Current opinion in critical care
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Curr Opin Crit Care · Apr 2006
ReviewEarly enteral nutrition in the critically ill: do we need more evidence or better evidence?
Nutritional support of the critically ill is accepted as a standard of care. Recommendations for early enteral nutrition are based on reasonable evidence but only 50% of eligible patients receive enteral nutrition within 48 h of admission to the intensive care unit. The purpose of this review is to determine how recent developments advance the current state of knowledge. ⋯ Higher levels of evidence, demonstrating benefit to a patient-oriented outcome, are more likely to change practice. The addition of more level II trials to a meta-analysis composed of level II trials may not convince clinicians to change practice. A level I trial (equivalent to a phase III Food and Drug Administration licensing trial) is required to convince more clinicians to provide early enteral nutrition. A level I trial would also provide an important opportunity to validate changes in disease-oriented outcomes (measures of nutritional status) against improvements in patient-oriented outcomes.
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Curr Opin Crit Care · Apr 2006
ReviewMedical complications after subarachnoid hemorrhage: new strategies for prevention and management.
To summarize new concepts regarding the occurrence, prevention, and management of medical complications following subarachnoid hemorrhage. ⋯ Clinical trials to investigate interventions targeted at preventing or treating common medical complications after subarachnoid hemorrhage are needed.
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Curr Opin Crit Care · Apr 2006
ReviewOptimizing perioperative management of patients undergoing colorectal surgery: what is new?
This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes. ⋯ There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not utilized in daily practice. Further evidence has emerged supporting several perioperative treatments, and successful experiences of enhanced-recovery programmes have now been reported from several centres.
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A recent editorial proclaimed, 'Glutamine, a life saving nutrient, but why?' This review will assess if recent data support glutamine as a life-saving nutrient in critical illness, and, if so, utilize new understanding of gene-nutrient interactions to address potential mechanisms by which glutamine may be 'life-saving'. ⋯ Glutamine may be potentially 'life-saving' in critical illness, particularly when administered in doses greater then 0.3 g/kg/day. Present data indicate that glutamine functions as a 'stress signaling molecule' following illness/injury and thus, needs to be given as a pharmacologic agent, rather then as nutritional replacement. Presently, multicenter clinical trials utilizing glutamine as a drug, independent of nutritional needs, are indicated.
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Curr Opin Crit Care · Apr 2006
ReviewDetecting and treating microvascular ischemia after subarachnoid hemorrhage.
To provide an overview of the current management of cerebral vasospasm following subarachnoid hemorrhage, emphasizing the detection and treatment of delayed ischemia. ⋯ Diagnosis of microvascular ischemia following subarachnoid hemorrhage involves clinical observation, non-invasive determination of cerebral hemodynamic variables, autoregulation studies and invasive online monitoring of cerebral oxygenation and metabolism. Nimodipine is administered prophylactically, while HHH is initiated therapeutically. New causal therapies are being evaluated.