Current opinion in critical care
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Curr Opin Crit Care · Apr 2010
ReviewInfectious intracranial complications in the neuro-ICU patient population.
To provide an overview of infectious intracranial complications secondary to invasive procedures or trauma in the neuro-ICU patient population. Nosocomial infections of the central nervous system are a serious complication contributing to morbidity, prolonged length of stay in the ICU and/or hospital, and mortality of neurocritical care patients. ⋯ Despite recent advances in prevention and treatment, the management of nosocomial intracranial infections still poses a challenge to the neuro-ICU specialist and must consider timely diagnosis and prompt initiation of appropriate antibiotic therapy. This review focuses on the definition, epidemiology, clinical features, and therapeutical approach to this distinct complication of neurocritical care.
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To summarize a consensus of European authorities about the applications of clinical neurophysiology in the ICU and, particularly, for a clinically useful management of individual patients. ⋯ The domain of clinical neurophysiology is similar to that of clinical examination and complementary to that of imaging techniques. It substantially improves the individual management of ICU patients.
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Traumatic brain injury (TBI) is a leading cause of death and long-term cognitive and behavioral dysfunction in children and young adults, yet effective treatments are lacking, in part because critical aspects of TBI neurobiology and natural history are not understood. We review recent advances in neuroimaging and discuss how they are helping to address these fundamental gaps. ⋯ Refinements in neuroimaging offer a window into the complex neuroanatomical and neurophysiological disturbances induced by TBI. Research is needed to understand how these alterations evolve with time and in response to therapeutic interventions.
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Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk. ⋯ Gastrointestinal motility disturbances are caused by a myriad of pathological processes. Moreover, bowel integrity is governed by comorbidity, impaired metabolic function and pharmacological interventions in critically ill patients. Restoring gastrointestinal function, therefore, requires a multimodal approach including prophylactic management strategies and the sensible use of substances with inhibitory effects on intestinal motility.