Current opinion in critical care
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Diagnosis of acute mesenteric ischemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischemia may be treated with urgent intestinal revascularization. ⋯ Intestinal revascularization in patients with arterial occlusive mesenteric ischemia reduces bowel morbidity and mortality. Observational studies report that both endovascular and open vascular therapy options are effective, but endovascular technique may be preferred in these often elderly and fragile patients.
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Curr Opin Crit Care · Apr 2015
ReviewRationale for lumbar drains in aneurysmal subarachnoid hemorrhage.
The amount of blood in the basal cisterns is predictive for the final outcome after aneurysmal subarachnoid hemorrhage (SAH) and clinical problems such as delayed cerebral ischemia and angiographic vasospasm. A lumbar drainage presents an additional, physiologically appealing treatment. In contrast to an external ventricular drain, stasis of clots is thought to be prevented and clearance of the basal cisterns accelerated. In theory, patients with higher clinical grades and dense layers of subarachnoid blood should benefit most. ⋯ At present, no definite conclusions and recommendations on lumbar drains in patients after aneurysmal SAH are warranted.
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To summarize existing evidence on definition, epidemiology, mechanisms, risk factors, consequences, outcome and management of diarrhoea in the critically ill. ⋯ A definition of diarrhoea and a practical approach to identify the precipitant and to manage diarrhoea in critically ill patients are proposed.
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Curr Opin Crit Care · Apr 2015
ReviewRecommendations for management of large hemispheric infarction.
Large hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema. ⋯ Large hemispheric infarcts continue to have significant morbidity and mortality. Recent guidelines have provided an excellent framework to help intensivists manage these complicated patients. Recent surgical data continue to support early hemicraniectomy even in elderly patients.
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Curr Opin Crit Care · Apr 2015
ReviewReversal of the novel oral anticoagulants dabigatran, rivoraxaban, and apixaban.
We summarize the available data related to reversing the anticoagulant effect of the oral direct thrombin and factor Xa inhibitors and provide our opinion on treating patients presenting with severe and life-threatening hemorrhage related to these agents. ⋯ In the absence of evidence in bleeding patients, animal models and ex-vivo studies suggest administration of coagulant factors in the form of hemostatic agents may be of benefit in reversing the effect of direct thrombin and factor Xa inhibitors. Specific reversal agents and clinical data in patients with hemorrhage remain an unmet need.