1,721,072 research outputs found
Short acting insulin analogues in intensive care unit patients
No full textBlood glucose control in intensive care unit (ICU) pa- tients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an ad-
equate calories load and, when necessary, to continu-
ously infuse insulin titrated to patients needs: intensive insulin therapy (IIT). Short acting insulin analogues (SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter on- set and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a
Bilotta F, Guerra C, Badenes R, Lolli S, Rosa G. Short acting insulin analogues in intensive care unit patients. World J Dia- betes 2014; 5(3): 000-000 Available from: URL: http://www.
wjgnet.com/1948-9358/full/v5/i3/000.htm DOI: http://dx.doi. org/10.4239/wjd.v5.i3.000
more limited risk of inducing episodes of iatrogenic hy-
poglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and research- ers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients (i.e. , sedation and treatment of arterial hypertension) and we also de- scribe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relate
Inhaled sedation in acute brain injury patients
No full textEditor—Thanks for the chance to respond to the letter by
Badenes and Bilotta. We appreciate their interest in our article1
and fully agree that tight management of the arterial partial pres sure of carbon dioxide ðPaCO2 Þ is crucial for avoiding increases in
intracerebral pressure (ICP) resulting from hypercapnic vasodila tory effects. However, in our study increases in ICP have occurred
not only in response to PaCO2 increases, but also independently,
and at times these were fairly delayed after switching to the
anaesthetic conserving device (ACD).1 Prompt increases in ICP
are usually not expected after a more gradual increase in PaCO2 ,
but rather after sudden increases of PaCO2 , which might indeed
occur directly after switching to the ACD in the absence of com pensatory mechanism
Neurocritical care for intracranial haemorrhage: a systematic review of recent studies
No full textAbstract
Intracerebral haemorrhage (ICH) is associated with significant early mortality (up to 50% at 30 days) and long-term morbidity
(with permanent neurological deficits in 75–80% of patients) and represents a serious health issue worldwide. The past decade
has seen a dramatic increase in clinical research on ICH diagnosis and treatment that has led to revision of the guidelines for the
diagnosis and management of ICH from the American Heart Association and American Stroke Association in 2013. This
systematic review reports recent clinical evidence (original studies published between September 2013 and July 2015) related to
neurocritical care and intensive care unit management of patients with ICH. All but one publication included in this review
report original studies related to managment of patients with intracerebral or subarachnoid haemorrhage. These include
insights on risk stratification and neurocritical care or intensive care unit treatment, management of haemodynamic variables
and mechanical ventilation (goal-directed fluid therapy, advanced haemodynamic monitoring, and avoidance of hyperoxia and
hyperventilation), and pharmacological neuroprotectio
Intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanesthesia procedures
No full textSummary
Recent studies provide interesting evidence of intraoperative monitoring of NIRS, brptiO2 and BIS. The
brptiO2/PaO2 ratio is much more reliable than an absolute brptiO2 reading; NIRS helps clinicians to
monitor patients who are undergoing endovascular treatment, and BIS guides the titration of anaesthesia
during awake craniotomy; its values are not affected by the presence of a frontal brain tumou
Cerebral protection during neurosurgery and stroke
No full textPurpose of review
This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain
surgery and in patients with acute strok
Seizures and sepsis: A narrative review
Full text linkPatients with sepsis-associated encephalopathy (SAE) can develop convulsive or nonconvulsive seizures. The cytokine storm and the overwhelming systemic inflammation trigger the electric circuits that promote seizures. Several neurologic symptoms, associated with this disease, range from mild consciousness impairment to coma. Focal or generalized convulsive seizures are frequent in sepsis, although nonconvulsive seizures (NCS) are often misdiagnosed and prevalent in SAE. In order to map the trigger zone in all patients that present focal or generalized seizures and also to detect NCS, EEG is indicated but continuous EEG (cEEG) is not very widespread; timing, duration, and efficacy of this tool are still unknown. The long-term risk of seizures in survivors is increased. The typical stepwise approach of seizures management begins with benzodiazepines and follows with anticonvulsants up to anesthetic drugs such as propofol or thiopental, which are able to induce burst suppression and interrupt the pathological electrical circuits. This narrative review discusses pathophysiology, clinical presentation, diagnosis and treatment of seizures in sepsis
Neuro-ICU patient disposition: optimal venue for acute needs
No full textPurpose of review
This article revises the recent evidence on ICU admission criteria for acute neurological patients [traumatic
brain injury (TBI) patients, postoperative neurosurgical procedures and stroke].
Recent findings
The appropriate utilization of ICU beds is essential, but it is complex and a challenge to attain. To date
there are no widely accepted international guidelines for managing these acute brain-injured patients
(stroke, TBI, postneurosurgery) in the ICU. The criteria for ICU admission after neurological acute injury,
high-dependency unit or a specialized neurosurgical ward vary from institution to institution depending on
local structures and characteristics of the available resources. Better evidence to standardize the treatment
and the degree of monitoring is needed during neurological acute injury. It is highly recommended to
implement clinical vigilance in these patients regardless of their destination (ICU, stroke unit or ward).
Summary
Currently evidence do not allow to define standardized protocol to guide ICU admission for acute
neurological patients (TBI patients, postoperative neurosurgical procedures and strok
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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