Current opinion in critical care
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Traumatic brain injury (TBI) is a leading cause of death and long-term cognitive and behavioral dysfunction in children and young adults, yet effective treatments are lacking, in part because critical aspects of TBI neurobiology and natural history are not understood. We review recent advances in neuroimaging and discuss how they are helping to address these fundamental gaps. ⋯ Refinements in neuroimaging offer a window into the complex neuroanatomical and neurophysiological disturbances induced by TBI. Research is needed to understand how these alterations evolve with time and in response to therapeutic interventions.
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Curr Opin Crit Care · Apr 2010
ReviewInfectious intracranial complications in the neuro-ICU patient population.
To provide an overview of infectious intracranial complications secondary to invasive procedures or trauma in the neuro-ICU patient population. Nosocomial infections of the central nervous system are a serious complication contributing to morbidity, prolonged length of stay in the ICU and/or hospital, and mortality of neurocritical care patients. ⋯ Despite recent advances in prevention and treatment, the management of nosocomial intracranial infections still poses a challenge to the neuro-ICU specialist and must consider timely diagnosis and prompt initiation of appropriate antibiotic therapy. This review focuses on the definition, epidemiology, clinical features, and therapeutical approach to this distinct complication of neurocritical care.
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Curr Opin Crit Care · Apr 2010
ReviewThe neuro-ICU patient and electroencephalography paroxysms: if and when to treat.
To review recent clinical data and summarize actual recommendations for the management of electrographic seizures and status epilepticus in neuro-ICU patients. ⋯ We provide a pragmatic approach for the management of electrographic seizures in neuro-ICU patients. International consensus guidelines on continuous electroencephalography monitoring and seizure therapy are needed and would represent the rationale for a future multicenter randomized trial.
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This review presents important pathophysiological alterations associated with impaired liver function and discusses protective perioperative strategies and the various anaesthetic agents recommended. ⋯ Targeted perioperative liver protection still lacks adequate monitoring tools and is currently based on optimization of global haemodynamic variables. While there is currently no evidence suggesting a positive effect of ischaemic preconditioning, promising experimental results of pharmacological preconditioning and therapeutic hypothermia require further evaluation in larger randomized clinical trials.
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Critical illness myopathy and neuropathy are common complications in the ICU, causing limb and respiratory muscle weakness. We review the most recent data concerning their presentation, diagnosis and treatment. ⋯ Systematic application of diagnostic criteria and early physiotherapy may help clinicians to timely diagnose critical illness myopathy and neuropathy and to reduce the associated morbidity.