ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The choice of intervention for acute ischemic stroke is dependent on a number of variables. The patient must be seen and evaluated within a limited temporal window, and treatment decisions must be made rapidly. This review discusses methods being used to improve patient and staff recognition of stroke, as well as the initial diagnostic study of an acute stroke patient. It then reviews parameters that may influence outcome, such as blood pressure, serum glucose, supplementary oxygenation, and temperature. The potential benefits and risks of thrombolysis, anticoagulation, and revascularization are discussed. Finally, treatments for severe ischemic strokes with malignant cerebral edema are reviewed, along with new techniques, including hypothermia and hemicraniectomy. Curr Opin Crit Care 2000, 6:77–84 © 2000 Lippincott Williams & Wilkins, Inc.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The last decade has seen significant developments in imaging, particularly in relation to the application of magnetic resonance techniques to critically ill patients with central nervous system disease. Most notable has been an increasing trend toward obtaining early spatially resolved information regarding pathophysiology through the use of functional imaging techniques. Although the imaging of critically ill patients in clinically hostile environments such as the magnetic resonance imaging units may represent a logistic problem, the benefits make the exercise worthwhile. Physiologic and metabolic imaging can provide information regarding disease processes at a stage when full reversal is a possibility. In addition, such imaging studies may allow the identification of new therapeutic targets, permit the selection of subgroups of patients who are most likely to benefit from novel therapies aimed at these targets, and contribute to the assessment of efficacy of these interventions.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Many patients who have cardiac surgery experience cerebral complications. Recently, the focus of interest has shifted from gross sequelae, such as stroke, to less conspicuous, but more frequent, neurologic and cognitive deficits. Although subtle, these deficits result in significant morbidity and resource use. Biochemical markers of cerebral injury have been used to identify these deficits. A multifactorial etiology, including emboli and cerebral hypoperfusion as well as genetic predisposition, has recently been proposed; there are distinct groups of patients who may be at very high risk. Intervention and prevention remain controversial, but there may be the possibility of pharmacologic protection. Although propofol has been found to be ineffective, lidocaine and remacemide may have some small benefit. Much interesting research has been published in the last year, but it may have raised more questions about the cerebral sequelae of cardiac surgery than it has answered.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The central nervous system (CNS) requires an intact and peculiar environment in order to function properly. This homeostasis is maintained by the blood-brain barrier, which separates the CNS from the peripheral circulation. The ability of the CNS tissue to counteract the pathogenic effect of infectious agents is poor, because immune cells and humoral factors have no free access into the brain due to the formation of tight junctions by cerebral endothelial cells. In addition, under normal conditions the low expression of histocompatibility antigens, adhesion molecules, and immune mediators renders the CNS refractory to immune responses compared with peripheral organs. In addition, once inflammation within the nervous system occurs, it is difficult to control. Although inflammatory events are aimed at defending the CNS from pathogens and repairing lesioned tissue, they can also be deleterious by contributing to tissue damage and impairment of neurologic functions. Abundant research activity in this field has revealed that resident cells of the nervous system actively participate in intracranial immune defense by releasing inflammatory mediators able to regulate, neuronal functions in addition to immunological functions. The dichotomy of neuroinflammation is discussed in this review article, which reports diverse examples of chronic and acute diseases of the CNS in humans as well as in animal models.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The Glasgow Coma Scale has been used since 1974 to assess the severity of brain damage, and thus as a tool to predict mortality and compare results between series of patients. Variables such as age, secondary brain insults, and type of cranial lesion seen on computed tomography scan are closely related with outcome. The authors discuss the limitations of the Glasgow Coma Scale and how general intensive care severity scoring systems used in critical care perform very well in assessment of severity of brain damage, with good discrimination and calibration. Other systems also perform very well, but they are not widely used. Moreover, other aspects of patients with head trauma, such as genetic predisposition, inflammatory response to injury, and management could play a role in predicting mortality. To predict mortality accurately in head trauma patients, physicians need a system that includes all the important variables, that is easy to perform at admission, and that has wide acceptance. In patients with subarachnoid hemorrhage, a reliable neurologic evaluation and a careful cranial computed tomography interpretation are enough to assess the outcome.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Available data document that translocation of enteric microbes is a normal process, occurring at low background levels in normal humans and in laboratory animals, and increasing in certain clinical conditions. There is likely no one common mechanism facilitating systemic infection with enteric flora; rather, systemic infection depends on the extent to which the host experiences enteric overgrowth, increased intestinal permeability, and/or immunosuppression. Thus, systemic infection results from these three factors, acting alone or in concert, to overwhelm the host’s ability to eliminate translocating microbes. Although the existence of microbial translocation is well documented in humans and experimental animals, the clinical significance of this phenomenon has been the subject of intense debate. Data from recent clinical studies support the hypothesis that the translocation of enteric flora is clinically significant and predisposes to infectious complications, possibly including multiple organ failure.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Splanchnic blood flow and blood volume are highly variable in critically ill patients, depending on the underlying disease, compensatory mechanisms, and therapeutic interventions. During low blood flow states or hypoxemia, adaptive mechanisms include profound reductions in splanchnic blood flow and volume. The splanchnic organs are both source and target of systemic inflammation and significant derangements in splanchnic blood flow and metabolism may occur under these conditions. Therapeutic interventions such as vasoactive drugs or nursing procedures may have additional effects on splanchnic tissue perfusion and metabolic demands.Although transient reduction of splanchnic perfusion may be life-saving under certain circumstances, splanchnic hypoperfusion may contribute to the pathogenesis of systemic inflammation, sepsis, and multiple organ failureviaseveral mechanisms, including ischemia and reperfusion injury, increased mucosal permeability, translocation of endotoxin and bacteria, and local activation of cytokines and their inflammatory mediators. The clinical syndromes of systemic inflammation, sepsis, and multiple organ failure are associated with a high morbidity and mortality, and are major contributors to the high cost of modern intensive care.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The use of gastric tonometry for the measurement of splanchnic perfusion as a surrogate of tissue oxygen delivery is a well-established technique, but one that has not enjoyed widespread clinical usage. Automated air tonometry, together with the measurement of gastric to arterial or end-tidal alveolar differences in carbon dioxide tension, is starting to replace the use of saline tonometry and the measurement of intramucosal pH. Although this technique is in the early stages of validation, it is thought that it will be a more clinically useful tool.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID