1,736 results match your criteria Critical Care Clinics[Journal]


Modern Critical Care Endocrinology and Its Impact on Critical Care Medicine.

Authors:
Rinaldo Bellomo

Crit Care Clin 2019 Apr;35(2):xiii-xvi

Department of Medicine, Radiology and Critical Care, Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC 3084, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.ccc.2019.01.001DOI Listing

Hormonal Therapy in Organ Donors.

Crit Care Clin 2019 Apr 24;35(2):389-405. Epub 2019 Jan 24.

Department of Intensive Care, Austin Hospital, Melbourne, 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address:

Optimal supportive treatment of brain dead potential organ donors maximizes donation and transplant outcomes. Brain death is associated with activation of inflammatory pathways and loss of autoregulatory brain functions that may include hypothalamic-pituitary dysfunction. As well as general supportive care, specific treatment to counter the common sequelae of brain death such as hypotension, hypothermia, and diabetes insipidus is required. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.013DOI Listing

Thyroid Hormones in Critical Illness.

Crit Care Clin 2019 Apr 24;35(2):375-388. Epub 2019 Jan 24.

Endocrine and Metabolic Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia.

Thyroid hormone is integral for normal function, yet during illness, circulating levels of the most active form (triiodothyronine [T3]) decline. Whether this is an adaptive response in critical illness or contributes to progressive disease has remained controversial. This review outlines the basis of thyroid hormone changes during critical illness and considers the evidence regarding T3 replacement. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.012DOI Listing

Therapeutic Opportunities for Hepcidin in Acute Care Medicine.

Crit Care Clin 2019 Apr 30;35(2):357-374. Epub 2019 Jan 30.

La Jolla Pharmaceutical Company, 4550 Towne Centre Court, San Diego, CA 92121, USA; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA.

Iron homeostasis is often disrupted in acute disease with an increase in catalytic free iron leading to the formation of reactive oxygen species and subsequent tissue-specific oxidative damage. This article highlights the potential therapeutic benefit of exogenous hepcidin to prevent and treat iron-induced injury, specifically in the management of infection from enteric gram-negative bacilli or fungi, malaria, sepsis, acute kidney injury, trauma, transfusion, cardiopulmonary bypass surgery, and liver disease. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.014DOI Listing

Incretin Physiology and Pharmacology in the Intensive Care Unit.

Crit Care Clin 2019 Apr 24;35(2):341-355. Epub 2019 Jan 24.

Intensive Care Unit, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia; Intensive Care, University of Melbourne, 300 Grattan Street, Parkville, Victoria 3050, Australia.

In health, postprandial glycemic excursions are attenuated via stimulation of insulin secretion, suppression of glucagon secretion, and slowing of gastric emptying. The incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, are primary modulators of this response. Drugs have recently been developed that exploit the incretin-axis for the management of type 2 diabetes. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.011DOI Listing

Melatonin in Critical Care.

Crit Care Clin 2019 Apr 30;35(2):329-340. Epub 2019 Jan 30.

Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 422, Nashville, TN 37212, USA. Electronic address:

Melatonin is involved in regulation of a variety of physiologic functions, including circadian rhythm, reproduction, mood, and immune function. Exogenous melatonin has demonstrated many clinical effects. Numerous clinical studies have documented improved sleep quality following administration of exogenous melatonin. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.008DOI Listing
April 2019
1 Read

New Agents for the Treatment of Type 2 Diabetes.

Crit Care Clin 2019 Apr 23;35(2):315-328. Epub 2019 Jan 23.

Department of Medicine, The University of Melbourne, Austin Health, 300 Waterdale Road, Heidelberg West, Melbourne, Victoria 3081, Australia; Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg West, Melbourne, Victoria 3081, Australia. Electronic address:

The Renaissance of glucose-lowering therapies has arrived with multiple agents that lower blood glucose and demonstrate cardiovascular and renal benefits in people with type 2 diabetes. This article summarizes these new classes of therapies, including the sodium glucose co-transporter-2 inhibitors, glucagon-like peptide-1 agonists, and dipeptidyl peptidase-4 inhibitors. Their cardiovascular safety profile, effects on glycemic, weight, and renal outcomes are discussed. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.007DOI Listing

Osteoporosis and the Critically Ill Patient.

Crit Care Clin 2019 Apr 28;35(2):301-313. Epub 2019 Jan 28.

University Hospital Geelong, Barwon Health, Bellerine St, Geelong, VIC 3220, Australia; School of Medicine, Deakin University, 75 Pigdons Rd, Geelong, VIC 3216, Australia; Department of Medicine, Melbourne Medical School-Western Campus, The University of Melbourne, McKechnie St, St Albans, VIC 3021, Australia.

Improved survival after critical illness has led to recognition of impaired recovery following critical illness as a major public health problem. A consistent association between critical illness and accelerated bone loss has been described, including changes in bone turnover markers, bone mineral density, and fragility fracture rate. An association between accelerated bone turnover and increased mortality after critical illness is probable. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.006DOI Listing

Hemoglobin A1c and Permissive Hyperglycemia in Patients in the Intensive Care Unit with Diabetes.

Crit Care Clin 2019 Apr 24;35(2):289-300. Epub 2019 Jan 24.

Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Solnavägen 9, Stockholm, 171 65 Solna, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 171 76, Sweden. Electronic address:

Glycated hemoglobin A1c can be used to assess intensive care unit patients' level of chronic glycemic control. Compared with patients with normal glycated hemoglobin A1c, patients with elevated glycated hemoglobin A1c seem to better tolerate hyperglycemia and large glucose fluctuations during critical illness. The risks associated with hypoglycemia are markedly greater among patients with elevated glycated hemoglobin A1c. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.010DOI Listing

Erythropoietin in Critical Illness and Trauma.

Authors:
Craig French

Crit Care Clin 2019 Apr 28;35(2):277-287. Epub 2019 Jan 28.

Western Health, Footscray Hospital, Gordon Street Footscray, Melbourne, VIC 3011, Australia; The University of Melbourne, Parkville, VIC 3010, Australia; Monash University, School of Public Health and Preventive Medicine, 553 St Kilda Road, Melbourne, VIC 3004, Australia. Electronic address:

Erythropoietin (EPO) is a 34kD pleiotropic cytokine that was first identified as being essential for red blood cell (RBC) production. It is now recognized however that EPO is produced by many tissues. It plays a key role in the modulation of the response to injury, inflammation, and tissue hypoxia via the inhibition of apoptosis. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.015DOI Listing

Hydrocortisone in Vasodilatory Shock.

Crit Care Clin 2019 Apr 28;35(2):263-275. Epub 2019 Jan 28.

Department of Intensive Care, The Wesley Hospital, Coronation Drive, QLD 4066, Australia; Department of Intensive Care, The Royal Brisbane and Women's Hospital, University of Queensland, Herston Road, QLD 4066, Australia; Division of Critical Care, The George Institute for Global Health, King Street, Sydney, NSW 2050, Australia.

Vasodilatory shock is the most common type of circulatory shock in critically ill patients; sepsis the predominant cause. Steroid use in septic shock gained favor in the 1970s; however, studies of high-dose steroids demonstrated excess morbidity and mortality. Lower dosage steroid use was driven by trials demonstrating improved hemodynamic status and the possibility of relative adrenal insufficiency; however, divergent results led to uncertainty about hydrocortisone treatment. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.005DOI Listing

Vasopressin in Vasodilatory Shock.

Crit Care Clin 2019 Apr 23;35(2):247-261. Epub 2019 Jan 23.

Division of Critical Care Medicine, Centre for Heart Lung Innovation, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. Electronic address:

Vasodilatory shock is the final common pathway for all forms of severe shock, with sepsis the most common primary etiology and the leading cause of critical illness-related mortality. The pathophysiology of this condition remains incompletely elucidated. Deficiency of the neuropeptide hormone vasopressin seems to play a significant role. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.004DOI Listing

Angiotensin II in Vasodilatory Shock.

Crit Care Clin 2019 Apr 23;35(2):229-245. Epub 2019 Jan 23.

Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Center for Critical Care, Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue - G58, Cleveland, OH 44195, USA; Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address:

The Angiotensin II for the Treatment of Vasodilatory Shock (ATHOS-3) trial demonstrated the vasopressor effects and catecholamine-sparing properties of angiotensin II. As a result, the Food and Drug Administration has approved angiotensin II for the treatment of vasodilatory shock. This review details the goals of treatment of vasodilatory shock in addition to the history, current use, and recent research regarding the use of angiotensin II. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.003DOI Listing

Classic and Nonclassic Renin-Angiotensin Systems in the Critically Ill.

Crit Care Clin 2019 Apr 28;35(2):213-227. Epub 2019 Jan 28.

Department of Medicine, University of Melbourne, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia.

Classic and nonclassic renin-angiotensin systems (RAS) are 2 sides of an ubiquitous endocrine/paracrine cascade regulating blood pressure and homeostasis. Angiotensin II and angiotensin-converting enzyme (ACE) levels are associated with severity of disease in the critically ill, and are central to the physiology and the pathogenesis of circulatory shock. Angiotensin (1-7) and ACE2 act as an endogenous counterregulatory arm to the angiotensin II/ACE axis. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.002DOI Listing
April 2019
1 Read

Hormone Therapy in Trauma Patients.

Crit Care Clin 2019 Apr 24;35(2):201-211. Epub 2019 Jan 24.

EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Medical University of Nantes, 21 boulevard Benoni Goullin, Nantes 44000, France; Surgical Intensive Care Unit, Hotel Dieu, CHU Nantes, 1 place alexis ricordeau, Nantes 44093, France.

Low-dose hydrocortisone reduces the dose of vasopressors and hospital length of stay; it may also decrease the rate of hospital-acquired pneumonia and time on ventilator. No major side effect was reported, but glycemia and natremia should be monitored. Progesterone did not enhance outcome of trauma patients. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.009DOI Listing

Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone in Critically Ill Patients.

Crit Care Clin 2019 Apr 28;35(2):187-200. Epub 2019 Jan 28.

Intensive Care Unit, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia.

Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion lie at opposite ends of the spectrum of disordered renal handling of water. Whereas renal retention of water insidiously causes hypotonic hyponatremia in syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus may lead to free water loss, hypernatremia, and volume depletion. Hypernatremia and hyponatremia are associated with worse outcomes and longer intensive care stays. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.11.001DOI Listing

Caring for the Critically Ill Liver Transplant Patients: A Fifty-Year Journey!

Authors:
Ali Al-Khafaji

Crit Care Clin 2019 Jan 17;35(1):xv-xvi. Epub 2018 Oct 17.

Transplant Intensive Care Unit, University of Pittsburgh School of Medicine, Room 613 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccc.2018.10.002DOI Listing
January 2019
1 Read

Thoracic Transplantation.

Crit Care Clin 2019 Jan 26;35(1):xiii-xiv. Epub 2018 Oct 26.

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute and Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA. Electronic address:

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January 2019
7 Reads

Perioperative Management of the Liver Transplant Recipient.

Crit Care Clin 2019 Jan;35(1):95-105

Aurora Critical Care Service, Advocate Aurora Health Care, 2901 W Kinnickinnic River Parkway, Suite 305, Milwaukee, WI 53215, USA; Aurora Abdominal Transplant and Hepatobiliary Program, 2801 W Kinnickinnic River Parkway, Suite 580, Milwaukee, WI 53215, USA.

Perioperative management of the liver transplant recipient is a team effort that requires close collaboration between intensivist, surgeon, anesthesiologist, hepatologist, nephrologist, other specialists, and hospital staff before and after surgery. Transplant viability must be reassessed regularly and particularly with each donor organ. Regular discussions with patient and family facilitate realistic determinations of goals based on patient aspirations and clinical realities. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.012DOI Listing
January 2019
14 Reads

Infections in Heart and Lung Transplant Recipients.

Crit Care Clin 2019 Jan 25;35(1):75-93. Epub 2018 Oct 25.

Division of Infectious Diseases, Multi-Organ Transplant Program, Department of Medicine, University of Toronto, University Health Network, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada. Electronic address:

Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.010DOI Listing
January 2019
15 Reads

Renal Complications Following Lung Transplantation and Heart Transplantation.

Crit Care Clin 2019 Jan 25;35(1):61-73. Epub 2018 Oct 25.

Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15261, USA.

Renal complications are common following heart and/or lung transplantation and lead to increased morbidity and mortality. Renal dysfunction is also associated with increased mortality for patients on the transplant wait list. Dialysis dependence is a relative contraindication for heart or lung transplantation at most centers, and such patients are often listed for a simultaneous kidney transplant. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.009DOI Listing
January 2019
25 Reads

Perioperative Management of the Cardiac Transplant Recipient.

Crit Care Clin 2019 Jan 25;35(1):45-60. Epub 2018 Oct 25.

Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA. Electronic address:

Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.008DOI Listing
January 2019
10 Reads

Perioperative Management of the Lung Graft Following Lung Transplantation.

Crit Care Clin 2019 Jan 26;35(1):27-43. Epub 2018 Oct 26.

Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA.

Perioperative management of patients undergoing lung transplantation is one of the most complex in cardiothoracic surgery. Certain perioperative interventions, such as mechanical ventilation, fluid management and blood transfusions, use of extracorporeal mechanical support, and pain management, may have significant impact on the lung graft function and clinical outcome. This article provides a review of perioperative interventions that have been shown to impact the perioperative course after lung transplantation. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.007DOI Listing
January 2019
7 Reads

Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.

Crit Care Clin 2019 Jan 25;35(1):169-186. Epub 2018 Oct 25.

Department of Critical Care Medicine, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.

Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.011DOI Listing
January 2019
14 Reads

Infectious Complications Following Solid Organ Transplantation.

Crit Care Clin 2019 Jan;35(1):151-168

Division of Infectious Disease, Multi-Organ Transplant Program, University Health Network, University of Toronto, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada. Electronic address:

Infections in solid organ transplant recipients are complex and heterogeneous. This article reviews the clinical syndromes that will likely be encountered in the intensive care unit and helps to guide in the therapy and management of these patients. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.004DOI Listing
January 2019
8 Reads

Extracorporeal Devices.

Crit Care Clin 2019 Jan;35(1):135-150

Critical Care and Hepatology, Emory University, 1364 Clifton Road Northeast, 2nd Floor, 2D ICU- D264, Atlanta, GA 30322, USA. Electronic address:

Extracorporeal liver support (ECLS) emerged from the need stabilize high-acuity liver failure patients with the highest risk of death. The goal is to optimize the hemodynamic, neurologic, and biochemical parameters in preparation for transplantation or to facilitate spontaneous recovery. Patients with acute liver failure and acute-on-chronic liver failure stand to benefit from these devices, especially because they have lost many of the primary functions of the liver, including detoxifying the blood of various endogenous and exogenous substances, manufacturing circulating proteins, secreting bile, and storing energy. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.003DOI Listing
January 2019
9 Reads

Graft Dysfunction and Management in Liver Transplantation.

Crit Care Clin 2019 Jan 25;35(1):117-133. Epub 2018 Oct 25.

Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta T6G-2X8, Canada. Electronic address:

Graft dysfunction of the liver allograft manifests across a spectrum in both timing posttransplantation and clinical presentation. This can range from mild transient abnormalities of liver tests to acute liver failure potentially leading to graft failure. The causes of graft dysfunction can be divided into those resulting in early and late graft dysfunction. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.002DOI Listing
January 2019
2 Reads

Bridging to Lung Transplantation.

Crit Care Clin 2019 Jan;35(1):11-25

Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, Baylor St Luke's Medical Center, Baylor College of Medicine, 6770 Bertner Avenue, Suite C-355K, Houston, TX 77030, USA. Electronic address:

Lung transplantation is the gold standard for treating patients with end-stage lung disease. Such patients can present with severe illness on the waitlist and may deteriorate before a lung donor is available. Bridging strategies with extracorporeal membrane oxygenation (ECMO) are valuable for getting patients to transplant and provide a chance at survival. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.006DOI Listing
January 2019
13 Reads

Critical Care Management of Living Donor Liver Transplants.

Crit Care Clin 2019 Jan 25;35(1):107-116. Epub 2018 Oct 25.

Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.

This article represents a review of the postoperative management of donors and recipients after living donor liver transplant, including monitoring, liberation from mechanical ventilation, nutritional support, and pain control. Vascular complications, such as biliary and sepsis, and bleeding are also discussed. Finally, commonly used immunosuppression and antimicrobial prophylaxes are reviewed. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.08.001DOI Listing
January 2019
11 Reads

Brief Overview of Lung, Heart, and Heart-Lung Transplantation.

Crit Care Clin 2019 Jan 25;35(1):1-9. Epub 2018 Oct 25.

Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA. Electronic address:

Lung transplantation, heart transplantation, and heart-lung transplantation are life-saving treatment options for patients with lung and/or cardiac failure. Evolution in these therapies over the past several decades has led to better outcomes with application to more patients. The complexity and severity of illness of patients in the pretransplant phase has steadily increased, making posttransplant intensive care unit management more difficult. Read More

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January 2019
9 Reads

Preface: Complications During and After Critical Illness.

Authors:
Carol L Hodgson

Crit Care Clin 2018 Oct 30;34(4):xi-xiii. Epub 2018 Jul 30.

Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.ccc.2018.07.001DOI Listing
October 2018
17 Reads

Family and Support Networks Following Critical Illness.

Crit Care Clin 2018 Oct 11;34(4):609-623. Epub 2018 Aug 11.

Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland.

Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.008DOI Listing
October 2018
12 Reads

Psychiatric Morbidity After Critical Illness.

Crit Care Clin 2018 Oct 11;34(4):599-608. Epub 2018 Aug 11.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 106 and 115, Baltimore, MD 21287, USA. Electronic address:

Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.006DOI Listing
October 2018
3 Reads

Sedation, Delirium, and Cognitive Function After Critical Illness.

Authors:
Timothy D Girard

Crit Care Clin 2018 Oct;34(4):585-598

Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 638 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Electronic address:

Delirium has been consistently identified as a risk factor for critical illness brain injury, but ICU patients are exposed to a multitude of risk factors for delirium and it remains unclear which of these risk factors should be targeted to improve long-term cognitive outcomes. Because exposure to sedating medications-which are frequently used to treat unwanted yet common symptoms during critical illness-is a risk factor for delirium that is directly controlled by clinicians, the relationship between sedation, delirium, and long-term cognition is of great interest to clinicians, researchers, and patients. This review describes theoretic relationships between sedation, delirium, and long-term cognition and reviews the evidence supporting these theoretic relationships. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.009DOI Listing
October 2018
1 Read

Intensive Care Nutrition and Post-Intensive Care Recovery.

Crit Care Clin 2018 Oct 11;34(4):573-583. Epub 2018 Aug 11.

Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address:

Intensive care unit (ICU)-acquired weakness frequently complicates critical illness, which prolongs intensive care dependency and causes long-term burden. Observational studies have suggested that prolonged underfeeding could aggravate ICU-acquired weakness and impair outcome. However, recent large randomized controlled trials have failed to show a benefit of early enhanced nutrition to critically ill patients. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.004DOI Listing
October 2018
1 Read

Early Mobilization in the Intensive Care Unit to Improve Long-Term Recovery.

Crit Care Clin 2018 Oct 11;34(4):557-571. Epub 2018 Aug 11.

ANZIC-RC, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. Electronic address:

This article outlines the effect of early mobilization on the long-term recovery of patients following critical illness. It investigates the safety of performing exercise in this environment, the differing types of rehabilitation that can be provided, and the gaps remaining in evidence around this area. It also attempts to assist clinicians in prescription of exercise in this cohort while informing all readers about the impact that mobilization can have for the outcomes of intensive care patients. Read More

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October 2018
29 Reads

The Pathophysiology of Neuromuscular Dysfunction in Critical Illness.

Crit Care Clin 2018 Oct 14;34(4):549-556. Epub 2018 Aug 14.

Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada; Department of Medicine, University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.

Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. As the population ages and accrues a greater burden of comorbid illness and medical complexity, those patients admitted to an intensive care unit will be challenged in their recovery because of diminished organ reserve and variable tissue resiliency. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.010DOI Listing
October 2018
4 Reads

Frailty and the Association Between Long-Term Recovery After Intensive Care Unit Admission.

Crit Care Clin 2018 Oct 11;34(4):527-547. Epub 2018 Aug 11.

Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada. Electronic address:

Frailty is common, although infrequently screened for among patients admitted to intensive care. Frailty has been the focus of research in geriatric medicine; however, its epidemiology and interaction with critical illness have only recently been studied. Instruments to screen for and measure frailty require refinement in intensive care settings. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07490704183071
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http://dx.doi.org/10.1016/j.ccc.2018.06.007DOI Listing
October 2018
7 Reads

Measuring Outcomes After Critical Illness.

Authors:
Nathan E Brummel

Crit Care Clin 2018 Oct 14;34(4):515-526. Epub 2018 Aug 14.

Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Suite 350, 2525 West End Avenue, Nashville, TN 37203, USA. Electronic address:

Outcomes after critical illness remain poorly understood. Conceptual models developed by other disciplines can serve as a framework by which to increase knowledge about outcomes after critical illness. This article reviews 3 models to understand the distinct but interrelated content of outcome domains, to review the components of functional status, and to describe how injuries and illnesses relate to disabilities and impairments afterward. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146399PMC
October 2018
1 Read

Preventing Chronic Critical Illness and Rehospitalization: A Focus on Sepsis.

Crit Care Clin 2018 Oct 11;34(4):501-513. Epub 2018 Aug 11.

Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48019, USA; VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI 48109, USA. Electronic address:

An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital admission with in 90 days, most commonly for infection. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.002DOI Listing
October 2018
4 Reads

Patient and Population-Level Approaches to Persistent Critical Illness and Prolonged Intensive Care Unit Stays.

Crit Care Clin 2018 Oct 10;34(4):493-500. Epub 2018 Aug 10.

Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, 3916 Taubman Center, 1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109-5360, USA.

The differential diagnosis of prolonged intensive care unit (ICU) stays includes intrinsic patient and admitting diagnostic characteristics, occurrences during the course of critical illness, and system failures. Existing data suggest that the most common cause of prolonged ICU stay is the development of new cascading problems, which is now more related to ongoing critical illness than the original reason for ICU admission. Accepting the dynamism inherent in such a clinical course has implications for contemporary clinical care. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146412PMC
October 2018
1 Read

Challenges and Future Directions in Left Ventricular Assist Device Therapy.

Crit Care Clin 2018 Jul;34(3):479-492

Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA.

The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.010DOI Listing
July 2018
4 Reads

Complications of Durable Left Ventricular Assist Device Therapy.

Authors:
Sitaramesh Emani

Crit Care Clin 2018 Jul;34(3):465-477

Advanced Heart Failure and Cardiac Transplant, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200 DHLRI, Columbus, OH 43221, USA. Electronic address:

Heart failure patients on durable left ventricular assist device support experience improved survival, quality of life, and exercise capacity. The complication rate, however, remains unacceptably high, although it has declined with improvements in pump design, better patient selection, and greater understanding of the pump physiology and flow dynamics. Most complications are categorized as those related to the pump-patient interface or those related to patient physiology. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07490704183068
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http://dx.doi.org/10.1016/j.ccc.2018.03.003DOI Listing
July 2018
5 Reads

Device Management and Flow Optimization on Left Ventricular Assist Device Support.

Crit Care Clin 2018 Jul;34(3):453-463

Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Transplantation, The Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, P.O. Box 980204, Richmond, VA 23298-0204, USA.

The authors discuss principles of continuous flow left ventricular assist device (LVAD) operation, basic differences between the axial and centrifugal flow designs and hemodynamic performance, normal LVAD physiology, and device interaction with the heart. Systematic interpretation of LVAD parameters and recognition of abnormal patterns of flow and pulsatility on the device interrogation are necessary for clinical assessment of the patient. Optimization of pump flow using LVAD parameters and echocardiographic and hemodynamics guidance are reviewed. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.002DOI Listing
July 2018
4 Reads

Prevention and Treatment of Right Ventricular Failure During Left Ventricular Assist Device Therapy.

Crit Care Clin 2018 Jul 4;34(3):439-452. Epub 2018 May 4.

Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772, USA.

Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.001DOI Listing
July 2018
11 Reads

A Targeted Management Approach to Cardiogenic Shock.

Crit Care Clin 2018 Jul;34(3):423-437

Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA. Electronic address:

Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.009DOI Listing
July 2018
3 Reads

Extracorporeal Gas Exchange.

Crit Care Clin 2018 Jul;34(3):413-422

Department of Anesthesiology and Intensive Care Medicine, University Hospital, Georg-August University of Göttingen, Robert Koch Straße 40, Göttingen 37075, Germany. Electronic address:

Extracorporeal gas exchange is increasingly used for various indications. Among these are refractory acute respiratory failure, including the acute respiratory distress syndrome (ARDS), and the avoidance of ventilator-induced lung injury (VILI) by enabling lung-protective ventilation. Additionally, extracorporeal gas exchange allows the treatment of hypercapnic respiratory failure while helping to unload the respiratory muscles and avoid intubation and invasive ventilation, as well as facilitating weaning from the ventilator. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.011DOI Listing
July 2018
32 Reads

Noninvasive Options.

Crit Care Clin 2018 Jul 4;34(3):395-412. Epub 2018 May 4.

Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy.

Noninvasive ventilation (NIV) has assumed a central role in the treatment of selected patients with acute respiratory failure due to exacerbated chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema. Recent advances in the understanding of physiologic aspects of NIV application through different interfaces and ventilator settings have led to improved patient-machine interaction, enhancing favorable NIV outcome. In recent years, the growing role of NIV in the acute care setting has led to the development of technical innovations to overcome the problems related to gas leakage and dead space, improving the quality of the devices and optimizing ventilation modes. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07490704183068
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http://dx.doi.org/10.1016/j.ccc.2018.03.007DOI Listing
July 2018
13 Reads

Automation of Mechanical Ventilation.

Crit Care Clin 2018 Jul;34(3):383-394

Division of Trauma and Critical Care, University of Cincinnati, 231 Albert Sabin Way #558, Cincinnati, OH 45267, USA. Electronic address:

Closed loop control of mechanical ventilation is routine and operates behind the ventilator interface. Reducing caregiver interactions is neither an advantage for the patient or the staff. Automated systems causing lack of situational awareness of the intensive care unit are a concern. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.012DOI Listing
July 2018
4 Reads

Avoiding Respiratory and Peripheral Muscle Injury During Mechanical Ventilation: Diaphragm-Protective Ventilation and Early Mobilization.

Crit Care Clin 2018 Jul;34(3):357-381

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, 585 University Avenue, Peter Munk Building, 11th Floor Room 192, Toronto, ON M5G 2N2, Canada. Electronic address:

Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Read More

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http://dx.doi.org/10.1016/j.ccc.2018.03.005DOI Listing
July 2018
10 Reads