Current opinion in critical care
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To discuss the concept and implementation of regionalized postcardiac arrest care. ⋯ It is feasible to implement a large system of care in which eligible postcardiac patients are triaged to centers capable of delivering standardized, state-of-the art postarrest care. Further research is warranted to determine the optimal design of such a system of care.
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Intracerebral hemorrhage (ICH) is the most serious but least treatable form of stroke, with prognosis critically dependent on both the size and degree of hematoma expansion. Treatments that target hematoma expansion offer potential to improve outcomes. This review analyzes the recent literature pertaining to the medical management of ICH. ⋯ In patients with acute ICH, rapid intensive BP-lowering treatment may provide protection against hematoma growth without concerns about safety and tolerability. How well such treatment can translate into overall benefits to patients is yet to be determined. At present, recombinant activated factor VII cannot be recommended for routine use, although BP lowering should generally follow conservative guidelines.
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Fever in the neurocritical care setting is very common and has a negative impact on outcome of all disease types. Recent advances have made eliminating fever and maintaining normothermia feasible. However, important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. ⋯ The negative impact of fever after neurologic injury is well understood. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential infectious risk of prolonged fever control.
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This review highlights recent advances in cerebral microdialysis for investigational and clinical neurochemical monitoring in patients with critical neurological conditions. ⋯ Cerebral microdialysis is an established tool for neurochemical research in the ICU. This technique cannot be fruitfully used in isolation, but when combined with other monitoring methods provides unique insights into the biochemical and physiological derangements in the injured brain.
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Curr Opin Crit Care · Apr 2009
ReviewManagement of cardiac arrest patients to maximize neurologic outcome.
Each year, hundreds of thousands of people will be resuscitated after a cardiac arrest. A significant portion of these patients will lapse into a disease state which is the product of modern emergency and critical care medicine: the postcardiac arrest syndrome. The ability to return a patient to his or her prior state of health after cardiac arrest, once completely beyond the capacities of clinicians, is now one of the most important areas of medical science. Much of this ability depends on preserving the nervous system from a complicated sequence of secondary injuries, which ensue from global ischemia. ⋯ This study reviews the latest advances in treating patients after cardiac arrest in the emergency department and critical care unit environments.