Current opinion in critical care
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Although advances in critical care management and liver transplantation have improved survival in acute liver failure (ALF), mortality remains significant. An evidence base to support management has been lacking, due to the condition's rarity, severity and heterogeneity. The purpose of this review is to critically appraise the latest evidence, updating clinicians on the current understanding of the best management. ⋯ Traditional dogma in ALF management is questioned: transplant thresholds for acetaminophen overdose, steroid use in autoimmune ALF, routine antimicrobial prophylaxis, the coagulopathy of liver disease, the value of intracranial pressure monitoring and extracorporeal liver support.
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Curr Opin Crit Care · Apr 2015
ReviewRationale for lumbar drains in aneurysmal subarachnoid hemorrhage.
The amount of blood in the basal cisterns is predictive for the final outcome after aneurysmal subarachnoid hemorrhage (SAH) and clinical problems such as delayed cerebral ischemia and angiographic vasospasm. A lumbar drainage presents an additional, physiologically appealing treatment. In contrast to an external ventricular drain, stasis of clots is thought to be prevented and clearance of the basal cisterns accelerated. In theory, patients with higher clinical grades and dense layers of subarachnoid blood should benefit most. ⋯ At present, no definite conclusions and recommendations on lumbar drains in patients after aneurysmal SAH are warranted.
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To summarize existing evidence on definition, epidemiology, mechanisms, risk factors, consequences, outcome and management of diarrhoea in the critically ill. ⋯ A definition of diarrhoea and a practical approach to identify the precipitant and to manage diarrhoea in critically ill patients are proposed.
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Curr Opin Crit Care · Apr 2015
ReviewRecommendations for management of large hemispheric infarction.
Large hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema. ⋯ Large hemispheric infarcts continue to have significant morbidity and mortality. Recent guidelines have provided an excellent framework to help intensivists manage these complicated patients. Recent surgical data continue to support early hemicraniectomy even in elderly patients.
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Curr Opin Crit Care · Apr 2015
ReviewLiver transplantation in the context of organ shortage: toward extension and restriction of indications considering recent clinical data and ethical framework.
The scarcity of liver grafts requires to optimize the results of transplantation. Extensions and alternatives of liver transplantation have to be regularly evaluated. ⋯ Before implementation of these potential changes into decisional algorithms for listing and organ allocation, their consequences, either for patient's individual benefit or for global transplant outcomes, should be closely evaluated using objective long-term end points and taking into account the ethical recommendations for organ transplantation.