Current opinion in critical care
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Curr Opin Crit Care · Apr 2009
ReviewManagement of cardiac arrest patients to maximize neurologic outcome.
Each year, hundreds of thousands of people will be resuscitated after a cardiac arrest. A significant portion of these patients will lapse into a disease state which is the product of modern emergency and critical care medicine: the postcardiac arrest syndrome. The ability to return a patient to his or her prior state of health after cardiac arrest, once completely beyond the capacities of clinicians, is now one of the most important areas of medical science. Much of this ability depends on preserving the nervous system from a complicated sequence of secondary injuries, which ensue from global ischemia. ⋯ This study reviews the latest advances in treating patients after cardiac arrest in the emergency department and critical care unit environments.
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Intracerebral hemorrhage (ICH) is the most serious but least treatable form of stroke, with prognosis critically dependent on both the size and degree of hematoma expansion. Treatments that target hematoma expansion offer potential to improve outcomes. This review analyzes the recent literature pertaining to the medical management of ICH. ⋯ In patients with acute ICH, rapid intensive BP-lowering treatment may provide protection against hematoma growth without concerns about safety and tolerability. How well such treatment can translate into overall benefits to patients is yet to be determined. At present, recombinant activated factor VII cannot be recommended for routine use, although BP lowering should generally follow conservative guidelines.
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To examine current knowledge regarding the utility of probiotics in a variety of medical conditions afflicting critically ill patients in the intensive care unit (ICU). ⋯ Data supporting the use of probiotics in different clinical conditions are variable in scope and quality. Large, well designed, randomized, multicenter trials are needed to better define the role and safety of probiotics in critically ill patients.
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To discuss the risk factors and underlying illnesses that play a role in the pathophysiology of stress ulcer, and to evaluate the evidence pertaining to stress ulcer-related bleeding prophylaxis in critically ill patients. ⋯ Routine prophylaxis against stress ulcers in the ICU is not well justified by current evidence. Patients at risk of stress ulcer-related bleeding are most likely to benefit from prophylaxis. Thus, healthcare professionals should continue to evaluate risk and assess the need for stress ulcer-related prophylaxis.
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Continuous electroencephalography (cEEG) is being used more frequently in intensive care units to detect epileptic activity and ischemia. This review analyzes clinical applications and limitations of cEEG as a routine neuromonitoring tool. ⋯ cEEG should be considered as an integral part of multimodality monitoring of the injured brain, particularly in patients at risk for nonconvulsive seizure or ischemia. Automated alarms may help establish cEEG monitoring as an integral part of brain monitoring. All neurological ICUs that routinely care for patients with refractory status epilepticus should have the capability to perform cEEG monitoring. Further research determining the impact on outcome and making EEG monitoring more user friendly may help move this technique out of the subspecialized ICU setting into the general ICU environment. In the future, it may be possible to use specific EEG parameters as endpoints for therapeutic interventions.