By Jose I. Suarez
Case Western Reserve Univ., Cleveland, OH. offers an authoritative overview of diagnostic, medical, and administration matters in neurocritical care. deals guidance for organizing a neurosciences severe care unit and makes a speciality of either neurologic and neurosurgical stipulations. additionally addresses bioethical matters. considerable illustrations.
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Additional info for Critical Care Neurology and Neurosurgery (Current Clinical Neurology)
Outcomes and resource utilization for patients with prolonged critical illness managed by university based or community based subspecialties. Am. J. Respir. Crit. Care Med. 1989;158:1410–1415. 39. Multz A, Chalfin DB, Samson IM, et al. A ‘closed’ medical intensive care unit (MICU) improves resource utilization when compared with an ‘open’ MICU. Am. J. Respir. Crit. Care Med. 1978;157:1468–1473. 40. Hanson CW III, Deutschman CS, Anderson HL III, et al. Effects of an organized critical care service on outcomes and resource utilization: a cohort study.
Because the brain has no significant storage capacity, cerebral metabolism, CBF, and oxygen extraction are tightly coupled. This relationship is expressed by the Fick’s equation: CMRO2 = CBF × AVDO2, in which CMRO2 represents cerebral metabolic rate for oxygen and AVDO2, arterio-venous difference of oxygen (2). Under normal conditions, the brain maintains a constant AVDO2 by responding to changes in metabolism, cerebral perfusion pressure (CPP), and blood viscosity with changes in vessel caliber, a phenomenon referred to as autoregulation (7,8).
Although admitting diagnoses have not changed, emergence of new means of diagnosing and treating acute neurological diseases increases the number of patients that are candidates for NSU care. Acute management of stroke, until recently, was characterized by supportive therapy alone. Although advances in cardiorespiratory care have allowed improved outcomes, it has taken new therapies directed at the brain to improve function. For example, patients with vertebrobasilar territory infarcts uniformly died before techniques to support ventilation and treat cardiovascular collapse.