device that can obtain objective measurements of pupillary size and reactivity. ⋯ Pupillometric measurements had better precision and reproducibility compared with the manual pupillary examination. Based on these data, we conclude that pupillometry monitoring can serve as an important tool in the ICU. Further large scale studies on patients in the neurocritical care unit and medical ICU are needed to support the routine use of automated pupillometry.
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Journal of critical care · Aug 2014
Review Meta AnalysisPredictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis.
We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. ⋯ The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.
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Journal of critical care · Aug 2014
Review Meta AnalysisPredictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis.
We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. ⋯ The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.
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Journal of critical care · Aug 2014
ReviewFrom data patterns to mechanistic models in acute critical illness.
The complexity of the physiologic and inflammatory response in acute critical illness has stymied the accurate diagnosis and development of therapies. The Society for Complex Acute Illness was formed a decade ago with the goal of leveraging multiple complex systems approaches to address this unmet need. ⋯ We suggest that the next decade holds the potential to merge these approaches, connecting patient diagnosis to treatment via mechanism-based dynamical system modeling and feedback control and allowing extrapolation from physiologic signals to biomarkers to novel drug candidates. As a predicate example, we focus on the role of data-driven and mechanistic models in neuroscience and the impact that merging these modeling approaches can have on general anesthesia.