Current opinion in critical care
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Curr Opin Crit Care · Apr 2010
Review13CO2 breath tests, a tool to assess intestinal and liver function in the ICU?
CO2 breath tests, based on nondispersive infrared (NDIR) measurement technology, offer the chance for a noninvasive online quantitation of physiological processes. With recent extensions of the NDIR measurement technology breath tests could be used in an ICU setting without any restriction. Since online tools to assess feed intolerance with gastric emptying and to quantify gradual changes in liver function are still missing, this review explores the potential of breath tests to fill this gap. ⋯ Breath tests for liver function and gastric emptying taken alone may fail in their ability to specifically quantify the clinical disorders. However, invasive test extensions could help to characterize their validity and thus to identify additional, noninvasive measurements to assure and expand this domain.
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Curr Opin Crit Care · Apr 2010
ReviewThe effects of vasopressin and its analogues on the liver and its disorders in the critically ill.
Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function. ⋯ The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.
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The liver comprises a multitude of parenchymal and nonparenchymal cells with diverse metabolic, hemodynamic and immune functions. Available monitoring options consist of 'static' laboratory parameters, quantitative tests of liver function based on clearance, elimination or metabolite formation and scores, most notably the 'model for end-stage liver disease'. This review aims at balancing conventional markers against 'dynamic' tests in the critically ill. ⋯ Progress has been made in the last year to weigh static and dynamic tests to monitor parenchymal liver functions, whereas biomarkers to assess nonparenchymal functions remain largely obscure.
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Curr Opin Crit Care · Apr 2010
ReviewThe neuro-ICU patient and electroencephalography paroxysms: if and when to treat.
To review recent clinical data and summarize actual recommendations for the management of electrographic seizures and status epilepticus in neuro-ICU patients. ⋯ We provide a pragmatic approach for the management of electrographic seizures in neuro-ICU patients. International consensus guidelines on continuous electroencephalography monitoring and seizure therapy are needed and would represent the rationale for a future multicenter randomized trial.
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This review presents important pathophysiological alterations associated with impaired liver function and discusses protective perioperative strategies and the various anaesthetic agents recommended. ⋯ Targeted perioperative liver protection still lacks adequate monitoring tools and is currently based on optimization of global haemodynamic variables. While there is currently no evidence suggesting a positive effect of ischaemic preconditioning, promising experimental results of pharmacological preconditioning and therapeutic hypothermia require further evaluation in larger randomized clinical trials.