Current opinion in critical care
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Curr Opin Crit Care · Apr 2005
ReviewMultimodality monitoring and telemonitoring in neurocritical care: from microdialysis to robotic telepresence.
This review will highlight the state-of-the-art in brain monitoring in neurointensive care and define methods of integrating this technology into patient care using telemedicine methods. ⋯ Multimodality and telemedicine techniques have advanced the state of knowledge about brain function in critically ill patients, and are presently being implemented to direct therapy. Increasing complexity of care will become commonplace, but will be facilitated by computer-enhanced tools that permit the intensivist to integrate this information into an improved treatment regimen.
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To present the major pathophysiological and diagnostic features of critical illness myopathy (CIM) and polyneuropathy (CIP), and to discuss problems concerning the risk factors for CIM and CIP. ⋯ Basic and clinical research is unraveling the pathophysiological mechanisms of critical illness myopathy and polyneuropathy, and methods for rapid diagnosis are actively investigated. Future studies should better define the population at risk of developing CIM and CIP. In fact, although sepsis, multi-organ failure and steroids are often cited as risk factors, uncertainty remains due to the poor methodological quality of studies, or because of inferences that are exclusively based on animal studies. New simplified diagnostic techniques and machines for electrophysiological investigations of peripheral nerves and muscles in the intensive-care unit (ICU) patient would also be welcome.
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Curr Opin Crit Care · Apr 2005
ReviewIntra-abdominal hypertension in the critically ill: it is time to pay attention.
There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). Comparison of the published data however is difficult due to the lack of consensus definitions. This review will focus on the available literature from the last 2 years. A Medline and PubMed search was performed using 'intra-abdominal pressure' (IAP), 'intra-abdominal hypertension' (IAH), and 'abdominal compartment syndrome' (ACS) as search items. The aim was to find an answer to the question 'Isn't it time to pay attention to intra-abdominal pressure in the critically ill?' ⋯ It is time to pay attention to intra-abdominal pressure in the critically ill. It is also time for standardized IAP measurement methods, good consensus definitions and randomized interventional studies.
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Curr Opin Crit Care · Apr 2005
ReviewNon-neurological organ dysfunction in neurocritical care: impact on outcome and etiological considerations.
Organ dysfunction is an important determinant of outcome in critical care medicine. Patients with life threatening neurologic injury represent a distinct subset of critically ill patients in whom non-neurologic organ dysfunction may develop. In this paper the incidence and impact of non-neurologic organ dysfunction in patients with major neurologic injury will be reviewed. Further, potential etiological considerations will be addressed and management strategies discussed. ⋯ Non-neurologic organ dysfunction is common. This dysfunction independently predicts poor outcome following brain injury and represents a potentially modifiable risk factor. Further study is required to develop optimal management strategies.
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Curr Opin Crit Care · Apr 2005
ReviewTo clip or to coil acutely ruptured intracranial aneurysms: update on the debate.
The purpose of this review is to consider why the International Subarachnoid Aneurysm Trial (ISAT) led to such an uproar, provide a summary of the criticisms of the study and responses from the investigators, and discuss the implications of ISAT. ⋯ The study was well designed and executed. The published results met the most up-to-date standards for reporting clinical trials. Important questions remain to be answered, including how to define clinical equipoise and the long-term durability of coiling aneurysms.