Journal of critical care
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Journal of critical care · Aug 2017
ReviewTransesophageal echocardiography in the evaluation of the trauma patient: A trauma resuscitation transesophageal echocardiography exam.
The point-of-care ultrasound exam has become an essential tool for hemodynamic monitoring and resuscitation in the trauma bay as well as the intensive care unit. Transthoracic ultrasound provides a dynamic assessment of cardiac function, volume status, and fluid responsiveness that offers potential advantage over traditional methods of hemodynamic monitoring. More recently, a focused transthoracic echocardiography exam was described to improve immediate resuscitation of severely injured patients in the trauma bay. ⋯ TEE offers improved visualization of cardiac anatomy and physiology, improved diagnostic accuracy, and real-time assessment of intraoperative resuscitation progress, particularly in the operating room. This review discusses the fundamental principles of echocardiography as well as different ultrasound modes with their respective strengths and limitations. It reviews the current literature on the use of TEE in trauma, and suggests views for a trauma resuscitation transesophageal echocardiography exam (TREE), including sample images and videos.
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Journal of critical care · Jun 2017
Review Meta AnalysisEffect of ulinastatin combined with thymosin alpha1 on sepsis: A systematic review and meta-analysis of Chinese and Indian patients.
To assess the effects of urinary trypsin inhibitor (UTI) ulinastatin combined with thymosin alpha1 (Tα1) on sepsis. ⋯ Treatment of UTI+Tα1 can suppress the production of proinflammatory cytokines, decrease the APACHE II score, shorten the duration of mechanical ventilation, and improve the 28-day survival rate.
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Journal of critical care · Jun 2017
Review Meta AnalysisEffect of ulinastatin combined with thymosin alpha1 on sepsis: A systematic review and meta-analysis of Chinese and Indian patients.
To assess the effects of urinary trypsin inhibitor (UTI) ulinastatin combined with thymosin alpha1 (Tα1) on sepsis. ⋯ Treatment of UTI+Tα1 can suppress the production of proinflammatory cytokines, decrease the APACHE II score, shorten the duration of mechanical ventilation, and improve the 28-day survival rate.
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Journal of critical care · Jun 2017
ReviewReconsidering the role of decompressive craniectomy for neurological emergencies.
There is little doubt that decompressive craniectomy can reduce mortality. However, there is concern that any reduction in mortality comes at an increase in the number of survivors with severe neurological disability. ⋯ It would appear unlikely that further randomised controlled trials will be possible given the significant reduction in mortality achieved by surgical decompression. It may be that observational cohort studies and outcome prediction models may provide data to determine those patients most likely to benefit from surgical decompression.
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Acute liver failure is a rare but potentially devastating disease. Throughout the last few decades, acute liver failure outcomes have been improving in the context of the optimized overall management. This positive trend has been associated with the earlier recognition of this condition, the improvement of the intensive care unit management, and the developments in emergent liver transplantation. Accordingly, we aimed to review the current diagnostic and therapeutic approach to this syndrome, especially in the intensive care unit setting.