Current opinion in critical care
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Continuous electroencephalography (cEEG) is being used more frequently in intensive care units to detect epileptic activity and ischemia. This review analyzes clinical applications and limitations of cEEG as a routine neuromonitoring tool. ⋯ cEEG should be considered as an integral part of multimodality monitoring of the injured brain, particularly in patients at risk for nonconvulsive seizure or ischemia. Automated alarms may help establish cEEG monitoring as an integral part of brain monitoring. All neurological ICUs that routinely care for patients with refractory status epilepticus should have the capability to perform cEEG monitoring. Further research determining the impact on outcome and making EEG monitoring more user friendly may help move this technique out of the subspecialized ICU setting into the general ICU environment. In the future, it may be possible to use specific EEG parameters as endpoints for therapeutic interventions.
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Clostridium difficile infection (CDI), long-associated with morbidity and mortality in healthcare settings, has evolved in recent years with unprecedented clinical manifestations. Today, CDI is characterized by unusually toxigenic and resistant subtypes, expanded epidemiology, and a growing list of risk factors. In this article, we discuss current trends and research for CDI in critical care settings, and new controversies that influence clinical practice. ⋯ Annually, CDI adds billions of dollars to US healthcare costs compared with just a few years ago, and reflects a new and profound pattern of morbidity and mortality. As this disease changes, our knowledge and practice patterns must adjust to meet the current challenge of CDI.
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Curr Opin Crit Care · Apr 2009
ReviewPractical management of acute liver failure in the Intensive Care Unit.
Acute liver failure is an uncommon condition affecting about 2500 patients each year in the United States. Optimal medical management in the ICU is one of the more important factors impacting survival with or without liver transplantation. This review focuses on the practical aspects of the management of patients with acute liver failure in the ICU. ⋯ The careful management of the patient in the ICU with acute liver failure improves the likelihood of survival.
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Curr Opin Crit Care · Feb 2009
ReviewMechanical ventilation: epidemiological insights into current practices.
To describe the trends in the results of epidemiological studies of mechanical ventilation. ⋯ The burden of critical illness will likely continue to increase in the future. Evidence from randomized trials appears to have affected the management of mechanical ventilation, but adherence to evidence-based practices may not be ideal.