Current opinion in critical care
-
We summarize the therapeutic approach to patients with acute liver failure with the main focus on bioartificial and artificial liver support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute liver failure. ⋯ Mortality in patients with acute liver failure is still unacceptably high. The most effective treatment, liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal liver assist.
-
The review highlights current insights in the epidemiology, diagnosis and therapy of Candida peritonitis, focusing on complicated secondary and tertiary peritonitis. ⋯ The main challenge in Candida peritonitis remains the interpretation of Candida cultured from the peritoneal cavity. Future research should focus on more conclusive diagnosis and on factors potentially confounding outcome, such as site of the perforation and failure of surgical source control. While awaiting progress to discriminate Candida colonization from invasive infection, antifungal therapy is recommended in high-risk critically ill surgical patients. Rapid detection of Candida might be beneficial in this regard. Besides antifungal therapy, adequate source control is of key importance.
-
Curr Opin Crit Care · Apr 2007
ReviewGastrointestinal motility and prokinetics in the critically ill.
Enteral nutrition is frequently unsuccessful in the critically ill due to gastrointestinal dysfunction. Current treatment strategies are often disappointing. In this article upper gastrointestinal function in health together with abnormalities seen during critical illness are reviewed, and potential therapeutic options summarized. ⋯ There has been considerable progress in understanding the pathogenesis of mechanisms causing feed intolerance in critical illness, but this is yet to be translated into therapeutic benefit.
-
To identify the surgical indications in the treatment of posttraumatic intracranial hematomas and to evaluate the role of external decompression in severe posttraumatic intracranial hypertension. ⋯ A surgical approach is frequent in posttraumatic intracranial hematomas in spite of a low level of evidence. One of the surgical options either in association with hematoma evacuation or in isolation is the technique of bone flap decompression.
-
Curr Opin Crit Care · Apr 2007
ReviewHemodynamic manipulation in the neuro-intensive care unit: cerebral perfusion pressure therapy in head injury and hemodynamic augmentation for cerebral vasospasm.
The intent of this manuscript is to summarize the pathophysiologic basis for hemodynamic manipulation in subarachnoid hemorrhage and traumatic brain injury, highlight the most recent literature and present expert opinion on indications and use. ⋯ Hemodynamic manipulation is routinely used in the management of patients with acute vasospasm following subarachnoid hemorrhage and severe head injury. The rationale is to improve blood flow to the injured brain and prevent secondary ischemia.