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عمومی::
بخش مراقبتهای ویژه، بخش مراقبتهای ویژه، بخش مراقبتهای ویژه
in the neurological intensive care unit are recommended.
insipidus; DVT, deep vein thrombosis; ICP, intracranial pressure; ICU, intensive care unit; LP,،Pediatric Cardiac Intensive Care Unit, Department of Cardiology, Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, Rome 00165, Italy e-mail: z.ricci@libero.it
Providing artificial nutrition is a key part of the care of intensive care unit (ICU) patients.
As a result, malnourish- ment is frequently observed in intensive care unit, and most critically ill patients receive specialized nutrition therapy to prevent the development of malnutri- tion.
The high-quality, blinded 2-by-2 factorial trial of Heyland et al. included 1,223 patients from 40 different intensive care units in Canada, United States, and Europe [7].
First, intensive care unit (ICU) population is extremely heterogeneous.،Nutritional deficits occur often in brain injured critically ill patients, and greater energy and protein deficits are asso- ciated with prolonged intensive care unit (ICU) and hospital stays.23 According to the Brain Trauma Foundation (BTF), early enteral nutrition should be initiated at least by the fifth day and at most by the seventh day post injury.24 It is pos- sible that an even earlier start at day one after trauma can be beneficial in terms of better control of infection and over- all complications.25 For administration of enteral nutrition, a transgastric jejunal tube is recommended to reduce the incidences of ventilator-associated pneumonia.24
Fever occurs with an incidence of up to 70% in brain injured patients.28 The degree and duration of early hyperthermia are closely correlated with a higher morbidity and mortal- ity after neurologic injury.29 The temperature threshold that produces progressive thermal injury to the metaboli- cally active brain cells, blood-brain barrier, and vascu- lar endothelium appears to be between 39°C and 40°C.30 Hyperthermia, an often overlooked insult to the compro- mised brain, increases oxygen utilization and metabolic stress.29,31 Patients in the ICU can have multiple risk factors for hyperthermia such as infection from indwelling cathe- ters (e.g.
The management of TBI in the ICU should include comprehensive examination and assessment using such principles as outlined in the Advanced Trauma and Life Support protocol because occult injuries can escape initial screening.
Ischemic strokes are the most common (80%-90%) of stroke subtypes and are increasingly a larger proportion of post-procedural ICU management.
Hemorrhagic strokes account for the remaining 10% to 20% of strokes, but are often the most medically complex and have the longest length of stay and highest morbidity and mortality in the ICU.144 The follow- ing sections will provide an overview of the most common critical care management issues for SAH, ischemic stroke, and intracerebral hemorrhage (ICH).
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