| 1. |
- Blaser, Annika Reintam, et al.
(författare)
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Acute mesenteric ischaemia
- 2022
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Ingår i: Current Opinion in Critical Care. - : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 28:6, s. 702-708
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review To summarize the recent evidence on acute mesenteric ischaemia (AMI). Recent findings The overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce. Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI. Improved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.
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| 2. |
- Chew, Michelle, et al.
(författare)
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Echocardiography in shock
- 2023
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Ingår i: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 29:3, s. 252-258
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Forskningsöversikt (refereegranskat)abstract
- Purpose of reviewThe aim of this study was to illustrate the varying roles of echocardiography in all phases of shock ranging from a rapid, diagnostic tool at the bedside, to a tool for monitoring the adequacy and effects of shock treatment and finally for identification of patients suitable for de-escalation of therapy.Recent findingsEchocardiography has become an indispensable tool for establishing diagnosis in patients with shock. It is also important for assessing the adequacy of treatment such as fluid resuscitation, vasopressors and inotropes by providing integrated information on cardiac contractility and systemic flow conditions, particularly when used in conjunction with other methods of advanced haemodynamic monitoring. Apart from a traditional, diagnostic role, it may be used as an advanced, albeit intermittent, monitoring tool. Examples include the assessment of heart-lung interactions in mechanically ventilated patients, fluid responsiveness, vasopressor adequacy, preload dependence in ventilator-induced pulmonary oedema and indications for and monitoring during extracorporeal life support. Emerging studies also illustrate the role of echocardiography in de-escalation of shock treatment.This study provides the reader with a structured review on the uses of echocardiography in all phases of shock treatment.
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| 3. |
- Chew, Michelle, et al.
(författare)
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Myocardial injury after noncardiac surgery: facts, fallacies and how to approach clinically
- 2021
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Ingår i: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 27:6, s. 670-675
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review Acute myocardial injury occurs commonly during perioperative care. There is still considerable confusion regarding its diagnosis and definition, and a lack of consensus on who and how to screen, exacerbated by a lack of studies addressing how to manage patients with detected myocardial injury. Recent findings Far from a benign biochemical anomaly, myocardial injury occurring perioperatively is largely a silent disease and is not necessarily because of ischaemia. Preoperative, postoperative, and perioperative changes in cardiac troponins (cTns) are independently associated with increased mortality and adverse cardiovascular outcomes. Routine screening with cTns is required for reliable detection of myocardial injury. Measurement of changes (from preoperative to postoperative) will detect acute events as well as identify patients with chronic troponin increases. This review aims to bring together current literature regarding myocardial injury that is detected perioperatively, identifies knowledge gaps for future research and provides suggestions for management.
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| 4. |
- Hedenstierna, Göran, et al.
(författare)
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Influence of abdominal pressure on respiratory and abdominal organ function
- 2012
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 18:1, s. 80-85
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review:Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been realized as severe complications in the intensive care patient. Laparoscopic surgery in older and more obese patients increases the risk of IAH and ACS.Recent findings:The incidence of IAH may be larger than thought of being approximately one-third of mechanically ventilated intensive care patients. In shock/trauma, three-fourths of all patients may suffer from IAH. Kidney and liver may dysfunction and the gut barrier may be impeded, permitting spread of inflammation to other organs. IAH and ACS have an impact on respiratory mechanics and may impede ventilation and require higher ventilation pressures than under normal conditions. Prone position and alternating (asynchronous) ventilation may moderate the IAH. In addition, surgical decompression should be considered.Summary: In view of the frequent occurrence of IAH in intensive care, the need of better understanding of the mechanisms behind IAH is a prerequisite for better treatment. Respiratory mechanics are affected but may also indicate routes of ventilatory treatment to lower IAH.
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| 5. |
- Hedenstierna, Göran, et al.
(författare)
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Lymphatics and lymph in acute lung injury
- 2008
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 14:1, s. 31-36
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review Lymph flow will be discussed as part of the drainage and fluid balance of lung tissue and abdomen as well as a qualitative analysis of inflammatory processes. Recent findings Measurement of lung lymph is still a technical challenge. Mechanical ventilation and positive end-expiratory pressure impede lung lymph flow by increased intrathoracic pressure and increased central venous pressure. Positive end-expiratory pressure may thus enhance edema formation of the lung. Inflammatory spread from abdomen to the lung via the lymphatic system has been shown in a number of experimental studies. Ligation or diversion of the thoracic duct has been proposed to blunt the effects of noxious stimuli mediated by lymphatics to the lungs. Lymphatics have a major role on abdominal fluid balance while draining extravascular fluid accumulation and edema, especially during sepsis. Mechanical ventilation with high airway pressure increases abdominal edema (ascites) and spontaneous breathing protects from edema formation. Summary Lymph flow measurements are still a difficult task to perform; however, new results show an important function in the fluid balance of the lung and abdomen. Inflammatory spread may occur from the lung to the periphery by the blood stream and from the abdomen to the lung by lymph flow.
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| 6. |
- Hossain, Iftakher, et al.
(författare)
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The management of severe traumatic brain injury in the initial postinjury hours : current evidence and controversies
- 2023
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Ingår i: Current Opinion in Critical Care. - : Wolters Kluwer. - 1070-5295 .- 1531-7072. ; 29:6, s. 650-658
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours.Recent findings Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials.Summary Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.
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| 7. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Metabolic perioperative management : novel concepts
- 2005
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Ingår i: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 11:4, s. 295-9
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review: This review summarizes novel information regarding the role of metabolic control in the perioperative period.Recent findings: Managing perioperative metabolism has recently been shown to be an important way to improve outcomes in surgical care. In particular, postoperative insulin resistance and hyperglycemia have been linked to many common complications. Recent studies have explored the toxicity of hyperglycemia and suggest a causal relation between insulin resistance and complications in the postoperative state. Controlling glucose concentrations with insulin has been shown to also improve protein balance and fat metabolism. In addition, insulin may affect other hormones including insulinlike growth factor-I during surgical stress. Lastly, recent data suggest that hyperglycemia plays an important role in aggravating the inflammatory response, in that overflow of substrates in the mitochondria causes the formation of excess free oxygen radicals and may also alter gene expression to enhance cytokine production. Although overcoming insulin resistance by insulin infusion is one way of combating hyperglycemia, prevention of its development can also be achieved by using epidural blockade to reduce the release of adrenal stress hormones and to control pain, by preoperative carbohydrates instead of overnight fasting, and by minimal invasive surgical techniques.Summary: Minimizing the effects of insulin resistance has been shown to substantially improve outcome after surgical stress.
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| 8. |
- Rubertsson, Sten
(författare)
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Update on mechanical cardiopulmonary resuscitation devices
- 2016
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 22:3, s. 225-229
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. Recent findings Three recently published large multicenter randomized trials have not been able to show any improved outcome in adult out-of-hospital cardiac arrest patients when compared with manual chest compressions. Summary Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.
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| 9. |
- Soop, Mattias, et al.
(författare)
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Optimizing perioperative management of patients undergoing colorectal surgery : what is new?
- 2006
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Ingår i: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 12:2, s. 166-70
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Forskningsöversikt (refereegranskat)abstract
- Purpose or review: This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes.Recent findings: A new survey from five northern European countries has revealed that best clinical practice in perioperative care, based on previously published high-grade evidence, is only partially in use in daily clinical practice. Recently, a number of trials contrasting clinical results in enhanced-recovery protocols versus traditional care clearly show that such protocols indeed enhance recovery, although effects on morbidity are less obvious. Further evidence supporting preoperative oral carbohydrate treatment, avoidance of oral bowel preparation and wound drainage in elective colonic surgery and avoidance of intraoperative fluid excess has emerged. The oral opioid antagonist alvimopan has recently been shown to limit postoperative gastrointestinal paralysis. The role of laparoscopic surgery in the era of enhanced-recovery programmes is unclear.Summary: 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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| 10. |
- Suarez-Sipmann, Fernando, et al.
(författare)
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Volumetric capnography : the time has come
- 2014
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 20:3, s. 333-339
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review This review article summarizes the recent advances in electrical impedance tomography (EIT) related to cardiopulmonary imaging and monitoring on the background of the 30-year development of this technology. Recent findings EIT is expected to become a bedside tool for monitoring and guiding ventilator therapy. In this context, several studies applied EIT to determine spatial ventilation distribution during different ventilation modes and settings. EIT was increasingly combined with other signals, such as airway pressure, enabling the assessment of regional respiratory system mechanics. EIT was for the first time used prospectively to define ventilator settings in an experimental and a clinical study. Increased neonatal and paediatric use of EIT was noted. Only few studies focused on cardiac function and lung perfusion. Advanced radiological imaging techniques were applied to assess EIT performance in detecting regional lung ventilation. New approaches to improve the quality of thoracic EIT images were proposed. EIT is not routinely used in a clinical setting, but the interest in EIT is evident. The major task for EIT research is to provide the clinicians with guidelines how to conduct, analyse and interpret EIT examinations and combine them with other medical techniques so as to meaningfully impact the clinical decision-making.
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| 11. |
- Acosta, Stefan
(författare)
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Mesenteric ischemia.
- 2015
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 21:2, s. 171-178
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Forskningsöversikt (refereegranskat)abstract
- Diagnosis of acute mesenteric ischemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischemia may be treated with urgent intestinal revascularization.
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| 12. |
- Blennow Nordström, Erik, et al.
(författare)
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Assessment of neurocognitive function after cardiac arrest
- 2019
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 25:3, s. 234-239
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest. RECENT FINDINGS: Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments. A subjective report is a simple method to screen for cognitive problems, but divergent findings were reported when comparing with objective measures. A standardized observer report may be useful for cognitive screening postcardiac arrest. The Montreal Cognitive Assessment (MoCA) was recommended for cognitive screening after cardiac arrest. Detailed neurocognitive assessments were reported as valuable for in-depth evaluation of patients in interventional studies. The best time-point for neurocognitive assessments remains unknown. Recent findings report that most neurocognitive recovery is seen within the first months after cardiac arrest, with some improvement also noted between 3 and 12 months postcardiac arrest. SUMMARY: Neurocognitive assessments after cardiac arrest are important and the approach should differ depending on the clinical situation. Large, prospective, well designed studies, to guide the selection of neurocognitive assessments after cardiac arrest, are urgently needed.
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| 13. |
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| 14. |
- Chew, Michelle, et al.
(författare)
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Haemodynamic monitoring using arterial waveform analysis.
- 2013
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 19:3, s. 234-241
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE OF REVIEW: To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. RECENT FINDINGS: The precision of cardiac output (CO) measurements varies considerably and deteriorates during haemodynamic instability. Significant device-to-device differences exist. Nevertheless, most are sufficiently accurate for tracking changes in CO. Targeted intervention guided by haemodynamic monitoring reduces mortality and morbidity in high-risk surgical patients. Dynamic changes in variables such as systolic pulse variation, pulse pressure variation (PPV) and stroke volume variation (SVV) may be useful for evaluating fluid responsiveness, although important caveats exist. Newer indices such as PPV : SVV ratio may be useful in identifying preload and vasopressor-dependent patients. Peripheral arterial dP/dt has not been validated in critically ill patients and requires further investigation. SUMMARY: Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
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| 15. |
- Cronberg, Tobias
(författare)
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Assessing brain injury after cardiac arrest, towards a quantitative approach
- 2019
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 25:3, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury. RECENT FINDINGS: Qualitative assessment of clinical findings, neurophysiological signals and radiological images are prone to error due to the individual assessors' experience and competence. Currently, the only quantitative method for assessment of postarrest brain injury in regular clinical use is the measurement of neuron-specific enolase in serum. Since 2015 several promising methods to standardize assessment have been introduced including pupillometry, standardized electroencephalography interpretation and the quantification of somatosensory evoked potentials, computed tomography and MRI-signals. In addition, novel and superior blood biomarkers are on the verge of clinical introduction. SUMMARY: The current guidelines for neuroprognostication include a step-by-step multimodal algorithm but many patients will still be left with an uncertain prognosis 4-5 days after cardiac arrest. Novel quantitative methods are a necessary step to a more nuanced prediction of outcome for this group of patients.
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| 16. |
- Hillman, Ken, et al.
(författare)
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Continuum of hospital care: the role of intensive care.
- 2010
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Ingår i: Current opinion in critical care. - 1531-7072. ; 16:5, s. 505-9
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Tidskriftsartikel (refereegranskat)abstract
- This review outlines the way the specialty of intensive care has expanded over the last decade in response to the changing population of hospital patients, being older with more comorbidities and having more complex interventions. The previous disjointed professional and geographical silos, providing patient care, are being challenged and a more patient focussed continuum of care is replacing it.
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| 17. |
- Horn, Janneke, et al.
(författare)
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Prognostication after cardiac arrest.
- 2014
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 20:3, s. 280-286
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Forskningsöversikt (refereegranskat)abstract
- The prognosis of patients with postanoxic coma (PAC) after cardiac arrest is a challenging task for clinicians. The need for early and accurate prognostic predictors is crucial. Treatment with therapeutic hypothermia and sedation alters the reliability of neurological examination. Considering the extensive literature existing on this topic, we aimed to provide a practical approach on how to predict outcome in patients with PAC, particularly in those treated with therapeutic hypothermia.
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| 18. |
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| 19. |
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| 20. |
- Lundin, Stefan, 1953, et al.
(författare)
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Electrical impedance tomography: potentials and pitfalls.
- 2012
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Ingår i: Current opinion in critical care. - 1531-7072. ; 18:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- Electrical impedance tomography (EIT) is a useful noninvasive tool for monitoring ventilation finding its way into the clinical setting. The focus of this review is to discuss the balance between the potential for EIT as a clinical monitor accepting a level of uncertainty and the scientific demand for absolute perfection.
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| 21. |
- Martensson, J, et al.
(författare)
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Are all fluids bad for the kidney?
- 2015
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Ingår i: Current opinion in critical care. - 1531-7072. ; 21:4, s. 292-301
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Tidskriftsartikel (refereegranskat)
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| 22. |
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| 23. |
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| 24. |
- Nielsen, Niklas, et al.
(författare)
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Temperature management after cardiac arrest.
- 2015
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 21:3, s. 202-208
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Forskningsöversikt (refereegranskat)abstract
- Temperature management for patients comatose after cardiac arrest has been an integral component of postcardiac arrest care for the last decade. In this review, we present recent findings and discuss implications for future trials.
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| 25. |
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| 26. |
- Oddo, Mauro, et al.
(författare)
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Neuroprognostication after cardiac arrest in the light of targeted temperature management
- 2017
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Ingår i: Current Opinion in Critical Care. - 1070-5295. ; 23:3, s. 244-250
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction. RECENT FINDINGS: Studies from the TTM era confirmed that combining neurological examination with electrophysiological assessment [electroencephalography (EEG) and somato-sensory evoked potentials (SSEP)] greatly improves coma prognostication. This combination is nowadays recognized as the most useful by many clinicians and appears widely applicable as part of initial patient assessment. Additional tests (serum neuron specific enolase and neuroimaging) may be most useful to orient clinical decisions in patients with prolonged coma. Advanced analysis of EEG and SSEP recordings and the emergence of quantitative pupillometry hold great promise. SUMMARY: Multimodal prognostication offers a comprehensive approach of anoxic–ischemic encephalopathy and is increasingly used in postresuscitation care. Worldwide implementation and future advancements of available modalities, together with the increasing use of novel automated devices for quantitative neurological examination, may further optimize prognostic accuracy in the early ICU phase following cardiac arrest.
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| 27. |
- Reintam Blaser, Annika, et al.
(författare)
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A clinical approach to acute mesenteric ischemia
- 2021
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 27:2, s. 183-192
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE OF REVIEW: To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management.RECENT FINDINGS: A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved.SUMMARY: Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.
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| 28. |
- Rylander, Christian, 1960
(författare)
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Historic review of long-term outcomes research
- 2019
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Ingår i: Current Opinion in Critical Care. - 1070-5295. ; 25:5, s. 523-529
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Forskningsöversikt (refereegranskat)abstract
- Purpose of reviewThis review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research.Recent findingsThe postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components.SummaryInterest in patient-centred outcomes has been present since the beginning of modern intensive care. Findings from early long-term studies remain valid even in the face of contemporary large registries that facilitate follow-up of larger cohorts. A further understanding of the mechanisms leading to experienced physical and psychological impairment of PICS will be essential to the design of future intervention trials. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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| 29. |
- Sandroni, Claudio, et al.
(författare)
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The role of the electroencephalogram and evoked potentials after cardiac arrest
- 2023
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Ingår i: Current Opinion in Critical Care. - 1070-5295. ; 29:3, s. 199-207
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review: In comatose cardiac arrest survivors, the electroencephalogram (EEG) is the most widely used test to assess the severity of hypoxic-ischemic brain injury (HIBI) and guide antiseizure treatment. However, a wide variety of EEG patterns are described in literature. Moreover, the value of postarrest seizure treatment is uncertain. Absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) are a specific predictor of irreversible HIBI. However, the prognostic significance of the N20 amplitude is less known. Recent findings: The increasing adoption of standardized EEG pattern classification identified suppression and burst-suppression as 'highly-malignant' EEG patterns, accurately predicting irreversible HIBI. Conversely, continuous normal-voltage EEG is a reliable predictor of recovery from postarrest coma. A recent trial on EEG-guided antiseizure treatment in HIBI was neutral but suggested potential benefits in specific subgroups. A prognostic approach based on the amplitude rather than on the presence/absence of the N20 SSEP wave recently showed greater sensitivity for poor outcome prediction and added potential for predicting recovery. Summary: Standardized EEG terminology and quantitative approach to SSEP are promising for improving the neuroprognostic accuracy of these tests. Further research is needed to identify the potential benefits of antiseizure treatment after cardiac arrest.
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| 30. |
- Stenqvist, Ola, 1944, et al.
(författare)
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Dynamic respiratory mechanics in acute lung injury/acute respiratory distress syndrome: research or clinical tool?
- 2008
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Ingår i: Current opinion in critical care. - 1070-5295. ; 14:1, s. 87-93
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE OF REVIEW: Classic static measurements of lung mechanics have been used mainly for research purposes, but have not gained widespread clinical acceptance. Instead, dynamic measurements have been used, but interpretation of results has been hampered by lack of clear definitions. The review provides an overview of possible definitions and a description of methods for evaluating lung mechanics in acute lung injury/acute respiratory distress syndrome patients. RECENT FINDINGS: Compliance measured using static techniques is significantly higher compared to measurements during ongoing ventilation. This indicates that lung mechanic properties depend on flow velocity during inflation and the time allowed for equilibration of viscoelastic forces. Thus, methods for evaluating lung mechanics should be clearly defined in terms of whether they are classically static, i.e. excluding resistance to flow and equilibration of viscoelastic forces, or truly dynamic, i.e. including flow resistance and unequilibrated viscoelastic forces. New techniques have emerged which make it possible to monitor lung mechanics during ongoing, therapeutic ventilation, 'functional lung mechanics', where the impact of flow resistance on tube and airway resistance has been eliminated, providing alveolar pressure/volume curves. SUMMARY: Functional lung mechanics obtained during ongoing ventilator treatment have the potential to provide information for optimizing ventilator management in critically ill patients.
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| 31. |
- Tardif, N, et al.
(författare)
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Muscle metabolism
- 2017
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Ingår i: Current opinion in critical care. - 1531-7072. ; 23:4, s. 264-268
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Tidskriftsartikel (refereegranskat)
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| 32. |
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