Current opinion in critical care
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Early aggressive treatment of poor-grade subarachnoid hemorrhage patients has resulted in more favorable long-term outcomes. This article covers the aspects of neurocritical care management directed to the patient with poor-grade subarachnoid hemorrhage (Hunt and Hess 4 and 5) and outlines important prognostic features. ⋯ Poor-grade subarachnoid hemorrhage patients have the potential to recover and should therefore be fully resuscitated and treated aggressively with the available standards and monitoring techniques.
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Curr Opin Crit Care · Apr 2011
ReviewAcute-on-chronic liver failure: concept, natural history, and prognosis.
A population of patients with previously compensated cirrhosis will develop acute deterioration resulting in multiorgan failure and high short-term mortality. Complications of cirrhosis frequently culminate in admissions to the ICU. This review advances the concept of acute-on-chronic liver failure as a distinct clinical entity. ⋯ Acute-on-chronic liver failure may be a distinct clinical entity with a potential for reversibility when identified early and managed with aggressive critical care support.
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Status epilepticus is one of the most common emergencies in neurology, and every third patient does not respond to adequate first-line treatment. Refractory status epilepticus may be associated with increased morbidity and mortality, and new treatment options are urgently required. This review critically discusses recently published data regarding the role of 'new' antiepileptic drugs, the efficacy and safety of anesthetic agents, and the overall clinical outcome that is an integral part of treatment decisions. ⋯ Unambiguous recommendations regarding treatment strategies for refractory status epilepticus are limited by a lack of reliable data. Therefore, randomized controlled trials or at least prospective observational studies based on strict protocols incorporating long-term outcome data are urgently required.
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ICU delirium is a common and serious acute brain dysfunction with adverse outcome and high risk of mortality. The awareness of ICU delirium as a problem, which immediately requires therapeutic intervention, has been increased in the past years. This article aims to provide information in order to increasingly modify the management of this severe problem, that is, its detection, prevention, and treatment toward algorithm-based and protocol-driven procedures. ⋯ The management of ICU delirium must be a key aspect to improve the outcome of critically ill patients. The development of pharmacological treatment strategies and deeper understanding of the underlying pathophysiology will require further research.
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Curr Opin Crit Care · Apr 2011
ReviewMultiple organ failure in sepsis: prognosis and role of systemic inflammatory response.
To describe the pathogenesis and emphasize prognosis of systemic inflammatory response during severe infection. ⋯ Sepsis is viewed as an excessive host response to pathogen inducing a complex network of molecular cascades leading to tissue damages, organ failures, and death.