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Brain dysfunction in critically ill patients--the intensive care unit and beyond.
1Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Illinois, USA.
Critical Care (London, England)
|August 2, 2006
Summary
Critical care physicians can now accurately predict patient outcomes after cardiac arrest using clinical exams and biomarkers. This aids families in understanding prognosis for severe neurologic injury and coma.
Area of Science:
- Neurology
- Critical Care Medicine
- Prognostics
Background:
- Prognostication in critical care, particularly for neurologic injury, is challenging.
- Coma after cardiac arrest has high mortality and severe disability rates.
- Neurologic damage can manifest acutely and chronically after critical illness.
Purpose of the Study:
- To review current methods for predicting outcomes in comatose patients.
- To discuss the prevalence and impact of delirium in the ICU.
- To explore long-term neurologic and psychiatric sequelae of critical illness.
Main Methods:
- Review of clinical examination findings for prognostication.
- Analysis of serum biomarkers, including neuron-specific enolase.
- Evaluation of somatosensory evoked potentials (SEPs) in comatose patients.
- Discussion of delirium assessment and its consequences.
- Review of long-term cognitive and psychiatric dysfunction.
Main Results:
- Clinical examination, serum markers, and SEPs enable accurate prediction of poor outcomes in comatose patients.
- Delirium is prevalent in ICUs and linked to increased mortality and worse recovery.
- Neurologic damage can lead to persistent cognitive dysfunction and psychiatric issues post-ICU.
Conclusions:
- Accurate prognostication is achievable for comatose patients, aiding family communication.
- Addressing delirium is crucial for improving patient outcomes.
- Long-term neurologic and psychiatric monitoring is essential after critical illness.