Current opinion in critical care
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Hypertonic saline solutions have received renewed attention as effective agents for the treatment of cerebral edema and in brain resuscitation in a variety of brain injury paradigms. Although evidence of the beneficial action of hypertonic saline solutions in traumatic brain injury is robust, data supporting use in other conditions are only now mounting. ⋯ Brain injury from diverse etiologies including trauma, ischemic stroke, global cerebral ischemia from cardiac arrest, intraparenchymal or subarachnoid hemorrhage, infection, or toxic-metabolic derangements are commonly encountered in the clinical setting. Many of these conditions are associated with cerebral edema with or without elevated intracranial pressure. Osmotherapy constitutes the cornerstone of medical therapy for such patients. Hypertonic saline solutions have received renewed attention in clinical practice as osmotic agents for cerebral resuscitation. This article reviews experimental and clinical evidence of the efficacy of hypertonic saline solutions and elaborates on their use in patients with acute neurologic injury. Important areas for current and future research are highlighted before the use of hypertonic saline solutions can be accepted for widespread use.
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To examine the evidence of regional cerebral ischemia after traumatic brain injury. ⋯ There is increasing evidence to suggest that a small but significant volume of brain tissue is at risk of ischemic injury after trauma. Future studies should examine the pathophysiology underlying such ischemia and how monitoring techniques can be used to direct appropriate therapy and influence outcome.
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A number of papers have suggested that the splanchnic circulation and oxidative metabolism are compromised in critical illness. This review discusses this hypothesis and outlines the recent advances in the understanding of splanchnic metabolism with special focus on acute liver failure and hyperdynamic sepsis. ⋯ There is increasing evidence that both acute liver failure and sepsis are accompanied by a hypermetabolic state in the hepatosplanchnic area, characterized by enhanced glycolysis and hyperlactatemia. This should not be rigorously interpreted as an indication of hypoxia. In fact, clinically important splanchnic hypoxia may be a relatively uncommon phenomenon in such patients.
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Curr Opin Crit Care · Apr 2004
ReviewIs keeping cool still hot? An update on hypothermia in brain injury.
The purpose of this review is to examine recent research results for hypothermia as a treatment for brain injury. ⋯ Hypothermia is a useful adjunct to barbiturates and mannitol to control elevated intracranial pressure. The results of trials that have tested systemic hypothermia as a neuroprotectant have been negative or equivocal, and cooling may have been induced outside the treatment window.
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Curr Opin Crit Care · Apr 2004
ReviewIs it wise not to think about intraabdominal hypertension in the ICU?
This review focuses on the available literature published in the past 2 years. MEDLINE and PubMed searches were performed using intraabdominal pressure, intraabdominal hypertension, and abdominal compartment as search items. The aim was to find an answer to the question: "Is it wise not to measure or even not to think about intraabdominal hypertension in ICU?" ⋯ The answer is that it is unwise not to measure intraabdominal pressure in the ICU or even not to think about it.