Current opinion in critical care
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Curr Opin Crit Care · Apr 2014
ReviewFeeding the gut: how, when and with what - the metabolic issue.
To review the literature on feeding critically ill patients with special emphasis on the intestine. ⋯ The use of gastric feeding in critical illness is recommended. Successful gastric feeding is indicative of a functional gastrointestinal tract. Pharmacological effects of nutrients are questionable, but supplementation of deficits (glutamine, selenium, etc.) may be in the patient's best interest. A more individualized prescription of nutrition in the critically ill is advocated.
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Data from MRI can be used to generate detailed maps of central nervous system anatomy and functional activation. Here, we review new research that integrates advanced MRI acquisition and analysis to predict and track recovery following severe traumatic brain injury (TBI) or anoxic ischemic encephalopathy (AIE) following cardiac arrest. ⋯ MRI of the brain is feasible in critically ill patients following TBI or cardiac arrest, revealing patterns of structural damage and functional disconnection that can help predict outcome in the long term. Prospective studies are needed to validate these findings and to identify relationships between MRI-defined alterations and specific postinjury cognitive and behavioural phenotypes.
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Curr Opin Crit Care · Apr 2014
ReviewNursing collaboration: a key element in debunking neurocritical care myths.
To explore the origin of myths and their progression toward dogma. The process of debunking myths in the neurocritical care unit (NCCU) is facilitated if nurses are involved early during the process. ⋯ Myth and dogma are problems confronted in all of medicine and here we provide specific examples from the NCCU. Nursing care, especially in the ICU, can help identify these myths and, in conjunction with physicians, tests these myths via the scientific method instead of accepting the null hypothesis. Even when myths are proven false, changing clinical practice, altering physician or nurse behavior, and fighting dogma remain a challenge.
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Spontaneous intracerebral haemorrhage (ICH) imposes a significant health and economic burden on society. Despite this, ICH remains the only stroke subtype without a definitive treatment. Without a clearly identified and effective treatment for spontaneous ICH, clinical practice varies greatly from aggressive surgery to supportive care alone. This review will discuss the current modalities of treatments for ICH including preliminary experience and investigative efforts to advance the care of these patients. ⋯ ICH lacks a definitive primary treatment as well as a therapy targeting surrounding perihematomal oedema and associated secondary damage. An ongoing phase III trial using MIS techniques shows promise for providing treatment for these patients.
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Curr Opin Crit Care · Apr 2014
ReviewUpdate in intensive care medicine: acute liver failure. Initial management, supportive treatment and who to transplant.
Acute liver failure (ALF) is associated with significant mortality. Although specific therapies may be available, the evidence base for these and for many aspects of supportive therapy has been slow to emerge. Liver transplantation continues to be a cornerstone of treatment, and the management of ALF, therefore, remains the domain of the specialist ICU. The purpose of this review is to identify and critically appraise the recent evidence and to inspire those who strive to provide excellent care for a difficult patient cohort. ⋯ Increasingly sophisticated prognostication tools are evolving, which have the potential to transform clinical decision-making. A review of the indications for transplantation in acetaminophen toxicity is overdue. The use of therapeutic plasma exchange and extracorporeal liver support in ALF requires further investigation.