Critical care clinics
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Critical illness frequently is associated with neurologic failure that may involve the central and peripheral nervous systems. Central nervous system failure is associated with a spectrum of neurobehavioral changes including delirium, coma, and long-term cognitive dysfunction. ⋯ While the burden of neurological disease complicating critical illness is considerable, preventive or therapeutic options are limited. This article provides an overview of research evaluating the relationship between critical illness and neurologic function, with a special emphasis on underlying mechanisms.
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Critical care clinics · Jan 2008
ReviewMechanisms of neuromuscular dysfunction in critical illness.
The development of neuromuscular dysfunction (NMD) during critical illness is increasingly recognized as a cause of failure to wean from mechanical ventilation and is associated with significant morbidity and mortality. At times, it is difficult to identify the presence of NMD and distinguish the etiology of the weakness in patients with critical illness, but subtle clinical findings and bedside electrophysiologic testing are helpful in establishing the diagnosis. This article describes the clinical spectrum of acquired neuromuscular weakness in the setting of critical illness, provides an approach to diagnosis, and discusses its pathogenesis. Finally, a defective sodium channel regulation as a unifying mechanism underlying NMD in critically ill patients is proposed.
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Critical care clinics · Jan 2008
ReviewThe pathophysiology of long-term neuromuscular and cognitive outcomes following critical illness.
Despite the recent and marked improvement in short-term mortality after critical illness, significant morbidities persist for many patients following hospital discharge. This article discusses the risk factors for muscle, nerve, and brain dysfunction after critical illness and preliminary basic science data to support possible pathophysiologic mechanisms mediating this disability. Additionally, it presents a roadmap outlining future directions in this area of research.
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Critical care clinics · Jan 2008
ReviewThe alteration of autonomic function in multiple organ dysfunction syndrome.
Autonomic dysfunction is associated with the severity of illness and mortality in patients with multiple organ dysfunction syndrome (MODS) and may contribute significantly to the pathogenesis of this syndrome. Several treatment approaches may possibly restore autonomic function in MODS and thus cause the survival benefit.
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Brain dysfunction is a severe complication of sepsis with an incidence ranging from 9% to 71% that is associated with increased morbidity and mortality. Its diagnosis relies mainly on neurologic examination with clinical manifestations ranging from confusion to coma. An electroencephalogram, somatosensory evoked potentials, and measurement of plasma S-100b protein and neuron-specific enolase can be useful for the detection of brain dysfunction. ⋯ The mechanism of sepsis-associated encephalopathy involves inflammatory and non-inflammatory processes that affect endothelial cells, glial cells, and neurons and induce blood-brain barrier breakdown, derangements of intracellular metabolism, and cell death. Specific treatments for sepsis-associated encephalopathy need to be developed. Currently, treatment is mainly the management of sepsis.