Current opinion in critical care
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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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This review will give an overview of current trends in diagnosis, treatment, and pathogenesis of ascites and intraabdominal infection in cirrhotic and noncirrhotic critically ill patients. ⋯ Emerging pathophysiological concepts have modified the conventional view of hydrostatic and Starling forces in the evolution of ascites. Current data indicate that the dynamic sequence of bacterial translocation, mesenteric inflammation, splanchnic vasodilatation and intrahepatic vasoconstriction determines occurrence, severity, and outcome of ascites and intraabdominal infection.
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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.