Neurological complications in critical illness: a focus on mechanisms
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2008
|
| Schriftenreihe: | Critical care clinics
24,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVII, 236 S. Ill. |
| ISBN: | 1416058478 9781416058472 |
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NEUROLOGICAL COMPLICATIONS IN CRITICAL ILLNESS: A FOCUS
ON MECHANISMS
CONTENTS
Foreword xiii
Thomas P. Bleck
Preface xv
Robert D. Stevens
Mechanisms of Neurologic Failure in Critical Illness 1
Aliaksei Pustavoitau and Robert D. Stevens
Critical illness frequently is associated with neurologic failure that
may involve the central and peripheral nervous systems. Central
nervous system failure is associated with a spectrum of neuro-
behavioral changes including delirium, coma, and long-term
cognitive dysfunction. Peripheral neurologic failure, or critical
illness neuromuscular abnormalities, is suggested by diffuse
arreflexic weakness and protracted respiratory insufficiency, and
may also persist long after the acute hospitalization. While the
burden of neurological disease complicating critical illness is
considerable, preventive or therapeutic options are limited. This
article provides an overview of research evaluating the relationship
between critical illness and neurologic function, with a special
emphasis on underlying mechanisms.
Coma After Global Ischemic Brain Injury: Pathophysiology
and Emerging Therapies 25
Robert E. Hoesch, Matthew A. Koenig,
and Romergryko G. Geocadin
Cardiac arrest is a major cause of death and morbidity in the
United States, and neurological injury contributes significantly to
this. Neurological complications associated with global cerebral
ischemia include disorders of responsiveness, such as coma and the
vegetative state, seizures, motor deficits, and brain death. Coma,
complete unresponsiveness, is the most pervasive of these.
VOLUME 24 • NUMBER 1 • JANUARY 2008 vii
Therapies that improve neurological outcomes in general after
cardiac arrest and therapies that stimulate arousal from coma could
have enormous clinical impact. The authors review the physiology
of arousal and describe the biochemical and pathophysiological
derangements that develop after global cerebral ischemia. We then
describe the potential therapeutic mechanisms of hypothermia and
deep brain stimulation, which provide hope for better neurological
outcomes after global cerebral ischemia.
Pathophysiology of Delirium in the Intensive Care Unit 45
Max L. Gunther, Alessandro Morandi, and E. Wesley Ely
Delirium, or acute brain dysfunction, is a life-threatening global
disturbance in cognitive functioning that frequently manifests in
critically ill patients. This review examines the current status of
knowledge regarding the pathophysiology of delirium in the ICU,
in particular, evaluating the role of iatrogenic factors such as
sedatives and analgesic administration in brain dysfunction. This
hypothesis is considered along with several other plausible
mechanisms of ICU delirium, including sepsis, postoperative
cognitive dysfunction, and changes in biomarkers and neuro-
transmitters. The review concludes by highlighting potential future
directions in molecular genetics for the elucidation of delirium and
its long-term consequences.
The Encephalopathy in Sepsis 67
Shidasp Siami, Djillali Annane, and Tarek Sharshar
Brain dysfunction is a severe complication of sepsis with an
incidence ranging from 9% to 71% that is associated with increased
morbidity and mortality. Its diagnosis relies mainly on neurologic
examination with clinical manifestations ranging from confusion to
coma. An electroencephalogram, somatosensory evoked potentials,
and measurement of plasma S-lOOb protein and neuron-specific
enolase can be useful for the detection of brain dysfunction. Brain
MRI can identify brain lesions such as cerebral infarction, posterior
reversible encephalopathy syndrome, and leukoencephalopathy.
The mechanism of sepsis-associated encephalopathy involves
inflammatory and non-inflammatory processes that affect endo-
thelial cells, glial cells, and neurons and induce blood-brain
barrier breakdown, derangements of intracellular metabolism,
and cell death. Specific treatments for sepsis-associated encephal¬
opathy need to be developed. Currently, treatment is mainly the
management of sepsis.
Mechanisms of Cerebral Injury from Cardiac Surgery 83
Charles W. Hogue, Rebecca F. Gottesman, and Joshua Stearns
Cerebral injury is a frequent complication of cardiac surgery, and it
has been associated with high mortality, morbidity, hospital costs;
an increased likelihood of admission to a secondary care facility
viii CONTENTS
after hospital discharge; and impaired quality of life. This article
examines postulated mechanisms for cerebral injury from cardiac
surgery. Most emphasis has been placed in the past on the
intraoperative interval as being the period of highest cerebral
vulnerability. Many clinical cerebral events, however, occur in the
postoperative period.
Brain Edema in Acute Liver Failure 99
Andres T. Blei
Acute liver failure (ALF) is a syndrome of rapidly deteriorating liver
function that manifests as coagulopathy and encephalopathy in a
previously healthy individual. This article analyzes the repercus¬
sions of ALF on the brain through a discussion of special features of
this syndrome, important for the interpretation of neurologic
findings. Of particular interest within the context of ALF are
hepatic encephalopathy and the pathogenesis of brain edema in
acute liver failure as well as its clinical and therapeutic aspects.
Seizures and Status Epilepticus in the Critically 111 115
Marek A. Mirski and Panayiotis N. Varelas
Seizures represent stereotypic electroencephalographic (EEG) and
behavioral paroxysms as a consequence of electrical neurologic
derangement. Seizures are usually described as focal or generalized
motor convulsions; however, nonconvulsive seizures that occur in
the absence of motor activity may escape clinical detection. Because
of the admission diagnoses and dramatic physiologic and
metabolic derangements common to critically ill patients, the
entire spectrum of seizure disorders may be encountered in the
ICU. Seizures in the ICU are attributable to primary neurologic
pathology or secondary to critical illness and clinical management.
For optimal treatment, early diagnosis of the seizure type and its
cause is important to ensure appropriate therapy. Convulsive
status epilepticus requires emergent treatment before irreversible
brain injury and severe metabolic disturbances occur.
The Alteration of Autonomic Function in Multiple Organ
Dysfunction Syndrome 149
Hendrik Schmidt, Dirk Hoyer, Joachim Wilhelm, Gerold Soffker,
Konstantin Heinroth, Kuno Hottenrott, Samir M. Said,
Michael Buerke, Ursula Miiller-Werdan, and Karl Werdan
Autonomic dysfunction is associated with the severity of illness
and mortality in patients with multiple organ dysfunction
syndrome (MODS) and may contribute significantly to the patho¬
genesis of this syndrome. Several treatment approaches may
possibly restore autonomic function in MODS and thus cause the
survival benefit.
CONTENTS «
Mechanisms of Neuromuscular Dysfunction in Critical Illness 165
Jaffar Khan, Taylor B. Harrison, and Mark M. Rich
The development of neuromuscular dysfunction (NMD) during
critical illness is increasingly recognized as a cause of failure to
wean from mechanical ventilation and is associated with signifi¬
cant morbidity and mortality. At times, it is difficult to identify the
presence of NMD and distinguish the etiology of the weakness in
patients with critical illness, but subtle clinical findings and
bedside electrophysiologic testing are helpful in establishing the
diagnosis. This article describes the clinical spectrum of acquired
neuromuscular weakness in the setting of critical illness, provides
an approach to diagnosis, and discusses its pathogenesis. Finally, a
defective sodium channel regulation as a unifying mechanism
underlying NMD in critically ill patients is proposed.
The Pathophysiology of Long-term Neuromuscular
and Cognitive Outcomes Following Critical Illness 179
Margaret S. Herridge, Jane Batt, and Ramona O. Hopkins
Despite the recent and marked improvement in short-term
mortality after critical illness, significant morbidities persist for
many patients following hospital discharge. This article discusses
the risk factors for muscle, nerve, and brain dysfunction after
critical illness and preliminary basic science data to support
possible pathophysiologic mechanisms mediating this disability.
Additionally, it presents a roadmap outlining future directions in
this area of research.
Evidence-Based Performance and Quality Improvement
in the Acute Cardiac Care Setting 201
Arthur L. Riba
This article was originally planned to appear in the October 2007 issue of
Critical Care Clinics. The goal of this article is to summarize the
indicators, processes, and dimensions of care that are linked to
desired clinical outcomes of the most commonly encountered
conditions in the acute cardiovascular care setting, and specifically,
acute coronary syndromes and congestive heart failure. Addition¬
ally, it reinforces the concepts of best cardiovascular care practice
and reviews some of the highly successful quality initiatives that
have demonstrated a link between hospital process performance
and outcomes. Particular attention is focused on the evidence-
based treatments and diagnostic evaluation and processes of
inpatient cardiovascular care, which lead to desired outcomes
meaningful to patients and where available, provide physicians
with the strategies and tools to be successful in translating scientific
evidence into effective and rewarding care.
Index 231
x CONTENTS |
| adam_txt |
NEUROLOGICAL COMPLICATIONS IN CRITICAL ILLNESS: A FOCUS
ON MECHANISMS
CONTENTS
Foreword xiii
Thomas P. Bleck
Preface xv
Robert D. Stevens
Mechanisms of Neurologic Failure in Critical Illness 1
Aliaksei Pustavoitau and Robert D. Stevens
Critical illness frequently is associated with neurologic failure that
may involve the central and peripheral nervous systems. Central
nervous system failure is associated with a spectrum of neuro-
behavioral changes including delirium, coma, and long-term
cognitive dysfunction. Peripheral neurologic failure, or critical
illness neuromuscular abnormalities, is suggested by diffuse
arreflexic weakness and protracted respiratory insufficiency, and
may also persist long after the acute hospitalization. While the
burden of neurological disease complicating critical illness is
considerable, preventive or therapeutic options are limited. This
article provides an overview of research evaluating the relationship
between critical illness and neurologic function, with a special
emphasis on underlying mechanisms.
Coma After Global Ischemic Brain Injury: Pathophysiology
and Emerging Therapies 25
Robert E. Hoesch, Matthew A. Koenig,
and Romergryko G. Geocadin
Cardiac arrest is a major cause of death and morbidity in the
United States, and neurological injury contributes significantly to
this. Neurological complications associated with global cerebral
ischemia include disorders of responsiveness, such as coma and the
vegetative state, seizures, motor deficits, and brain death. Coma,
complete unresponsiveness, is the most pervasive of these.
VOLUME 24 • NUMBER 1 • JANUARY 2008 vii
Therapies that improve neurological outcomes in general after
cardiac arrest and therapies that stimulate arousal from coma could
have enormous clinical impact. The authors review the physiology
of arousal and describe the biochemical and pathophysiological
derangements that develop after global cerebral ischemia. We then
describe the potential therapeutic mechanisms of hypothermia and
deep brain stimulation, which provide hope for better neurological
outcomes after global cerebral ischemia.
Pathophysiology of Delirium in the Intensive Care Unit 45
Max L. Gunther, Alessandro Morandi, and E. Wesley Ely
Delirium, or acute brain dysfunction, is a life-threatening global
disturbance in cognitive functioning that frequently manifests in
critically ill patients. This review examines the current status of
knowledge regarding the pathophysiology of delirium in the ICU,
in particular, evaluating the role of iatrogenic factors such as
sedatives and analgesic administration in brain dysfunction. This
hypothesis is considered along with several other plausible
mechanisms of ICU delirium, including sepsis, postoperative
cognitive dysfunction, and changes in biomarkers and neuro-
transmitters. The review concludes by highlighting potential future
directions in molecular genetics for the elucidation of delirium and
its long-term consequences.
The Encephalopathy in Sepsis 67
Shidasp Siami, Djillali Annane, and Tarek Sharshar
Brain dysfunction is a severe complication of sepsis with an
incidence ranging from 9% to 71% that is associated with increased
morbidity and mortality. Its diagnosis relies mainly on neurologic
examination with clinical manifestations ranging from confusion to
coma. An electroencephalogram, somatosensory evoked potentials,
and measurement of plasma S-lOOb protein and neuron-specific
enolase can be useful for the detection of brain dysfunction. Brain
MRI can identify brain lesions such as cerebral infarction, posterior
reversible encephalopathy syndrome, and leukoencephalopathy.
The mechanism of sepsis-associated encephalopathy involves
inflammatory and non-inflammatory processes that affect endo-
thelial cells, glial cells, and neurons and induce blood-brain
barrier breakdown, derangements of intracellular metabolism,
and cell death. Specific treatments for sepsis-associated encephal¬
opathy need to be developed. Currently, treatment is mainly the
management of sepsis.
Mechanisms of Cerebral Injury from Cardiac Surgery 83
Charles W. Hogue, Rebecca F. Gottesman, and Joshua Stearns
Cerebral injury is a frequent complication of cardiac surgery, and it
has been associated with high mortality, morbidity, hospital costs;
an increased likelihood of admission to a secondary care facility
viii CONTENTS
after hospital discharge; and impaired quality of life. This article
examines postulated mechanisms for cerebral injury from cardiac
surgery. Most emphasis has been placed in the past on the
intraoperative interval as being the period of highest cerebral
vulnerability. Many clinical cerebral events, however, occur in the
postoperative period.
Brain Edema in Acute Liver Failure 99
Andres T. Blei
Acute liver failure (ALF) is a syndrome of rapidly deteriorating liver
function that manifests as coagulopathy and encephalopathy in a
previously healthy individual. This article analyzes the repercus¬
sions of ALF on the brain through a discussion of special features of
this syndrome, important for the interpretation of neurologic
findings. Of particular interest within the context of ALF are
hepatic encephalopathy and the pathogenesis of brain edema in
acute liver failure as well as its clinical and therapeutic aspects.
Seizures and Status Epilepticus in the Critically 111 115
Marek A. Mirski and Panayiotis N. Varelas
Seizures represent stereotypic electroencephalographic (EEG) and
behavioral paroxysms as a consequence of electrical neurologic
derangement. Seizures are usually described as focal or generalized
motor convulsions; however, nonconvulsive seizures that occur in
the absence of motor activity may escape clinical detection. Because
of the admission diagnoses and dramatic physiologic and
metabolic derangements common to critically ill patients, the
entire spectrum of seizure disorders may be encountered in the
ICU. Seizures in the ICU are attributable to primary neurologic
pathology or secondary to critical illness and clinical management.
For optimal treatment, early diagnosis of the seizure type and its
cause is important to ensure appropriate therapy. Convulsive
status epilepticus requires emergent treatment before irreversible
brain injury and severe metabolic disturbances occur.
The Alteration of Autonomic Function in Multiple Organ
Dysfunction Syndrome 149
Hendrik Schmidt, Dirk Hoyer, Joachim Wilhelm, Gerold Soffker,
Konstantin Heinroth, Kuno Hottenrott, Samir M. Said,
Michael Buerke, Ursula Miiller-Werdan, and Karl Werdan
Autonomic dysfunction is associated with the severity of illness
and mortality in patients with multiple organ dysfunction
syndrome (MODS) and may contribute significantly to the patho¬
genesis of this syndrome. Several treatment approaches may
possibly restore autonomic function in MODS and thus cause the
survival benefit.
CONTENTS «
Mechanisms of Neuromuscular Dysfunction in Critical Illness 165
Jaffar Khan, Taylor B. Harrison, and Mark M. Rich
The development of neuromuscular dysfunction (NMD) during
critical illness is increasingly recognized as a cause of failure to
wean from mechanical ventilation and is associated with signifi¬
cant morbidity and mortality. At times, it is difficult to identify the
presence of NMD and distinguish the etiology of the weakness in
patients with critical illness, but subtle clinical findings and
bedside electrophysiologic testing are helpful in establishing the
diagnosis. This article describes the clinical spectrum of acquired
neuromuscular weakness in the setting of critical illness, provides
an approach to diagnosis, and discusses its pathogenesis. Finally, a
defective sodium channel regulation as a unifying mechanism
underlying NMD in critically ill patients is proposed.
The Pathophysiology of Long-term Neuromuscular
and Cognitive Outcomes Following Critical Illness 179
Margaret S. Herridge, Jane Batt, and Ramona O. Hopkins
Despite the recent and marked improvement in short-term
mortality after critical illness, significant morbidities persist for
many patients following hospital discharge. This article discusses
the risk factors for muscle, nerve, and brain dysfunction after
critical illness and preliminary basic science data to support
possible pathophysiologic mechanisms mediating this disability.
Additionally, it presents a roadmap outlining future directions in
this area of research.
Evidence-Based Performance and Quality Improvement
in the Acute Cardiac Care Setting 201
Arthur L. Riba
This article was originally planned to appear in the October 2007 issue of
Critical Care Clinics. The goal of this article is to summarize the
indicators, processes, and dimensions of care that are linked to
desired clinical outcomes of the most commonly encountered
conditions in the acute cardiovascular care setting, and specifically,
acute coronary syndromes and congestive heart failure. Addition¬
ally, it reinforces the concepts of best cardiovascular care practice
and reviews some of the highly successful quality initiatives that
have demonstrated a link between hospital process performance
and outcomes. Particular attention is focused on the evidence-
based treatments and diagnostic evaluation and processes of
inpatient cardiovascular care, which lead to desired outcomes
meaningful to patients and where available, provide physicians
with the strategies and tools to be successful in translating scientific
evidence into effective and rewarding care.
Index 231
x CONTENTS |
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| index_date | 2024-07-02T20:24:27Z |
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| publishDate | 2008 |
| publishDateSearch | 2008 |
| publishDateSort | 2008 |
| publisher | Saunders |
| record_format | marc |
| series | Critical care clinics |
| series2 | Critical care clinics |
| spelling | Neurological complications in critical illness a focus on mechanisms guest ed. Robert D. Stevens Philadelphia [u.a.] Saunders 2008 XVII, 236 S. Ill. txt rdacontent n rdamedia nc rdacarrier Critical care clinics 24,1 Catastrophic illness Critical Illness Nervous System Diseases Nervous System Diseases etiology Neurologic manifestations of general diseases Nervensystem (DE-588)4041643-4 gnd rswk-swf Krankheit (DE-588)4032844-2 gnd rswk-swf Schwerkranker (DE-588)4180512-4 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Schwerkranker (DE-588)4180512-4 s Nervensystem (DE-588)4041643-4 s Krankheit (DE-588)4032844-2 s b DE-604 Stevens, Robert D. Sonstige oth Critical care clinics 24,1 (DE-604)BV000019838 24,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016428219&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Neurological complications in critical illness a focus on mechanisms Critical care clinics Catastrophic illness Critical Illness Nervous System Diseases Nervous System Diseases etiology Neurologic manifestations of general diseases Nervensystem (DE-588)4041643-4 gnd Krankheit (DE-588)4032844-2 gnd Schwerkranker (DE-588)4180512-4 gnd |
| subject_GND | (DE-588)4041643-4 (DE-588)4032844-2 (DE-588)4180512-4 (DE-588)4143413-4 |
| title | Neurological complications in critical illness a focus on mechanisms |
| title_auth | Neurological complications in critical illness a focus on mechanisms |
| title_exact_search | Neurological complications in critical illness a focus on mechanisms |
| title_exact_search_txtP | Neurological complications in critical illness a focus on mechanisms |
| title_full | Neurological complications in critical illness a focus on mechanisms guest ed. Robert D. Stevens |
| title_fullStr | Neurological complications in critical illness a focus on mechanisms guest ed. Robert D. Stevens |
| title_full_unstemmed | Neurological complications in critical illness a focus on mechanisms guest ed. Robert D. Stevens |
| title_short | Neurological complications in critical illness |
| title_sort | neurological complications in critical illness a focus on mechanisms |
| title_sub | a focus on mechanisms |
| topic | Catastrophic illness Critical Illness Nervous System Diseases Nervous System Diseases etiology Neurologic manifestations of general diseases Nervensystem (DE-588)4041643-4 gnd Krankheit (DE-588)4032844-2 gnd Schwerkranker (DE-588)4180512-4 gnd |
| topic_facet | Catastrophic illness Critical Illness Nervous System Diseases Nervous System Diseases etiology Neurologic manifestations of general diseases Nervensystem Krankheit Schwerkranker Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016428219&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000019838 |
| work_keys_str_mv | AT stevensrobertd neurologicalcomplicationsincriticalillnessafocusonmechanisms |