Non-neurological organ dysfunction in neurocritical care: impact on outcome and etiological considerations.
OBJECTIVE
Organ dysfunction is an important determinant of outcome in critical care medicine. Patients with life threatening neurologic injury represent a distinct subset of critically ill patients in whom non-neurologic organ dysfunction may develop. In this paper the incidence and impact of non-neurologic organ dysfunction in patients with major neurologic injury will be reviewed. Further, potential etiological considerations will be addressed and management strategies discussed.


RESULTS
Non-neurologic organ dysfunction is extremely common in patients with brain injury occurring in 80-90% of patients admitted to intensive-care units. Several studies have now identified this dysfunction as an independent predictor of poor outcome in neurocritical care. This dysfunction may arise as a result of the neurologic injury or secondary to treatment. Massive catecholamine release continues to be the primary etiological theory of non-neurologic organ dysfunction due to brain injury. Currently employed therapies directed at intracranial hypertension such as maintenance of cerebral perfusion pressure and the use of hypothermia or barbiturates predispose non-neurologic organ dysfunction.


CONCLUSIONS
Non-neurologic organ dysfunction is common. This dysfunction independently predicts poor outcome following brain injury and represents a potentially modifiable risk factor. Further study is required to develop optimal management strategies.
Zygun
David
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Department of Critical Care Medicine, University of Calgary Intensivist, Calgary Health Region, Alberta, Canada. david.zygun@calgaryhealthregion.ca
D001930:Brain Injuries / Q000150:complications* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D003422:Critical Care; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000628:therapy