Current opinion in critical care
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This review highlights recent advances in cerebral microdialysis for investigational and clinical neurochemical monitoring in patients with critical neurological conditions. ⋯ Cerebral microdialysis is an established tool for neurochemical research in the ICU. This technique cannot be fruitfully used in isolation, but when combined with other monitoring methods provides unique insights into the biochemical and physiological derangements in the injured brain.
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Fever in the neurocritical care setting is very common and has a negative impact on outcome of all disease types. Recent advances have made eliminating fever and maintaining normothermia feasible. However, important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. ⋯ The negative impact of fever after neurologic injury is well understood. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential infectious risk of prolonged fever control.
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Curr Opin Crit Care · Apr 2009
ReviewWhich H is the most important in triple-H therapy for cerebral vasospasm?
To summarize the recent literature of the hemodynamic management of subarachnoid hemorrhage and cerebral vasospasm, also designated as 'triple-H' therapy, and discuss each component of this management approach individually. ⋯ There remains a paucity of information regarding the efficacy and safety of triple-H therapy. The complexity in exploring this topic derives not only from the interdependence of the different components of triple-H therapy but also by the limitation in the assessment of hemodynamic variables. However, there is some emerging physiologic data suggesting that normovolemic hypertension may be the component most likely to increase cerebral blood flow after subarachnoid hemorrhage. In contrast, hypervolemic hemodilution is associated with increased complications and might also lower the hemoglobin to excessively low levels.
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Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the pathophysiologic implications of elevated intraabdominal pressure (IAP), have detrimental effects on all organ systems and are associated with significant morbidity and mortality. Within the past few years, the diagnosis and management of these syndromes have evolved tremendously. ⋯ Liberal IAP measurement in the presence of known risk factors combined with implementation of an evolving and comprehensive resuscitation strategy have resulted in significant improvements in both short and long-term outcome for patients who develop IAH/ACS. All clinicians should be aware of the risk factors that predict development of IAH/ACS, the appropriate measurement of IAP, and the current resuscitation options for managing these highly morbid syndromes.
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Curr Opin Crit Care · Apr 2009
ReviewCorrection of coagulopathy in warfarin associated cerebral hemorrhage.
Warfarin is the most commonly used oral anticoagulant. Intracranial hemorrhage is the most serious complication of anticoagulation and the anticoagulant effect of warfarin has to be urgently reversed in this situation. Traditional methods of reversal of the anticoagulant effect of warfarin involving the use of vitamin K and fresh frozen plasma are slow and relatively ineffective and there is a need for alternative treatment approaches. ⋯ There is a need for well designed randomized clinical trials aimed at evaluating the efficacy of these agents in improving the outcome of patients with anticoagulant associated intracranial hemorrhage.