Current opinion in critical care
-
Curr Opin Crit Care · Apr 2014
ReviewIntracranial pressure after the BEST TRIP trial: a call for more monitoring.
Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI), but whether its management improves the outcome is unclear. In this review, we will examine the implications of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST TRIP) trial, evidence for an influence of ICP care on outcome, and a need for greater understanding of the pathophysiology than just ICP through multimodal monitoring (MMM) to enhance the outcome. ⋯ ICP-based monitoring and treatment alone may not be enough to enhance TBI outcome, but ICP and cerebral perfusion pressure therapy remain important in TBI care. Although high-quality evidence for MMM is limited, it should be more widely adapted to better understand the complex pathophysiology after TBI, better target care, and identify new therapeutic opportunities.
-
To review the changing insights in the pathophysiology and management of acute pancreatitis. ⋯ Management of severe acute pancreatitis is changing fundamentally. 'Less is more' is the new paradigm in acute pancreatitis - less antibiotics, less fluids, less surgery, which should eventually lead to less morbidity and mortality.
-
Curr Opin Crit Care · Apr 2014
ReviewFever and therapeutic normothermia in severe brain injury: an update.
Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia. ⋯ The value of therapeutic normothermia in the neurocritical care unit (NCCU) is increasingly accepted, yet prospective trials that demonstrate a functional benefit to patients are lacking.
-
The care of critically ill brain-injured patients is complex and requires careful balancing of cerebral and systemic treatment priorities. A growing number of studies have reported improved outcomes when patients are admitted to dedicated neurocritical care units (NCCUs). The reasons for this observation have not been definitively clarified. ⋯ Neurocritical care is an evolving field that is associated with improvements in outcomes over the past decade. Further research is required to determine how monitoring and treatment protocols can be optimized.
-
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.