Critical care clinics
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This article presents a systematic review of the prognostic factors in coma caused by hypoxia and anoxia, and traumatic head injury. In the case of anoxic coma, poor prognosis can be determined very accurately at the bedside by the lack of brainstem reflexes assessed at day three post-insult. ⋯ Evoked potentials performed within the first week detect approximately half of patients with a poor prognosis. EEG adds only a small amount of prognostic information.
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Critical care clinics · Jul 1998
Meta AnalysisAn evidence-based approach to noninvasive ventilation in acute respiratory failure.
This article reviews the literature of noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure. The article divides acute respiratory failure into the categories of primary ventilation failure and oxygenation failure, and examines various diagnostic groups within these categories. Although the use of NPPV for patients with acute respiratory failure of other etiologies requires further study, the authors conclude that there is sufficient evidence to support the use of NPPV in acute, severe exacerbations of chronic obstructive pulmonary disease.
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Critical care clinics · Jul 1998
Meta AnalysisAn evidence-based approach to pressure- and volume-limited ventilation strategies.
In summary, based on the evidence reviewed, clinicians should continue to adopt a pressure-limited ventilation strategy for patients with acute lung injury, but combine this strategy with relatively liberal use of PEEP. Critical care clinicians can look forward to more information about the degree of hypercapnia that can be safely permitted in the full reports of the RCTs reviewed and in related critical care literature.
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Critical care clinics · Jul 1998
Meta AnalysisNutritional support in the critically ill patients. A critical review of the evidence.
Providing nutritional support has become a standard component of managing critically ill patients. While many studies have documented that providing nutritional support can change nutritional outcomes (e.g., amino acid profile, weight gain, nitrogen balance), data are lacking that demonstrate that nutrition actually influences clinically importance endpoints. This article systematically reviews and critically appraises the literature, examining the relationship between nutritional support and infectious morbidity and mortality in the critically ill patient. In addition, evidence-based recommendations are made.
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Critical care clinics · Jul 1998
ReviewAn evidence-based approach to management of increased intracranial pressure.
Current treatment of many conditions associated with elevated ICP of the brain involves stabilization and oxygenation with maintenance of adequate perfusion of cerebral tissue, while maintaining an acceptable ICP. As an example of a standard protocol that is in concordance with what is already known about a patient with a severe head injury, the first priority is radiographic screening for a surgical lesion. ⋯ Acutely elevated ICP is treated with mannitol, and if this fails, patients are routinely sedated, paralyzed, and mildly hyperventilated, while repeat radiology is obtained to rule out a further surgical lesion. Hypothermia, aggressive hyperventilation, and barbiturate coma continue to be used and are reserved for intractable ICP elevation, or as warranted based on a specific patient (Table 2).