Current opinion in critical care
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We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine. ⋯ Neurocritical care is one of the newest subspecialties of medicine and is at the forefront of bringing effective new therapies to patients with life-threatening neurological diseases.
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Curr Opin Crit Care · Apr 2007
ReviewCurrent status of cerebral protection with mild-to-moderate hypothermia after traumatic brain injury.
The aim of this article is to review the current status of protective effects of mild-to-moderate hypothermia on traumatic brain injury. ⋯ Mild-to-moderate hypothermia plays a significant role in cerebral protection after traumatic brain injury.
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Curr Opin Crit Care · Apr 2007
ReviewNeuroprotection in traumatic brain injury: a complex struggle against the biology of nature.
Translating the efficacy of neuroprotective agents in experimental traumatic brain injury to clinical benefit has proven an extremely complex and, to date, unsuccessful undertaking. The focus of this review is on neuroprotective agents that have recently been evaluated in clinical trials and are currently under clinical evaluation, as well as on those that appear promising and are likely to undergo clinical evaluation in the near future. ⋯ Traumatic brain injury is a complex disease, and development of clinically effective neuroprotective agents is a difficult task. Experimental traumatic brain injury has provided numerous promising compounds, but to date these have not been translated into successful clinical trials. Continued research efforts are required to identify and test new neuroprotective agents, to develop a better understanding of the sequential activity of pathophysiologic mechanisms, and to improve the design and analysis of clinical trials, thereby optimizing chances for showing benefit in future clinical trials.
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The review highlights current insights in the epidemiology, diagnosis and therapy of Candida peritonitis, focusing on complicated secondary and tertiary peritonitis. ⋯ The main challenge in Candida peritonitis remains the interpretation of Candida cultured from the peritoneal cavity. Future research should focus on more conclusive diagnosis and on factors potentially confounding outcome, such as site of the perforation and failure of surgical source control. While awaiting progress to discriminate Candida colonization from invasive infection, antifungal therapy is recommended in high-risk critically ill surgical patients. Rapid detection of Candida might be beneficial in this regard. Besides antifungal therapy, adequate source control is of key importance.
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Curr Opin Crit Care · Apr 2007
ReviewGastrointestinal motility and prokinetics in the critically ill.
Enteral nutrition is frequently unsuccessful in the critically ill due to gastrointestinal dysfunction. Current treatment strategies are often disappointing. In this article upper gastrointestinal function in health together with abnormalities seen during critical illness are reviewed, and potential therapeutic options summarized. ⋯ There has been considerable progress in understanding the pathogenesis of mechanisms causing feed intolerance in critical illness, but this is yet to be translated into therapeutic benefit.