Current opinion in critical care
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Curr Opin Crit Care · Apr 2006
ReviewMedical complications after subarachnoid hemorrhage: new strategies for prevention and management.
To summarize new concepts regarding the occurrence, prevention, and management of medical complications following subarachnoid hemorrhage. ⋯ Clinical trials to investigate interventions targeted at preventing or treating common medical complications after subarachnoid hemorrhage are needed.
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Curr Opin Crit Care · Apr 2006
ReviewOptimizing perioperative management of patients undergoing colorectal surgery: what is new?
This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes. ⋯ There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not utilized in daily practice. Further evidence has emerged supporting several perioperative treatments, and successful experiences of enhanced-recovery programmes have now been reported from several centres.
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A recent editorial proclaimed, 'Glutamine, a life saving nutrient, but why?' This review will assess if recent data support glutamine as a life-saving nutrient in critical illness, and, if so, utilize new understanding of gene-nutrient interactions to address potential mechanisms by which glutamine may be 'life-saving'. ⋯ Glutamine may be potentially 'life-saving' in critical illness, particularly when administered in doses greater then 0.3 g/kg/day. Present data indicate that glutamine functions as a 'stress signaling molecule' following illness/injury and thus, needs to be given as a pharmacologic agent, rather then as nutritional replacement. Presently, multicenter clinical trials utilizing glutamine as a drug, independent of nutritional needs, are indicated.
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Curr Opin Crit Care · Apr 2006
ReviewDetecting and treating microvascular ischemia after subarachnoid hemorrhage.
To provide an overview of the current management of cerebral vasospasm following subarachnoid hemorrhage, emphasizing the detection and treatment of delayed ischemia. ⋯ Diagnosis of microvascular ischemia following subarachnoid hemorrhage involves clinical observation, non-invasive determination of cerebral hemodynamic variables, autoregulation studies and invasive online monitoring of cerebral oxygenation and metabolism. Nimodipine is administered prophylactically, while HHH is initiated therapeutically. New causal therapies are being evaluated.
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Curr Opin Crit Care · Apr 2006
ReviewClinical treatments for mitochondrial dysfunctions after brain injury.
This review provides a comprehensive look at the evidence supporting the role of mitochondrial dysfunction in promoting neuronal death after acute brain injury, and critically discusses the most recent proposed therapies that could limit the deleterious effects of such a dysfunction on neurological outcome. ⋯ Therapeutic interventions directly targeting processes and mechanisms responsible for mitochondrial dysfunction, may offer neuroprotection in brain-injured patients. The multifactorial cause of mitochondrial dysfunction suggests, however, the need for further studies aimed at clarifying optimal dose and time for drug administration, as well as the logical combination/sequence of those approaches that may ultimately achieve improvement in neurological outcome.