Actualités en réanimation neurologique

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Corticoïdes dans les traumatismes du système nerveux central

Corticosteroids can restore vascular permeability in experimental cerebral oedema, reduce the release of free radicals and inhibit lipid peroxidation of cellular membranes. Experimental studies have shown beneficial results of corticosteroids in traumatic injuries of the central nervous system. Systematic reviews of randomised trials have recommended that corticosteroids should not be administered in head injury (high degree of certitude, standard). Nevertheless, a potential reduction of the risk for death or disability of 2% has justified performing a large randomised multicentre trial in order to confirm or refute this hypothesis. This study is in progress. In acute spinal cord injury, methylprednisolone (30 mg/kg in 1 h followed by 5.4 mg/kg per h) could be used during 24 h for trauma within 3 h, or during 48 h for trauma after 3 h and within 8 h time window. Methylprednisolone is not recommended for spinal cord trauma after 8 h. © 2004 Société de réanimation de langue française. Publié par Elsevier SAS. Tous droits réservés.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Relief of pain in intensive care patients

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LE SYNDROME CEREBRO CARDIAQUE EN NEURO TRAUMATOLOGIE

Head trauma is a possible cause of E.C.G. modifications originating in the brain and unresponsive to pure symptomatic cardiac therapy. On the other hand, these perturbations react in a favourable way to treatment aimed at protecting the heart against descending nociceptive influx caused by brain injury. This report shows the results of a retrospective electrographic study of 220 unoperated patients with head injuries aged 15 to 30 years. A correlation is established between E.C.G. findings and depth of coma. The authors discuss their findings and suggest an etiologic pathology based on clinical and experimental factors.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Oxygen-carrying substitutes other than fluorochemicals

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Nutrition artificielle en fin de vie: aspects éthiques

Current practice of nutrition support in the end-of-life critically ill patients is heterogeneous and namely influenced by ethical, cultural and religious factors. The translation of the ethical principles of beneficiency, non-maleficiency, autonomy and justice regarding the management of nutrition therapy are rarely evoked and largely varies between countries. This article will review these disparities and will try to discuss the potential causes. © 2010 Sociètè de rèanimation de langue française. Published by Elsevier Masson SAS. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions?

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Nutrition dans la période postopératoire (dont urgence)

Policies which tend to reduce surgical stress and therefore decrease catabolism and to improve anabolism could allow patients to recover more quickly and efficiently even after major surgery. In most instances, interruption of nutritional intake is not necessary after surgery. Oral intake can be started as soon as possible within the first 24. hours unless surgical contra-indication. Oral intake should be adjusted according to patient's tolerance. In patients without overt under-nutrition, postoperative nutritional support for periods of less than 7 days is not indicated. However, nutritional support is recommended when postoperative food intakes reach less than 60% of daily needs for 7 days. Moreover, early nutritional support should probably be administered if expected postoperative food intake will be less than 60% of daily needs for more than 7 days. In malnourished patients, nutritional support (using enteral rather than parenteral route) is strongly recommended within the first postoperative 24. hours regardless of preoperative nutritional support. © 2010 Elsevier Masson SAS.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Influence of enflurane on blood loss from the pregnant uterus

SCOPUS: ar.jinfo:eu-repo/semantics/publishe