Critical care clinics
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Neuromuscular sequelae are common in the critically ill. Critical illness polyneuropathy and critical illness myopathy are neuromuscular complications of sepsis or iatrogenic complications of treatments required in intensive care. This article discusses the diagnosis, treatment, and prognosis of these disorders based on a literature review. This review found that glycemic control, early mobilization, and judicious use of steroids and neuromuscular blocking agents are the primary approaches to reduce the incidence and severity of neuromuscular complications in affected patients.
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Critical care clinics · Oct 2014
ReviewIntracranial Pressure Monitoring and Management of Intracranial Hypertension.
Intracranial pressure (ICP) monitoring is considered the standard of care in the majority of neurosurgical centers in North America and Europe. ICP is a reflection of the relationship between alterations in craniospinal volume and the ability of the craniospinal axis to accommodate added volume. ICP cannot be reliably estimated from any specific clinical feature or CT finding and must be directly measured. This review describes methods of monitoring ICP and how monitoring technique can provide additional information and provides key points regarding the treatment of intracranial hypertension in the neuro-ICU.
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Critical care clinics · Oct 2014
ReviewBrain Death and Management of a Potential Organ Donor in the Intensive Care Unit.
The concept of brain death developed with the advent of mechanical ventilation, and guidelines for determining brain death have been refined over time. Organ donation after brain death is a common source of transplant organs in Western countries. ⋯ Management of potential organ donors must take into consideration specific pathophysiologic changes for medical optimization. Future aims in intensive and neurocritical care medicine must include reducing practice variability in the operational guidelines for brain death determination, as well as improving communication with families about the process of determining brain death.
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Cardiogenic shock is the most common cause of in-hospital mortality for patients who have suffered a myocardial infarction. Mortality exceeds 50% and management is focused on a rapid diagnosis of cardiogenic shock, restoration of coronary blood flow through early revascularization, complication management, and maintenance of end-organ homeostasis. Besides revascularization, inotropes and vasodilators are potent medical therapies to assist the failing heart. Pulmonary arterial catheters are an important adjunctive tool to assess patient hemodynamics, but their use should be limited to select patients in cardiogenic shock.
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Patients admitted to the intensive care unit (ICU) are at increased risk for cardiac arrhythmias, the most common of which can be subdivided into tachyarrhythmias and bradyarrhythmias. These arrhythmias may be the primary reason for ICU admission or may occur in the critically ill patient. This article addresses the occurrence of arrhythmias in the critically ill patient, and discusses their pathophysiology, implications, recognition, and management.