Current opinion in critical care
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Selenium is a trace element essential to human health. Critical illness is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing critically ill patients with antioxidant nutrients may improve survival. Selenium levels can be low due to redistribution to high-priority organs and dilution associated with aggressive resuscitation of the patient. The purpose of this review is to investigate the benefit of selenium supplementation in critically ill patients. ⋯ Selenium, by supporting antioxidant function, may be associated with a reduction in mortality. To demonstrate this large, well-designed randomized trials are required.
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Curr Opin Crit Care · Apr 2006
ReviewContinuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis.
This review highlights recent advances in cerebral microdialysis as a tool for neurochemical monitoring of patients with traumatic brain injury. ⋯ Microdialysis is established as a neurochemical research tool in neurointensive care, particularly in combination with other monitoring methods, and contributes to a growing knowledge of secondary injury mechanisms in traumatic brain injury. The value of microdialysis as a tool in routine neurointensive care decision-making remains unclear.
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Mechanical ventilation generates an increase in airway pressure and, therefore, in intrathoracic pressure, which may decrease systemic and intraabdominal organ perfusion. Critically ill patients rarely die of hypoxia and/or hypercarbia but commonly develop a systemic inflammatory response that culminates in multiple-organ dysfunction syndrome and death. In the pathogeneses of this syndrome the gastrointestinal tract and liver have received considerable attention. ⋯ In critically ill patients mechanical ventilation should be adjusted to avoid conditions known to be associated with decreased gastrointestinal and splanchnic perfusion.
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Curr Opin Crit Care · Apr 2006
ReviewContinuous monitoring of the microcirculation in neurocritical care: an update on brain tissue oxygenation.
This article summarizes recent clinical and experimental studies of parenchymal brain tissue oxygen monitoring and considers future directions for its use in neurocritical care. ⋯ The use of brain tissue oxygen monitoring is maturing as a tool to detect and treat secondary brain injury. PbrO2 measurements can provide continuous quantitative data about injury pathophysiology and severity that may help optimize neurointensive care management. Prospective trials of PbrO2 guided treatment protocols are now needed to demonstrate impact on clinical outcomes.
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Curr Opin Crit Care · Apr 2006
ReviewEarly enteral nutrition in the critically ill: do we need more evidence or better evidence?
Nutritional support of the critically ill is accepted as a standard of care. Recommendations for early enteral nutrition are based on reasonable evidence but only 50% of eligible patients receive enteral nutrition within 48 h of admission to the intensive care unit. The purpose of this review is to determine how recent developments advance the current state of knowledge. ⋯ Higher levels of evidence, demonstrating benefit to a patient-oriented outcome, are more likely to change practice. The addition of more level II trials to a meta-analysis composed of level II trials may not convince clinicians to change practice. A level I trial (equivalent to a phase III Food and Drug Administration licensing trial) is required to convince more clinicians to provide early enteral nutrition. A level I trial would also provide an important opportunity to validate changes in disease-oriented outcomes (measures of nutritional status) against improvements in patient-oriented outcomes.