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General ICU Care of the Neurological Patient 

General ICU Care of the Neurological Patient
Chapter:
General ICU Care of the Neurological Patient
Author(s):

Samuel A. Tisherman

, and Sara Hefton

DOI:
10.1093/med/9780199375349.003.0020
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date: 04 April 2020

Critically ill patients with acute neurologic conditions are at high risk for development of dysfunction of multiple extracerebral organs. They frequently need airway and ventilator support, and a lung-protective strategy is appropriate. Hemodynamic support is critical to prevent secondary brain injury from hypotension. These patients are at high risk for infectious complications and development of sepsis. Electrolyte abnormalities are common, particularly disorders of sodium metabolism. Controversy continues regarding optimal hemoglobin levels for transfusion. Allowing mild hyperglycemia does not seem to be harmful, though hypoglycemia should be avoided. Steroids may be indicated for specific neurologic diseases but otherwise have little role in the intensive care unit, except for refractory septic shock. Critically ill patients with acute neurologic conditions are very catabolic and require early enteral nutrition support, accompanied by stress ulcer prophylaxis in most circumstances. Optimizing extracerebral organ support can have a significant impact upon outcomes from acute neurologic conditions.

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