Current opinion in critical care
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Curr Opin Crit Care · Apr 2007
ReviewHemodynamic manipulation in the neuro-intensive care unit: cerebral perfusion pressure therapy in head injury and hemodynamic augmentation for cerebral vasospasm.
The intent of this manuscript is to summarize the pathophysiologic basis for hemodynamic manipulation in subarachnoid hemorrhage and traumatic brain injury, highlight the most recent literature and present expert opinion on indications and use. ⋯ Hemodynamic manipulation is routinely used in the management of patients with acute vasospasm following subarachnoid hemorrhage and severe head injury. The rationale is to improve blood flow to the injured brain and prevent secondary ischemia.
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Controversy still exists about the management of spontaneous intracerebral haemorrhage. This review summarizes our current knowledge on indications and benefits of surgery for intracerebral haemorrhage. It further describes the detailed meta-analysis of the surgical results in lobar (superficial) supratentorial intracerebral haemorrhage, summarizes the limited information on the surgical treatment of cerebellar intracerebral haemorrhage, and identifies three ongoing trials. ⋯ Clinicians are encouraged to discover if the suspected beneficial role of surgery truly exists by randomizing patients with intracerebral haemorrhage in the ongoing prospective randomized controlled trials in the following circumstances: lobar intracerebral haemorrhage (clot reaches to within 1 cm of the cortical surface), STICH II; intraventricular haemorrhage (clot maximum size of 30 ml), CLEAR IVH; deep intracerebral haemorrhage and minimal invasive surgery, MISTIE.
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We summarize the therapeutic approach to patients with acute liver failure with the main focus on bioartificial and artificial liver support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute liver failure. ⋯ Mortality in patients with acute liver failure is still unacceptably high. The most effective treatment, liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal liver assist.
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This is a review on the techniques for assessing liver function in critically ill patients. ⋯ Since no ideal tool is currently available, dynamic tests such as indocyanine green plasma disappearance rate and monoethylglycinxylidide test may be recommended for assessing liver function in critically ill patients. The indocyanine green plasma disappearance rate has the advantage, however, of being measurable noninvasively at the bedside and providing results within a few minutes.
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We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine. ⋯ Neurocritical care is one of the newest subspecialties of medicine and is at the forefront of bringing effective new therapies to patients with life-threatening neurological diseases.