Critical care clinics
-
Critical care clinics · Oct 2006
ReviewIntensive care for brain injury after cardiac arrest: therapeutic hypothermia and related neuroprotective strategies.
Neurologic injury is the predominant cause of poor functional outcome in patients who are resuscitated from cardiac arrest. The management of these patients in the ICU can be challenging because of the paucity of effective therapies and lack of readily available diagnostic and prognostic tools. ⋯ The American Academy of Neurology recently enhanced the delivery of care in survivors of cardiac arrest by providing evidence-based practice parameters on the prediction of poor outcome in comatose survivors of cardiac arrest, based on clinical evaluation and diagnostic tests. This article discusses these advances and their potential impact on the care provided in the ICU.
-
Patients with acute brain injury are a distinct group within the ICU who may develop non-neurologic organ dysfunction in the absence of systemic injury or infection. This dysfunction may arise directly as a result of the brain injury or indirectly with complications of brain-specific therapies. This article reviews the current literature with respect to the incidence of organ dysfunction or failure and its association with outcome in patients with acute brain injury. Organ system-specific etiologic considerations and management are discussed.
-
Critical care clinics · Oct 2006
ReviewComa, delirium, and cognitive dysfunction in critical illness.
Syndromes of global cerebral dysfunction that are associated with critical illness include acute disorders (eg, coma, delirium) and chronic processes (ie, cognitive impairment). These syndromes can result from direct cerebral injury; however, many cases develop as a complication of a systemic insult. Coma frequently evolves into phenomenologically distinct disorders of consciousness; it must be differentiated from conditions in which consciousness is preserved, as in the locked-in state. Advances have been made in defining, scoring, and delineating the epidemiology of cerebral dysfunction in the ICU, but research is needed to elucidate underlying mechanisms, with the goal of identifying targets for prevention and therapy.
-
Temperature management in acute neurologic disorders has received considerable attention in the last 2 decades. Numerous trials of hypothermia have been performed in patients with head injury, stroke, and cardiac arrest. ⋯ Detrimental effects of fever and benefits of normalizing elevated temperature in experimental models are discussed. This article presents a detailed analysis of trails of induced hypothermia in patients with acute neurologic insults and describes methods of fever control.
-
Critical care clinics · Oct 2006
ReviewAdvances in the management of seizures and status epilepticus in critically ill patients.
Seizures and status epilepticus are common in critically ill patients. They can be difficult to recognize because most are non-convulsive and require electroencephalogram monitoring to detect; hence, they are currently underdiagnosed. ⋯ Anti-seizure medication should be combined with management of the underlying cause and reversal of factors that can lower the seizure threshold, including many medications, fever, hypoxia, and metabolic imbalances. This article discusses specific treatments and specific situations, such as hepatic and renal failure patients and organ transplant patients.