Articles: function.
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Delirium is known to be a predictor of adverse outcomes. In a prospective study Abelha and colleagues showed that postoperative delirium was an independent risk factor for deterioration in functional capacity following discharge. ⋯ Early mobilisation of ICU patients has been demonstrated to decrease delirium and improve functional outcomes. Resources should be directed to appropriate, progressive mobilisation of all critically ill patients as a priority.
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Data suggest that treatment of critical illness-related corticosteroid insufficiency after traumatic brain injury (TBI) with a stress dose of hydrocortisone may improve the neurological outcome and the mortality rate. The mineralocorticoid properties of hydrocortisone may reduce the rate of hyponatremia and of brain swelling. ⋯ Considering side effects, corticosteroids are not equal; when a high dose of synthetic corticosteroids seems detrimental, a strategy using a stress dose of hydrocortisone seems attractive. Finally, results from a large multicenter study are needed to close the debate regarding the use of hydrocortisone in TBI patients.
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Editorial Comment
Improving ascertainment and communication of prognosis in intracerebral hemorrhage.
Prognostication after intracerebral hemorrhage remains a significant challenge for the field of neurocritical care. Despite several available tools that can predict mortality and, to some degree, functional outcomes, deciding which prediction score to use and how best to translate the resultant population-based value to the individual level is not always clear. As more and more scores are published, we need to give due attention to the qualitative aspect of prognostication and explore how best to move this critical aspect of our field forward.
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Editorial Comment
Of ions and temperature: the complicated interplay of temperature, fluids, and electrolytes on myocardial function.
This article discusses the potential of levosimendan to treat calcium-induced myocardial dysfunction associated with deep hypothermia. Moderate hypothermia (30 to 34°C) usually improves myocardial contractility and stabilizes heart rhythm, but deep hypothermia can cause severe myocardial dysfunction, which is mediated by intracellular calcium overload. In experimental studies, levosimendan appears effective in reversing this. Clinical studies are needed to confirm these findings and to determine whether levosimendan could also be used for accidental hypothermia and perhaps to mitigate diastolic dysfunction under moderate hypothermia.
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Editorial Comment
Video laryngoscopy improves intubation success and reduces esophageal intubations compared with direct laryngoscopy in the medical intensive care unit.
Urgent and emergent airway management outside the operating room is fraught with complications due to the nature of its acuity, single or multiple system dysfunction or failure, and physiological disturbances. These provide a challenge to the airway team and place the patient at grave risk for potentially life-threatening airway and hemodynamics-related consequences. ⋯ Yet to assume that airway management difficulties can be erased by incorporating a new device is optimistic but naïve. In regard to patient safety, the device is just one piece of the airway puzzle.