Critical care clinics
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Critical care clinics · Jan 1997
ReviewTranscranial Doppler ultrasonography in the neurocritical care unit.
TCD ultrasonography is a noninvasive means to study the cerebral vasculature. By varying the depth and angle of insonation of a pulsed sound wave, the direction and velocity profile of the cerebral arteries can be ascertained. This can be used to identify areas of focal stenosis and increased resistance and to estimate the adequacy of cerebral flow. ⋯ TCD ultrasonography is capable of studying dynamic cerebrovascular processes. By being able to determine vessel patency, TCD may become a useful adjuvant to thrombolytic therapy. Continuous monitoring of flow velocities and profiles along with testing to cerebrovascular reserve promises to be a future active area of research.
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Critical care clinics · Jan 1997
ReviewManagement of hypertension in acute intracerebral hemorrhage.
Hypertension commonly occurs in the acute period following spontaneous intracerebral hemorrhage. Management of this hypertension is controversial. Some advocate lowering blood pressure to reduce the risk of bleeding, edema formation, and systemic hypertensive complications, whereas others advocate allowing blood pressure to run its natural course as a protective measure against cerebral ischemia. This article reviews the pertinent clinical and experimental data regarding these issues and briefly discusses the use of antihypertensive agents commonly administered in this setting.
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The leading cause of acute neuromuscular weakness in the developed world is Guillain-Barré syndrome (GBS). Mortality rates vary widely. This article discusses the care and management of patients with GBS, with an emphasis on those patients who require admission to an intensive care unit.
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Critical care clinics · Jan 1997
ReviewNutritional management of the critically ill neurologic patient.
To summarize, the event of severe neurologic injury results in significant metabolic changes. These changes cause increased requirements for protein and nonprotein calories, micronutrients, and small bowel feedings or TPN. Early feeding has been shown to improve survival. ⋯ Provide 40% to 70% above basal needs as total calories, with 30% to 40% of calories as lipid to minimize hyperglycemia. Provide protein as small peptides to improve tolerance, absorption, utilization, and gut integrity. Provide a lipid source with 50% to 70% medium-chain triglycerides and an omega-6 to omega-3 ratio of 2:1 to 8:1 to minimize negative effects of omega-6 fatty acids and provide an easily absorbed and utilized source of lipid.
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Critical care clinics · Jan 1997
ReviewIntravenous agents and intraoperative neuroprotection. Beyond barbiturates.
The authors discuss the role of intravenous anesthetic agents in brain protection. The newer intravenous anesthetics, etomidate and propofol, have been proposed as neuroprotective agents. Thiopental remains the drug of choice, however, for use prior to intraoperative ischemic events. The anesthetic ketamine presents surprising similarities to other N-methyl-D-aspartate receptor inhibitors, but remains controversial in its use in neurologically compromised patients.