Current opinion in critical care
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Curr Opin Crit Care · Apr 2006
ReviewThe implications of cerebral ischemia and metabolic dysfunction for treatment strategies in neurointensive care.
This review outlines recent observations made in a clinical setting that document the extent and degree of cerebral ischemia and metabolic dysfunction after acute brain injury. The intent is to guide clinicians in considering how best to monitor and treat brain metabolism in the intensive care unit. ⋯ The intensive care of acute brain injury has entered a new era in which monitoring of brain metabolism will permit targeted therapy and may possibly minimize iatrogenic adverse effects by making better use of our powerful therapies.
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Curr Opin Crit Care · Apr 2006
ReviewAre there any real differences between enteral feed formulations used in the critically ill?
We know that adequate nutritional support is essential in the treatment of critically ill patients, because it can, if applied appropriately, improve the clinical outcome. Increasing evidence seems to suggest that malnutrition itself is a predictor of poor outcome in intensive care, and significant underfeeding during intensive care stay increases the risk of bloodstream infections. The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient. ⋯ This review offers information regarding the latest developments in nutritional support via the enteral route. Further research is needed to clarify the role of enteral supplements such as antioxidants and 'immune modulating substances'.
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Curr Opin Crit Care · Apr 2006
ReviewBrain ischaemia after traumatic brain injury: lessons from 15O2 positron emission tomography.
To describe the role of O2 positron emission tomography in studies aimed at understanding ischaemia in head injury. It has been difficult to use cerebral blood flow levels to provide a secure definition of cerebral ischaemia in head injury, since primary changes in cerebral metabolism may be responsible for coupled reductions in cerebral blood flow. Further, regional heterogeneity of pathophysiology can confound global measures of adequacy of cerebral oxygen delivery. There is a need for a technique that can provide a comprehensive and quantitative description of cerebral physiology in this setting. ⋯ There is a clear role for O2 positron emission tomography in elucidating pathophysiology in head injury. The technique may provide most information when combined with other imaging and monitoring tools.
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Curr Opin Crit Care · Feb 2006
ReviewDesigning clinical trials in acute lung injury/acute respiratory distress syndrome.
To review the implications of recent literature for clinical trial design in acute lung injury/acute respiratory distress syndrome (ARDS). ⋯ Clinical trial design in acute lung injury/acute respiratory distress syndrome faces many challenges. Although we have learned much from past trials, persistent design dilemmas must be addressed for future trials.