Critical care : the official journal of the Critical Care Forum
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Only limited data are available on consent and satisfaction of patients receiving specialized neurocritical care. In this study we (i) analyzed the extent of retrospective consent to neurocritical care--given by patients or their relatives--depending on functional outcome one year after hospital stay, and (ii) identified predisposing factors for retrospective agreement to neurocritical care. ⋯ Retrospective agreement to neurocritical care is influenced by functional outcome. Especially in severely affected stroke patients who cannot communicate their preferences regarding life-sustaining therapy, neurocritical care physicians should balance the expected burdens and benefits of treatment to meet the patients' putative wishes. Efforts should be undertaken to identify predictors for severe disability after neurocritical care.
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Over 500 million of the current world population will die from diseases caused by smoking cigarettes. The symptoms and signs of nicotine withdrawal are not well described in the critically ill. Since the various conditions of critical illness may lead to clinical manifestations mimicking nicotine withdrawal, describing its specific manifestations may not be easy. ⋯ However, retrospective studies have found that it may increase mortality. Despite the abundance of active smokers, there is a paucity of data describing nicotine withdrawal, and its prevention and treatment options in the critically ill. Future studies are warranted to address these issues.
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Mechanical ventilation (MV) is a life saving intervention in acute respiratory failure without alternative. However, particularly in pre-injured lungs, even protective ventilation strategies may evoke ventilator-induced lung injury (VILI), which is characterized by pulmonary inflammation and vascular leakage. Adjuvant pharmacologic strategies in addition to lung protective ventilation to attenuate VILI are lacking. Simvastatin exhibited anti-inflammatory and endothelial barrier stabilizing properties in vitro and in vivo. ⋯ High-dose simvastatin attenuated VILI in mice by reducing MV-induced pulmonary inflammation and hyperpermeability.
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Survivors of critical illnesses are at increased risk for posttraumatic stress disorder and major depression. In the present issue of Critical Care, Myhren and colleagues report on an investigation of predictors of posttraumatic stress, general anxiety, and depressive symptoms up to 1 year following intensive care unit admission for critical illnesses. The present study found that an endogenous patient characteristic, the personality trait pessimism, was associated with posttraumatic stress and depressive symptoms. Myhren and colleagues' study sheds light on potential predictors of psychopathology in critical illness survivors as well as stimulating directions for future research to address these complex problems.
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Comment Letter
Prophylactic open abdomen in patients with postoperative intra-abdominal hypertension.
Postoperative intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients operated on for severe abdominal trauma, secondary peritonitis or ruptured abdominal aortic aneurysm. IAH may progress to abdominal compartment syndrome (ACS) with new-onset organ dysfunction. Early recognition of IAH and interventions that prevent the development of ACS may preserve vital organ functions and increase the probability of survival. ⋯ Because significant morbidity and mortality are associated with the open abdomen, the measurement of IAP immediately after the fascial closure, when feasible, could offer an objective method for determining the optimal IAP threshold for leaving the abdomen open. The management of the open abdomen requires a temporary abdominal closure (TAC) system that would ideally prevent the development of ACS and facilitate later primary fascia closure. Among several TAC systems, the most promising are those that provide negative pressure to the wound or continuous fascial traction or both.