Current opinion in critical care
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Curr Opin Crit Care · Apr 2002
ReviewAdvanced monitoring in the intensive care unit: brain tissue oxygen tension.
Cerebral monitoring of patients with acute intracranial disorders generally focuses on intracranial pressure and cerebral perfusion pressure monitoring. Over the past few years, several new techniques have become available for more detailed routine monitoring of cerebral oxygenation and metabolism. Brain tissue oxygen pressure measurement is increasingly being used for evaluation of cerebral oxygenation. ⋯ Published experimental and clinical data are considered, and the current status of the clinical use and indications of the technique are summarized. Monitoring may be performed in relatively undamaged parts of the brain or, preferably, in the penumbra region of an intracerebral lesion. Pathophysiologic evidence warrants targeting therapy for patients with traumatic brain injury and subarachnoid hemorrhage toward improvement of cerebral oxygenation guided by continuous monitoring of brain tissue oxygen tension.
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Curr Opin Crit Care · Apr 2002
ReviewModerate hypothermia in severe head injuries: the present and the future.
The use of therapeutic moderate hypothermia for treating severe traumatic brain injury has been reported for more than 50 years. However, the most intense investigation of this treatment has occurred during the last 10 to 15 years. Virtually all preclinical studies have documented a robust treatment effect, not only in terms of reduced excitotoxicity and cerebral acidosis, but also in terms of histologic preservation and improved behavioral outcomes. ⋯ Current investigations, particularly in the preclinical arena, are focusing on combination therapy. To date, however, the addition of fibroblast growth factor, cyclosporine, or interleukin (IL)-10 to therapeutic moderate hypothermia has not been found to provide greater benefit than either therapy when used alone. Future investigations are aimed at further identifying the physiologic mechanisms responsible for secondary brain injury and ways in which other novel combination therapies may be expected to improve outcomes.
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Curr Opin Crit Care · Apr 2002
ReviewDecompressive surgery in the treatment of traumatic brain injury.
According to European Brain Injury Consortium (EBIC) and American Brain Injury Consortium (ABIC) guidelines for severe head injuries, decompressive craniectomy is one therapeutic option for brain edema that does not respond to conventional therapeutic measures. As a result of the failure of all recently developed drugs to improve outcome in this patient group, decompressive craniectomy has experienced a revival during the last decade. ⋯ Decompressive craniectomy may, however, be the only method available in developing countries with limited ICU and monitoring resources. Prospectively controlled and randomized studies to definitively evaluate the effect of this old neurosurgical method on outcome in patients with traumatic brain injury (TBI) are forthcoming.
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Curr Opin Crit Care · Apr 2002
ReviewLung injury in acute pancreatitis: mechanisms, prevention, and therapy.
Lung injury is the most pertinent manifestation of extra-abdominal organ dysfunction in pancreatitis. The propensity of this retroperitoneal inflammatory condition to engender a diffuse and life-threatening lung injury is significant. ⋯ The variability in the clinical course of pancreatitis renders it a vexing entity and makes demonstration of the efficacy of any specific intervention difficult. The distinct pathologic entity of pancreatitis-associated lung injury is reviewed with a focus on etiology and potential therapeutic maneuvers.