Critical care clinics
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Critical care clinics · Jul 1996
ReviewHypertensive, hypervolemic, hemodilutional therapy for aneurysmal subarachnoid hemorrhage. Is it efficacious? Yes.
Vasospasm is an important contributor to death and disability after aneurysmal SAH. CBF is decreased after SAH and correlates inversely with the severity of the clinical grade. ⋯ This is attributable, perhaps, to the fact that such trials are difficult to blind. Nevertheless, there is strong evidence that HHH therapy can reverse the delayed onset of profound neurologic deficits by restoring blood flow to ischemic regions, and its prophylactic use can reduce the incidence and severity of DID.
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Critical care clinics · Jul 1996
ReviewICU scoring systems do not allow prediction of patient outcomes or comparison of ICU performance.
Recent revisions of the major ICU scoring systems have broadened their database markedly and increased their statistical accuracy. For a specific patient, however, the systems cannot be accurate enough to direct management decisions. Significant questions remain about the reliability of these systems for comparing different ICUs and different patient populations, especially in surgical and trauma patients. Current scoring systems, therefore, cannot be used reliably in either the management of the individual patient or in the making of quality comparisons between ICUs.
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Because of the close relationship between the esophagus and the aorta, multiplane transesophageal echocardiography provides an excellent way to view the thoracic aorta. In this article, clinical features of aortic aneurysm, trauma, and aortic dissection are described, as is the potential use of transesophageal echocardiography in the assessment of these entities.
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Gastric tonometry is gaining acceptance rapidly as a noninvasive method of monitoring tissue dysoxia in a key organ system that previously could not be assessed easily. In addition to being noninvasive, gastric tonometry also identifies dysoxia in shock sooner than currently available monitors. This allows for more timely intervention with a subsequent improvement in prognosis in defined groups of patients. Tonometry data that suggest continued dysoxia despite intervention should signal clinicians to seek alternative diagnoses or to question the efficacy of current therapies, including antibiotics.
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The hypermetabolic state in critically ill patients is characterized by wasting of lean body mass and immunosuppression. The gut is among the most metabolically active organs. Failure to maintain gut function by way of early enteral nutrition can lead to increased infectious complications. Early enteral nutrition improves outcomes and may maintain muscle mass by blunting the cytokine-mediated hypermetabolic response.