Abstract：
:In general, coma portends a very poor outcome in ICU patients except when a drug overdose is the cause. Interactions with concurrent diseases and the cause of the comatose state are important variables that modify mortality rates. Recent studies have made it possible to predict irreversibility with a high degree of specificity in many cases. Three approaches show promise for early prediction of poor outcome--multivariate analysis, neurologic findings, and technologic innovations. Multivariate analysis of combinations of clinical conditions common in ICUs appears to have defined some patients whose prognosis is nearly hopeless, empirically. It would seem reasonable to consider withholding or withdrawing life support from these patients so that mere prolongation of death is avoided. Additional studies are needed and are relatively easy to perform with computerized statistical analyses of a readily available database derived from large patient populations in multicenter studies. A second useful approach for predicting irreversibility has arisen from studies using neurologic findings at defined time points after brain injury. The studies of Levy and colleagues exemplify this approach; their data suggest that coma can be declared irreversible with a high degree of confidence in a large subset of patients, delineated by simple sequential neurologic observations. Finally, technologies are evolving that may lead to noninvasive measurements to provide quantitative evidence of irreversible brain damage. Additional clinical studies are needed to validate the predictive value of these approaches to identifying patients who are certain to have a poor ultimate outcome. It then may be possible to predict function and irreversibility of central nervous system injury in individual cases with a high degree of certainty early in the clinical course.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Snyder JV,Colantonio Asubject
Has Abstractpub_date
1994-01-01 00:00:00pages
217-28issue
1eissn
0749-0704issn
1557-8232journal_volume
10pub_type
杂志文章,评审abstract：:In pediatric trauma care, many long-held tenets of management have been revised. This article reviews the latest advances in pediatric trauma care, particularly in the areas of resuscitation and management of thoracic and abdominal injuries. The final topic is a discussion of what the intensivist and surgeon must know...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(03)00005-8
更新日期：2003-07-01 00:00:00
abstract：:This article reviews two important innovations in echocardiography resulting from the recent advances in the capabilities of microprocessors. The first, automatic endocardial border detection, has been implemented on computers contained entirely within echocardiograph machines and is gaining wide clinical use. The sec...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70256-6
更新日期：1996-04-01 00:00:00
abstract：:Hypertensive crisis is an acute emergency requiring aggressive management. Its incidence has decreased in recent years but still is prevalent in the medical community. From review of past and present treatment regimens, the following recommendations can be considered. (1) In the treatment of malignant hypertension wit...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1989-07-01 00:00:00
abstract：:More than one-half million patients are hospitalized annually for traumatic brain injury (TBI). One-quarter demonstrate sleep-disordered breathing, up to 50% experience insomnia, and half have hypersomnia. Sleep disturbances after TBI may result from injury to sleep-regulating brain tissue, nonspecific neurohormonal r...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2015.03.012
更新日期：2015-07-01 00:00:00
abstract：:Approximately 12,000 Americans suffer traumatic spinal cord injuries each year. This article discusses the management of their neurologic, respiratory, cardiovascular, gastroenterologic, and genitourinary complications in the critical care setting. ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1986-10-01 00:00:00
abstract：:Electronic medical records can be used to mine clinical data (big data), providing automated analysis during patient care. This article describes the source and potential impact of big data analysis on risk stratification and early detection of deterioration. It compares use of big data analysis with existing methods ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2017.12.007
更新日期：2018-04-01 00:00:00
abstract：:In summary, interventional techniques are well-established and offer safe and effective alternatives for management of patients in the intensive care unit or other setting. It is likely that the radiologist will become more involved in the management of ill children and adults. It is hoped that this will reduce the ne...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1994-04-01 00:00:00
abstract：:Prolonged intubation and mechanical ventilation following cardiac surgery have been associated with increased hospital and intensive care unit length of stays; higher health care costs; and morbidity resulting from atelectasis, intrapulmonary shunting, and pneumonia. Early extubation was developed as a strategy in the...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2020.06.005
更新日期：2020-10-01 00:00:00
abstract：:As scientists and physicians have gained sophistication in understanding and treating illness, our view of disease has changed in scope. We appreciate more fully the diverse and wide-ranging effects of stress on the ability of the organism to maintain homeostasis. As our study of the failure of homeostasis has advance...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1988-10-01 00:00:00
abstract：:Providing effective critical care to vascular surgical patients is challenging to the intensivist. These patients often have multiple significant concurrent diseases that need to be adequately managed. A selective policy for identifying patients that need ICU is recommended. Early and smooth restoration to their preop...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(02)00056-8
更新日期：2003-01-01 00:00:00
abstract：:Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.08.008
更新日期：2019-01-01 00:00:00
abstract：:The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care seda...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2009.05.001
更新日期：2009-07-01 00:00:00
abstract：:Vancomycin-resistant enterococci (VRE) consist mainly of Enterococcus faecalis and E faecium, the latter mostly hospital-acquired. In addition, E gallinarum and E casseliflavus are intrinsically vancomycin-resistant and are community-acquired. VRE have become common in many hospitals throughout the world and, once est...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2013.06.006
更新日期：2013-10-01 00:00:00
abstract：:For well over a decade, intensive care unit (ICU) telemedicine programs have been providing care to patients and families and an invaluable service to many receiving sites that are otherwise outside the traditional reach of high-quality critical care. It will be important that during this growth, outcomes regarding th...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2019.02.006
更新日期：2019-07-01 00:00:00
abstract：:Infections caused by Candida species are now endemic and entrenched in the intensive care unit setting. Candida infections continue to provide a major diagnostic and therapeutic challenge to clinicians. The increased prevalence of Candida infections represent the high price clinicians and patients must pay for the adv...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1988-04-01 00:00:00
abstract：:The pregnant patient with normal cardiac function can accommodate many significant alterations in the cardiovascular system without difficulty. Pregnancy in a patient with significant cardiac disease, however, can be extremely hazardous, resulting in decompensation and even death. these conditions account for up to 30...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1991-10-01 00:00:00
abstract：:Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of t...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1992-07-01 00:00:00
abstract：:The EMR in the ICU has the utility of providing the necessary information to make sound clinical decisions for critically ill patients. For it to be optimized, the EMR must be more than just what is being replicated in the written record or merely a documentation tool; it must add value that supports and enhances clin...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70068-3
更新日期：1999-07-01 00:00:00
abstract：:In July 2001, the United States Joint Commission on Accreditation of Health care Organizations adopted a new leadership standard that requires department heads in health care organizations to perform at least one Failure Mode and Effects Analysis (FMEA) every year. This proactive approach to error prevention has prove...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.07.005
更新日期：2005-01-01 00:00:00
abstract：:This article summarizes the biomechanical relationship of the spinal column to load stresses with respect to column failure, and the resulting associated central nervous system injury. In addition, it presents pertinent animal research, which has focused onto the development standardized animal spinal cord injury mode...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-07-01 00:00:00
abstract：:The epidemiology, biomechanics, physiopathology, emergency medical systems, diagnostic criteria, and therapy related to acute cervical spinal cord injury are discussed in this article. ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1985-07-01 00:00:00
abstract：:It is as important to monitor the passage of time in the resuscitation effort as it is to follow the physiologic parameters. The goals in resuscitation are based on restoring cellular metabolism to a level consistent with optimum survival. The level of invasiveness of monitoring is dictated by the extent to which the ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1992-04-01 00:00:00
abstract：:Acute respiratory failure can be the result of a variety of clinical conditions, such as congestive heart failure, pneumonia, pulmonary embolism, exacerbation of obstructive lung diseases, and acute respiratory distress syndrome (ARDS). This article focuses on developments related to acute lung injury and ARDS and rev...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.05.010
更新日期：2004-10-01 00:00:00
abstract：:Advances in the area of pediatric medicine during the past few years have presented ethical dilemmas for the physician to consider. This article discusses the ethical principles upon which clinical reasoning and judgments can be made. ...
journal_title：Critical care clinics
pub_type： 杂志文章
doi：
更新日期：1992-01-01 00:00:00
abstract：:Cardiogenic shock remains the most dreaded complication of acute myocardial infarction. Mortality rates remain high despite modern interventional therapy. Patients with a variety of other cardiovascular entities may also develop cardiogenic shock. Management consists of rapid stabilization of systemic arterial blood p...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1993-04-01 00:00:00
abstract：:Given time, the brain can tolerate extraordinarily severe hyponatremia, but it does not take well to sudden changes; both rapid onset and rapid correction of hyponatremia can be injurious. Emergency treatment of hyponatremia should be reserved for the patient who has not had time to fully adapt to the disturbance. Whe...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1991-01-01 00:00:00
abstract：:Mechanical ventilation, although essential in taking care of acute lung injury and widely used during surgical procedures worldwide, remains a highly debated field. Clinical trials in the last decade have shown convincingly that mechanical ventilation can result in additional mortality in patients with acute lung inju...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2006.11.016
更新日期：2007-04-01 00:00:00
abstract：:This article provides an overview of some of the current issues involved in sedation and anxiolysis in the intensive care unit. The problems involved in trying to monitor sedation levels are discussed, as are some of the newer options available for physiologic monitoring of the central nervous system. The problem of a...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70043-9
更新日期：1999-01-01 00:00:00
abstract：:There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period. Mechanisms of hypoxemia include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonal...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-04-01 00:00:00
abstract：:Critical illness predisposes individuals to highly variable metabolic and immune responses, leading to muscle mass loss, impaired healing, immobility, and susceptibility to infections and cognitive impairment. Recommendations for nutrition in critically ill patients are supported by observational studies, small random...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2015.11.002
更新日期：2016-04-01 00:00:00
