Current opinion in critical care
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Since the development of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke (AIS), functional outcome has improved when treatment occurs within 4.5 h of stroke onset and treatment benefits are greater with earlier treatment. Endovascular revascularization also is better the sooner it is delivered. ⋯ MSUs likely will evolve further and be used for other acute neurologic disorders, help triage patients for endovascular therapy, and be incorporated into systems of care in remote areas. Further studies are awaited to fully understand the overall medical and health-economic benefit of MSUs.
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Curr Opin Crit Care · Apr 2020
ReviewUpdate on nutritional assessment and therapy in critical care.
To summarize recent data regarding nutritional assessment and interventions in the ICU. ⋯ Based on recent studies, full energy feeding early during critical illness has no measurable beneficial effect, and may even be harmful, when applied to entire populations. The mechanisms underlying this are unknown and remain proposed theories. Tools to assess nutritional risk in the ICU that identify patients who will benefit from a specific nutritional intervention are lacking. The optimal composition of feeds, and indications for specific interventions for enteral feeding intolerance remain uncertain.
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Curr Opin Crit Care · Apr 2020
ReviewEyeing up the injured brain: automated pupillometry and optic nerve sheath diameter.
Multimodal monitoring has emerged as a novel paradigm of care in acute brain injury, and in this context the value of noninvasive devices is increasingly under scrutiny. This narrative review summarizes recent clinical investigation focused on the role of automated infrared pupillometry (AIP) and optic nerve sheath diameter (ONSD) ultrasound as novel techniques to monitor and manage neurocritical care patients. ⋯ Noninvasive AIP and ONSD appear useful complements to multimodality monitoring of acute brain injury, in particular in patients at risk of elevated ICP and for early neuroprognostication following cardiac arrest.
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The review focuses on the evaluation and management of abdominal sepsis. ⋯ Early clinical diagnosis, adequate source control to stop ongoing contamination, appropriate antibiotic therapy dictated by patient and infection risk factors, and prompt resuscitation are the cornerstones of its management.
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Curr Opin Crit Care · Apr 2020
ReviewThe gastrointestinal system in the critically ill cirrhotic patient.
ICU admissions due to complications of advanced liver disease continue to rise. Among indications for admission to the ICU in patients with cirrhosis, gastrointestinal issues such as bleeding are common. In patients in whom gastrointestinal issues are not the principal indication for ICU, gastrointestinal issues such as nutrition and ileus remain important concerns for generalized intensive care support. This review highlights current trends in management of gastrointestinal issues in patients with cirrhosis admitted to the ICU. ⋯ Gastrointestinal complications are frequent in the critically ill cirrhotic patient. Recognition and intervention in a timely manner may minimize morbidity and mortality and result in improved outcomes for this vulnerable population.