Current opinion in critical care
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Curr Opin Crit Care · Apr 2006
ReviewBrain ischaemia after traumatic brain injury: lessons from 15O2 positron emission tomography.
To describe the role of O2 positron emission tomography in studies aimed at understanding ischaemia in head injury. It has been difficult to use cerebral blood flow levels to provide a secure definition of cerebral ischaemia in head injury, since primary changes in cerebral metabolism may be responsible for coupled reductions in cerebral blood flow. Further, regional heterogeneity of pathophysiology can confound global measures of adequacy of cerebral oxygen delivery. There is a need for a technique that can provide a comprehensive and quantitative description of cerebral physiology in this setting. ⋯ There is a clear role for O2 positron emission tomography in elucidating pathophysiology in head injury. The technique may provide most information when combined with other imaging and monitoring tools.
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Curr Opin Crit Care · Apr 2006
ReviewContinuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis.
This review highlights recent advances in cerebral microdialysis as a tool for neurochemical monitoring of patients with traumatic brain injury. ⋯ Microdialysis is established as a neurochemical research tool in neurointensive care, particularly in combination with other monitoring methods, and contributes to a growing knowledge of secondary injury mechanisms in traumatic brain injury. The value of microdialysis as a tool in routine neurointensive care decision-making remains unclear.
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Curr Opin Crit Care · Apr 2006
ReviewEarly enteral nutrition in the critically ill: do we need more evidence or better evidence?
Nutritional support of the critically ill is accepted as a standard of care. Recommendations for early enteral nutrition are based on reasonable evidence but only 50% of eligible patients receive enteral nutrition within 48 h of admission to the intensive care unit. The purpose of this review is to determine how recent developments advance the current state of knowledge. ⋯ Higher levels of evidence, demonstrating benefit to a patient-oriented outcome, are more likely to change practice. The addition of more level II trials to a meta-analysis composed of level II trials may not convince clinicians to change practice. A level I trial (equivalent to a phase III Food and Drug Administration licensing trial) is required to convince more clinicians to provide early enteral nutrition. A level I trial would also provide an important opportunity to validate changes in disease-oriented outcomes (measures of nutritional status) against improvements in patient-oriented outcomes.
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A recent editorial proclaimed, 'Glutamine, a life saving nutrient, but why?' This review will assess if recent data support glutamine as a life-saving nutrient in critical illness, and, if so, utilize new understanding of gene-nutrient interactions to address potential mechanisms by which glutamine may be 'life-saving'. ⋯ Glutamine may be potentially 'life-saving' in critical illness, particularly when administered in doses greater then 0.3 g/kg/day. Present data indicate that glutamine functions as a 'stress signaling molecule' following illness/injury and thus, needs to be given as a pharmacologic agent, rather then as nutritional replacement. Presently, multicenter clinical trials utilizing glutamine as a drug, independent of nutritional needs, are indicated.