Current opinion in critical care
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The review covers the main aspects of thermoregulation physiology and highlights the implications for therapeutic hypothermia trials. Prevention of shivering and other hypothermia side-effects is of key importance because controlling thermoregulatory responses may be essential for demonstrating neuro-protective properties of hypothermia in several pathologic conditions in which its role is still uncertain, such as in traumatic brain injury and stroke. ⋯ During moderate hypothermia treatment, conducted in an intensive care environment, shivering can be treated with sedatives, opioids (meperidine in particular), and α2-agonists, combined with active skin counter-warming. However, new randomized controlled clinical trials in intensive care patients are required to improve our knowledge regarding this treatment.
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Curr Opin Crit Care · Apr 2011
ReviewAcute-on-chronic liver failure: extracorporeal liver assist devices.
Acute-on-chronic liver failure (ACLF), a syndrome precipitated by acute liver injury in patients with advanced cirrhosis, is associated with multiorgan dysfunction and high rates of mortality. Liver support systems have been developed in an attempt to improve survival of patients with ACLF by providing a bridge until recovery of the native liver function. ⋯ Liver support systems are safe and well tolerated when used in management of patients with ACLF. Their use should continue in controlled clinical trials to explore their role in bridging patients to liver transplantation or recovery in well defined patient groups.
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Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality, providing substantial scope for improvements in outcome. This review will discuss recent developments and present consensus evidence for the management of ICH. ⋯ Well organized, multimodal therapy optimizing intracranial and systemic physiological variables improves outcome after ICH. Recent guidelines provide a useful consensus evidence-based framework for the management of acute ICH.