Current opinion in critical care
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To examine the evidence of regional cerebral ischemia after traumatic brain injury. ⋯ There is increasing evidence to suggest that a small but significant volume of brain tissue is at risk of ischemic injury after trauma. Future studies should examine the pathophysiology underlying such ischemia and how monitoring techniques can be used to direct appropriate therapy and influence outcome.
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Currently, no neuroprotective therapies have been shown to reduce the secondary neuronal damage occurring after traumatic brain injury. Recent studies have addressed the potentiality of hyperoxia to ameliorate brain metabolism after traumatic brain injury. In this article, we present the principles of oxygen transport to the brain, the effects of hyperoxia on cerebral metabolism, and the role of lactate in brain metabolism after traumatic brain injury. ⋯ At present, there is no evidence supporting any clinical benefit of hyperoxia in brain-injured patients, and the meaning of posttraumatic brain extracellular lactate accumulation should be further investigated.
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A number of papers have suggested that the splanchnic circulation and oxidative metabolism are compromised in critical illness. This review discusses this hypothesis and outlines the recent advances in the understanding of splanchnic metabolism with special focus on acute liver failure and hyperdynamic sepsis. ⋯ There is increasing evidence that both acute liver failure and sepsis are accompanied by a hypermetabolic state in the hepatosplanchnic area, characterized by enhanced glycolysis and hyperlactatemia. This should not be rigorously interpreted as an indication of hypoxia. In fact, clinically important splanchnic hypoxia may be a relatively uncommon phenomenon in such patients.
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To review and examine the efficacy of recently described medical and surgical interventions after acute ischaemic stroke using data from well conducted, clinical trials and systematic reviews. This review will consider recently published or updated articles. ⋯ It is estimated that there will be 8.5 million patients with acute ischaemic stroke in the European Union and the USA over the next decade, and of these, about one and a half million will die within six months of stroke onset. Of those who survive, about one third will depend on other people for help with their activities of daily living. Future treatment strategies are likely to involve agents that re-canalise vessels and minimise further neuronal damage.
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Curr Opin Crit Care · Apr 2004
ReviewIs it wise not to think about intraabdominal hypertension in the ICU?
This review focuses on the available literature published in the past 2 years. MEDLINE and PubMed searches were performed using intraabdominal pressure, intraabdominal hypertension, and abdominal compartment as search items. The aim was to find an answer to the question: "Is it wise not to measure or even not to think about intraabdominal hypertension in ICU?" ⋯ The answer is that it is unwise not to measure intraabdominal pressure in the ICU or even not to think about it.