Septic patients (Perel)
EBM de-emphasises intuition, unsystematic clinical experience & pathophysiological rationale as sufficient grounds for clinical decision making & stresses the examination of evidence from clinical research
No benefit to ARISE, PROCESS, PROMISE
Have multimodal approach to monitoring the CV system of septic patients
Solve therapeutic conflicts by choosing the least harmful option
Aim to de-escalate treatment as soon as possible and do not aim to normalise values
Positive fluid balance in septic patients
A protocol-less approach to septic patient
The High Risk Surgical Patient (Zsolt)
Choice of monitoring device amongst anaesthetists
No benefits of SV optimisation in elective abdo surgery
Liver Failure (Wendon)
EASL Practical guidelines for the management of alcoholic liver disease
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis
Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group
Subarachnoid Haemorrhage (Polderman)
Unsecured aneurysms rebleed 9-17% on day 0
Fever associated with poor outcomes
High incidence of CV dysfunction. Therefore would advocate CO monitoring
Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference.
Coma recovery score (revised) is used more prominently in the recovery literature which is validated in disorders of consciousness.
Carinal stimulation via suctioning rather than pain may be a more useful way of generating arousal.
Don’t say ‘squeeze my hands’ to assess commands – rather ‘give me (two) thumbs up’
Data from the IMPACT trials have been used to create a risk prediction model which is available online.
Prediction models for 6 month outcome after TBI
Alpha coma on EEG may have a poor prognosis but the cause is important to the outcome.
Etiology, neurologic correlations, and prognosis in alpha coma
Medial temporal lobe seizures may not be well detected on surface EEG
American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology
Anti-N-methyl-D-aspartate receptor antibodies: A potentially treatable cause of encephalitis in the intensive care unit
Should we admit elective neurosurgical patients to ICU?
Deciding on which patients to admit to ICU after neurosurgery depends upon pre-op comorbidity, intra-operative interventions and likely course post-operatively.
- Unexpected neuroworsening
- Medical compilation related to procedure per se (e.g. diabetes insipidus)
- Unrelated medical complications
- Lack of awareness on the ward
Continue reading Intensive Care for Neurosurgical Interventions