Current opinion in critical care
-
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.
-
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.
-
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.
-
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.
-
Curr Opin Crit Care · Apr 2004
Review Comparative StudyEstablishment of enteral nutrition: prokinetic agents and small bowel feeding tubes.
Nutritional support is vital to improving the clinical outcomes in patients in the intensive care unit. Enteral nutrition should be administered early and aggressively, thereby reducing the need for parenteral nutrition. Because nasogastric feeding is often associated with gastrointestinal intolerance, recent research has focused on the use of prokinetic agents or small bowel feeding tubes to enhance the successful establishment and maintenance of enteral nutrition. ⋯ Nasogastric feeding is preferred for almost all patients in the intensive care unit. Metoclopramide is the preferred prokinetic agent, although whether it or erythromycin should be administered to all patients in the intensive care unit or only those with gastrointestinal intolerance remains unknown. Small bowel feeding is not currently recommended for all patients in the intensive care unit because the benefits do not appear to outweigh the logistic and cost considerations. Nevertheless, when gastrointestinal intolerance develops in a nasogastrically fed patient, a small bowel feeding tube should be inserted at the earliest opportunity.