Current opinion in critical care
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We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine. ⋯ Neurocritical care is one of the newest subspecialties of medicine and is at the forefront of bringing effective new therapies to patients with life-threatening neurological diseases.
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Curr Opin Crit Care · Apr 2007
ReviewCortical spreading depression: an adverse but treatable factor in intensive care?
The aetiology and management of secondary deterioration in patients with acute traumatic or ischaemic brain injury remain serious challenges for clinicians and also for basic neuroscientists. The occurrence of spreading depolarization events and some of their features in the cerebral cortex in patients with traumatic brain injury and aneurysmal subarachnoid haemorrhage, as documented in recent papers, represent a novel pathophysiological mechanism in this setting. ⋯ Realization of the therapeutic potential of the new findings will depend on clear knowledge of the impact of the different patterns of depolarization on outcome. Meantime, current results call for even stricter attention during clinical management of acute brain injury to secondary factors such as body temperature and plasma glucose.
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Emergency research is possible only if informed consent is waived. Recent legislations have specifically addressed this issue, both in the US and in Europe. ⋯ Due to the active lobbying of emergency and intensive care specialists, the situation is slowly improving, with most national legislations recognizing the specificities and difficulty of emergency research.
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This is a review on the techniques for assessing liver function in critically ill patients. ⋯ Since no ideal tool is currently available, dynamic tests such as indocyanine green plasma disappearance rate and monoethylglycinxylidide test may be recommended for assessing liver function in critically ill patients. The indocyanine green plasma disappearance rate has the advantage, however, of being measurable noninvasively at the bedside and providing results within a few minutes.
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Curr Opin Crit Care · Apr 2007
ReviewNeuroprotection in traumatic brain injury: a complex struggle against the biology of nature.
Translating the efficacy of neuroprotective agents in experimental traumatic brain injury to clinical benefit has proven an extremely complex and, to date, unsuccessful undertaking. The focus of this review is on neuroprotective agents that have recently been evaluated in clinical trials and are currently under clinical evaluation, as well as on those that appear promising and are likely to undergo clinical evaluation in the near future. ⋯ Traumatic brain injury is a complex disease, and development of clinically effective neuroprotective agents is a difficult task. Experimental traumatic brain injury has provided numerous promising compounds, but to date these have not been translated into successful clinical trials. Continued research efforts are required to identify and test new neuroprotective agents, to develop a better understanding of the sequential activity of pathophysiologic mechanisms, and to improve the design and analysis of clinical trials, thereby optimizing chances for showing benefit in future clinical trials.