Current opinion in critical care
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Recent recognition of the importance of postresuscitation care has stimulated interest and new reports concerning therapies for postcardiac arrest myocardial dysfunction. Such cardiac dysfunction after successful resuscitation can be severe and even lethal; however, it is also transient emphasizing the importance of early supportive therapies. ⋯ Every community should be striving to provide more timely restoration of pulse and circulation, whereas every medical center receiving patients resuscitated from out-of-hospital cardiac arrest should be providing therapeutic hypothermia for both central nervous system and myocardial preservation. The ability and commitment to provide '24/7' early coronary angiography and percutaneous intervention for all resuscitated victims of sudden cardiac death with a likely cardiac cause for their arrest is also key.
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Status epilepticus is one of the most common emergencies in neurology, and every third patient does not respond to adequate first-line treatment. Refractory status epilepticus may be associated with increased morbidity and mortality, and new treatment options are urgently required. This review critically discusses recently published data regarding the role of 'new' antiepileptic drugs, the efficacy and safety of anesthetic agents, and the overall clinical outcome that is an integral part of treatment decisions. ⋯ Unambiguous recommendations regarding treatment strategies for refractory status epilepticus are limited by a lack of reliable data. Therefore, randomized controlled trials or at least prospective observational studies based on strict protocols incorporating long-term outcome data are urgently required.
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Curr Opin Crit Care · Apr 2011
ReviewMultiple organ failure in sepsis: prognosis and role of systemic inflammatory response.
To describe the pathogenesis and emphasize prognosis of systemic inflammatory response during severe infection. ⋯ Sepsis is viewed as an excessive host response to pathogen inducing a complex network of molecular cascades leading to tissue damages, organ failures, and death.
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ICU delirium is a common and serious acute brain dysfunction with adverse outcome and high risk of mortality. The awareness of ICU delirium as a problem, which immediately requires therapeutic intervention, has been increased in the past years. This article aims to provide information in order to increasingly modify the management of this severe problem, that is, its detection, prevention, and treatment toward algorithm-based and protocol-driven procedures. ⋯ The management of ICU delirium must be a key aspect to improve the outcome of critically ill patients. The development of pharmacological treatment strategies and deeper understanding of the underlying pathophysiology will require further research.
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Early aggressive treatment of poor-grade subarachnoid hemorrhage patients has resulted in more favorable long-term outcomes. This article covers the aspects of neurocritical care management directed to the patient with poor-grade subarachnoid hemorrhage (Hunt and Hess 4 and 5) and outlines important prognostic features. ⋯ Poor-grade subarachnoid hemorrhage patients have the potential to recover and should therefore be fully resuscitated and treated aggressively with the available standards and monitoring techniques.