1,760 results match your criteria Current Opinion in Critical Care[Journal]


How to deal with severe acute pancreatitis in the critically ill.

Curr Opin Crit Care 2019 Feb 5. Epub 2019 Feb 5.

Purpose Of Review: To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU.

Recent Findings: SAP is a devastating disease associated with a high morbidity and mortality. Recent evidence advocates adequate risk assessment and severity prediction (including intra-abdominal pressure monitoring), tailored fluid administration favoring balanced crystalloids, withholding prophylactic antibiotic therapy, and early detection and treatment of extra-pancreatic and fungal infections. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000596DOI Listing
February 2019
2 Reads

Impact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome.

Curr Opin Crit Care 2019 Jan 31. Epub 2019 Jan 31.

Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Purpose Of Review: Facilitating spontaneous breathing has been traditionally recommended during mechanical ventilation in acute respiratory distress syndrome (ARDS). However, early, short-term use of neuromuscular blockade appears to improve survival, and spontaneous effort has been shown to potentiate lung injury in animal and clinical studies. The purpose of this review is to describe the beneficial and deleterious effects of spontaneous breathing in ARDS, explain potential mechanisms for harm, and provide contemporary suggestions for clinical management. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000597DOI Listing
January 2019
8 Reads

Update on the management of acute liver failure.

Curr Opin Crit Care 2019 Jan 28. Epub 2019 Jan 28.

Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.

Purpose Of Review: This review describes the current intensive care management of acute liver failure (ALF) and the latest evidence for emerging therapies.

Recent Findings: Mortality from ALF continues to improve and in some cases, medical therapy can negate the need for liver transplantation because of protocolized management in specialist centres. Liver transplantation remains the cornerstone of management for poor prognosis ALF. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000583DOI Listing
January 2019
2 Reads

Pharmacotherapy in neurointensive care: an update on new options and developments.

Authors:
Mauro Oddo

Curr Opin Crit Care 2019 Jan 22. Epub 2019 Jan 22.

Department of Intensive Care Medicine, Critical Care Clinical Research Unit, CHUV-Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland.

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http://dx.doi.org/10.1097/MCC.0000000000000593DOI Listing
January 2019

Acute kidney injury in cirrhosis: implications for liver transplantation.

Curr Opin Crit Care 2019 Jan 22. Epub 2019 Jan 22.

Department of Critical Care Medicine.

Purpose Of Review: Acute kidney injury (AKI) in cirrhosis consists of varying phenotypes, with hepatorenal syndrome (HRS) representing a single entity. Prompt recognition and diagnosis of AKI cause identifies appropriate therapeutic measures. This review provides an overview of AKI definitions, highlights challenges in quantifying renal impairment in cirrhosis, lists novel diagnostic AKI biomarkers, and summarizes transplantation implications. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000590DOI Listing
January 2019
2 Reads

Acute-on-chronic liver failure: management and prognosis.

Authors:
Jody C Olson

Curr Opin Crit Care 2019 Jan 22. Epub 2019 Jan 22.

Departments of Internal Medicine and Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.

Purpose Of Review: Hospitalizations due to complications of cirrhosis continue to rise. Patients with chronic liver disease who suffer acute decompensation [acute-on-chronic liver failure (ACLF)] often require intensive care support and are at high risk for short-term mortality. Given the high mortality rate associated with this condition is incumbent on intensive care providers who care for this patient population to have a working knowledge of ACLF with its associated complications, management strategies and prognosis. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000595DOI Listing
January 2019
2 Reads

Fluids and hyperosmolar agents in neurocritical care: an update.

Curr Opin Crit Care 2019 Jan 22. Epub 2019 Jan 22.

Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery Johns Hopkins School of Medicine, Baltimore Maryland. USA.

Purpose Of Review: To discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care.

Recent Findings: Maintaining euvolemia with crystalloids seems to be the recommended fluid resuscitation for neurocritical care patients. Buffered crystalloids have been shown to reduce hyperchloremia in patients with subarachnoid hemorrhage without causing hyponatremia or hypo-osmolality. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000585DOI Listing
January 2019
1 Read

Sedatives in neurocritical care: an update on pharmacological agents and modes of sedation.

Curr Opin Crit Care 2019 Jan 21. Epub 2019 Jan 21.

Department of Intensive Care Medicine, University Hospitals Leuven.

Purpose Of Review: In this article, the specific and general indications for sedatives in the neurocritical care unit are discussed, together with an overview on current insights in sedative protocols for these patients. In addition, physiological effects of sedative agents on the central nervous system are reviewed.

Recent Findings: In the general ICU population, a large body of evidence supports light protocolized sedation over indiscriminate deep sedation. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000592DOI Listing
January 2019

Artificial liver support in acute and acute-on-chronic liver failure.

Curr Opin Crit Care 2019 Jan 21. Epub 2019 Jan 21.

Department of Hepatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Purpose Of Review: Liver failure is a life-threatening condition, and an artificial liver is highly desirable to replace the failing liver-functions in the waiting time for liver regeneration to happen or until liver transplantation can be undertaken. This review focuses on the efficacy of using artificial extracorporeal liver support devices.

Recent Findings: Artificial liver support devices such as the molecular adsorbent recirculating system (MARS), fractionated plasma separation and adsorption, and therapeutic plasma exchange (TPE) are well tolerated. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000584DOI Listing
January 2019
4 Reads

New physiological insights in ventilation during cardiopulmonary resuscitation.

Curr Opin Crit Care 2019 Feb;25(1):37-44

SAMU74, Emergency Department, General Hospital of Annecy, Annecy.

Purpose Of Review: In the setting of cardiopulmonary resuscitation (CPR), classical physiological concept about ventilation become challenging. Ventilation may exert detrimental hemodynamic effects that must be balanced with its expected benefits. The risks of hyperventilation have been thoroughly addressed, even questioning the need for ventilation, emphasizing the need to prioritize chest compression quality. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000573DOI Listing
February 2019
6 Reads
2.617 Impact Factor

Diaphragm-protective mechanical ventilation.

Curr Opin Crit Care 2019 Feb;25(1):77-85

Interdepartmental Division of Critical Care Medicine, University of Toronto.

Purpose Of Review: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000578DOI Listing
February 2019
2 Reads

Optimizing respiratory management in resource-limited settings.

Curr Opin Crit Care 2019 Feb;25(1):45-53

Department of Intensive Care.

Purpose Of Review: This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.

Recent Findings: Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319564PMC
February 2019
3 Reads

Bedside respiratory physiology to detect risk of lung injury in acute respiratory distress syndrome.

Authors:
Jeremy R Beitler

Curr Opin Crit Care 2019 Feb;25(1):3-11

Division of Pulmonary, Allergy, and Critical Care Medicine, Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons, New York, New York, USA.

Purpose Of Review: The most effective strategies for treating the patient with acute respiratory distress syndrome center on minimizing ventilation-induced lung injury (VILI). Yet, current standard-of-care does little to modify mechanical ventilation to patient-specific risk. This review focuses on evaluation of bedside respiratory mechanics, which when interpreted in patient-specific context, affords opportunity to individualize lung-protective ventilation in patients with acute respiratory distress syndrome. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000579DOI Listing
February 2019
3 Reads

Rare respiratory diseases in the ICU: when to suspect them and specific approaches.

Curr Opin Crit Care 2019 Feb;25(1):29-36

Université Paris Est Créteil, Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Créteil.

Purpose Of Review: A prompt identification of the cause of acute respiratory failure (ARF)/acute respiratory distress syndrome (ARDS) is required in order to initiate a targeted treatment. Yet, almost 10% of ARDS patients have no identified ARDS risk factor at ARDS diagnosis. Numerous rare causes of ARF have been reported in this setting. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000572DOI Listing
February 2019
9 Reads

Phenotypes in acute respiratory distress syndrome: moving towards precision medicine.

Curr Opin Crit Care 2019 Feb;25(1):12-20

Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine.

Purpose Of Review: To provide an overview of the current research in identifying homogeneous subgroups and phenotypes in ARDS.

Recent Findings: In recent years, investigations have used either physiology, clinical data, biomarkers or a combination of these to stratify patients with ARDS into distinct subgroups with divergent clinical outcomes. In some studies, there has also been evidence of differential treatment response within subgroups. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000571DOI Listing
February 2019
1 Read

Detection and management of dyspnea in mechanically ventilated patients.

Curr Opin Crit Care 2019 Feb;25(1):86-94

Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique.

Purpose Of Review: In ICU patients, dyspnea is one of the most prominent and distressing symptom. We sought to summarize current data on the prevalence and prognostic influence of dyspnea in the ICU setting and to provide concise and useful information for dyspnea detection and management.

Recent Findings: As opposed to pain, dyspnea has been a neglected symptom with regard to detection and management. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000574DOI Listing
February 2019
3 Reads

Editorial: Every breath you take…should be monitored.

Curr Opin Crit Care 2019 Feb;25(1):1-2

Interdepartmental Division of Critical Care Medicine, University of Toronto.

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http://dx.doi.org/10.1097/MCC.0000000000000576DOI Listing
February 2019
1 Read

Recent advances in venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.

Curr Opin Crit Care 2019 Feb;25(1):71-76

Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition.

Purpose Of Review: To summarize results of the most recent trials on venovenous extracorporeal membrane oxygenation (VV-ECMO) in severe acute respiratory distress syndrome (ARDS) and to elaborate on the unmet needs regarding VV-ECMO management in this setting.

Recent Findings: Although it was terminated early for futility (i.e. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000567DOI Listing
February 2019
2 Reads

Airway pressure release ventilation in children.

Curr Opin Crit Care 2019 Feb;25(1):63-70

Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Purpose Of Review: In patients with acute respiratory distress syndrome (ARDS), airway pressure release ventilation (APRV) has been purported to have several physiological benefits. This review synthesizes recent research evaluating APRV mode and provides perspectives on the utility of this mode in children with ARDS.

Recent Findings: Two single-center clinical trials on APRV, one adult and one pediatric, have been published this year. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000575DOI Listing
February 2019
2 Reads

Causes of acute respiratory failure in the immunocompromised host.

Curr Opin Crit Care 2019 Feb;25(1):21-28

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Ontario, Canada.

Purpose Of Review: A wide spectrum of heterogeneous conditions can render a patient immunocompromised. Recent years have seen an increase in the number of immunocompromised patients given the earlier detection of conditions that require immunosuppressive therapies, changes in immunosuppressive regimens leading to increased survival or novel therapeutic advancements in oncologic care. Acute respiratory failure (ARF) is the leading cause of critical illness and mortality in this population. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000569DOI Listing
February 2019
7 Reads

Noninvasive approach for de novo acute hypoxemic respiratory failure: noninvasive ventilation, high-flow nasal cannula, both or none?

Curr Opin Crit Care 2019 Feb;25(1):54-62

Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.

Purpose Of Review: To summarize the recent evidence regarding the use of noninvasive strategies for de novo acute hypoxemic respiratory failure (AHRF).

Recent Findings: New guidelines for the use of noninvasive ventilation (NIV) in acute respiratory failure have been published. In parallel, high-flow nasal cannula (HFNC) is an emerging noninvasive strategy for AHRF patients. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000570DOI Listing
February 2019
4 Reads

Pulmonary embolism critical care update: prognosis, treatment, and research gaps.

Curr Opin Crit Care 2018 Dec;24(6):540-546

Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Purpose Of Review: We provide a timely update on treatment care issues facing clinicians and patients with acute pulmonary embolism accompanied by either right ventricular strain (sub-massive pulmonary embolism) or shock (massive pulmonary embolism).

Recent Findings: Care and research changes over the last several years have resulted in four important trends: more consensus and accuracy in the way acute pulmonary embolism severity is described and communicated among acute care clinicians and researchers, increased availability and use of risk prediction scoring systems, increased use of advanced invasive therapy in the setting of severe right ventricular dysfunction, and emergence of multidisciplinary pulmonary embolism response teams to guide standard care decision-making.

Summary: Pulmonary embolism with shock should be treated with either systemic or catheter-based thrombolytic therapy in the absence of contraindications. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9913
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http://dx.doi.org/10.1097/MCC.0000000000000558DOI Listing
December 2018
35 Reads

Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how?

Curr Opin Crit Care 2018 Dec;24(6):493-503

Division of Pulmonary & Critical Care Medicine and Division of Nephrology Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Purpose Of Review: The use of extracorporeal membrane oxygenation (ECMO) is increasing rapidly. Patients on ECMO have a high risk of developing acute kidney injury (AKI) and needing renal replacement therapy (RRT). The aim of this review is to describe different strategies of combining RRT and ECMO and to outline their advantages and drawbacks. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000559DOI Listing
December 2018
16 Reads
2.620 Impact Factor

Who is a high-risk surgical patient?

Curr Opin Crit Care 2018 Dec;24(6):547-553

Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Purpose Of Review: Timely identification of high-risk surgical candidates facilitate surgical decision-making and allows appropriate tailoring of perioperative management strategies. This review aims to summarize the recent advances in perioperative risk stratification.

Recent Findings: Use of indices which include various combinations of preoperative and postoperative variables remain the most commonly used risk-stratification strategy. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9913
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http://dx.doi.org/10.1097/MCC.0000000000000556DOI Listing
December 2018
6 Reads

Optimizing continuous renal replacement therapy in the ICU: a team strategy.

Curr Opin Crit Care 2018 Dec;24(6):476-482

Department of Anesthesiology and Critical Care Medicine, Université Côte d'Azur, CHU de Nice, Hôpital Pasteur 2, Nice, France.

Purpose Of Review: The consideration of acute kidney injury, its incidence and its impact on the outcome of patients has grown continuously in recent years, leading to an increase in the use of renal replacement therapy (RRT) techniques. However, the successful conduct of RRT depends on the effectiveness of the entire team, doctors and nurses. It is therefore important to know the essential elements to be implemented in the ICU to ensure optimal RRT. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000564DOI Listing
December 2018
1 Read

Perioperative renal protection.

Curr Opin Crit Care 2018 Dec;24(6):568-574

Department of Intensive Care, Austin Hospital, Heidelberg.

Purpose Of Review: The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI).

Recent Findings: AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9913
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http://dx.doi.org/10.1097/MCC.0000000000000560DOI Listing
December 2018
4 Reads

Renal replacement therapy in the ICU: continued controversy despite recent advances.

Authors:
Thomas Rimmelé

Curr Opin Crit Care 2018 Dec;24(6):435-436

Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon.

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http://dx.doi.org/10.1097/MCC.0000000000000565DOI Listing
December 2018
1 Read

Emergencies in critical care: improving care by learning how to use old therapies better.

Authors:
Wesley H Self

Curr Opin Crit Care 2018 Dec;24(6):504-505

Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA.

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http://dx.doi.org/10.1097/MCC.0000000000000563DOI Listing
December 2018
2 Reads

How to optimize critical care resources in surgical patients: intensive care without physical borders.

Curr Opin Crit Care 2018 Dec;24(6):581-587

Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.

Purpose Of Review: Timely identification of surgery patients at risk of postoperative complications is important to improve the care process, including critical care. This review discusses epidemiology and impact of postoperative complications; prediction scores used to identify surgical patients at risk of complications, and the role of critical care in the postoperative management. It also discusses how critical care may change, with respect to admission to the ICU. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000557DOI Listing
December 2018
8 Reads

Perioperative management of obese patient.

Curr Opin Crit Care 2018 Dec;24(6):560-567

Policlinico San Martino IRCCS per l'Oncologia.

Purpose Of Review: The volume of bariatric and nonbariatric surgical procedures on obese patients is dramatically increasing worldwide over the past years. In this review, we discuss the physiopathlogy of respiratory function during anesthesia in obese patients, the stratification of perioperative risk to develop intraoperative and postoperative pulmonary complications, the optimization of airway management, and perioperative ventilation, including postoperative respiratory assistance.

Recent Findings: Scores have been proposed to stratify the risk of surgical patients, some of which were specifically developed for obese patients. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9914
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http://dx.doi.org/10.1097/MCC.0000000000000555DOI Listing
December 2018
6 Reads

Major surgery and the immune system: from pathophysiology to treatment.

Curr Opin Crit Care 2018 Dec;24(6):588-593

Cambridge University Hospitals NHS Foundation Trust.

Purpose Of Review: The purpose of this review is to provide an overview of the immune response to major surgery, and the ways in which it may be modulated to improve postoperative outcomes.

Recent Findings: Data from patients who have undergone a variety of tissue injuries (surgery, burns, sepsis, trauma) have shown the presence of a conserved 'genomic storm' that alters the leukocyte transcriptome, with upregulation of the innate immune response and concomitant downregulation of the adaptive immune response. The innate and adaptive immune systems are often regarded largely distinct. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000561DOI Listing
December 2018
5 Reads

Noninvasive ventilation as acute therapy.

Curr Opin Crit Care 2018 Dec;24(6):519-524

CHU de Poitiers, Réanimation Médicale.

Purpose Of Review: Noninvasive ventilation (NIV) is widely used in ICU patients to treat or to prevent acute respiratory failure. Whereas its physiological effects are clearly beneficial in hypercapnic patients, it could be deleterious in hypoxemic patients without hypercapnia.

Recent Findings: NIV should be cautiously used in patients with de-novo respiratory failure, the vast majority of whom meet the criteria for acute respiratory distress syndrome. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9914
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http://dx.doi.org/10.1097/MCC.0000000000000554DOI Listing
December 2018
3 Reads

Dialysis catheters in the ICU: selection, insertion and maintenance.

Curr Opin Crit Care 2018 Dec;24(6):469-475

Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon.

Purpose Of Review: Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9913
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http://dx.doi.org/10.1097/MCC.0000000000000543DOI Listing
December 2018
6 Reads

Resuscitation fluids.

Curr Opin Crit Care 2018 Dec;24(6):512-518

Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose Of Review: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients.

Recent Findings: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000551DOI Listing
December 2018
2 Reads

Corticosteroids administration to improve outcome in high-risk surgical patients.

Curr Opin Crit Care 2018 Dec;24(6):575-580

EA3826 Thérapeutiques Anti-Infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Medical University of Nantes.

Purpose Of Review: Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival. Major surgery is associated with a predictable and usually transient systemic inflammatory response (SIRS), depending on the magnitude of the surgical trauma. An excessive SIRS syndrome participates to the development of postoperative organ dysfunction, infection and mortality. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000553DOI Listing
December 2018
2 Reads

Oxygen therapy in acute resuscitation.

Curr Opin Crit Care 2018 Dec;24(6):506-511

Intensive Care Unit, Wellington Hospital.

Purpose Of Review: Avoidance and treatment of hypoxaemia is a cornerstone of acute resuscitation and yet the optimal approach to oxygen therapy in the acute care setting is uncertain. The aim of this review is to appraise recent evidence relating to the provision of supplemental oxygen to adult patients with acute illnesses with a focus on the resuscitation phase.

Recent Findings: Recent findings generally support the notion that exposure to hyperoxaemia is associated with adverse outcomes in acutely ill adults with a range of diseases and raise the possibility that liberal provision of oxygen may cause harm. Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9915
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http://dx.doi.org/10.1097/MCC.0000000000000549DOI Listing
December 2018
3 Reads

Continuous renal replacement therapy: understanding circuit hemodynamics to improve therapy adequacy.

Curr Opin Crit Care 2018 Dec;24(6):455-462

Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne.

Purpose Of Review: The utilization of continuous renal replacement therapy (CRRT) increases throughout the world. Technological improvements have made its administration easier and safer. However, CRRT remains associated with numerous pitfalls and issues. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000545DOI Listing
December 2018
2 Reads

An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock.

Curr Opin Crit Care 2018 Dec;24(6):463-468

Universitair Ziekenhuis Brussel, VUB University, Brussels, Belgium.

Purpose Of Review: This review aims to summarize the most recent advances on different membranes and cartridges used for extracorporeal blood purification in critically ill patients with sepsis or septic shock.

Recent Findings: Despite positive signals from experimental, cases and small clinical studies, blood purification showed no distinct morbidity and mortality benefit in large clinical trials.

Summary: None of the discussed specific membranes or cartridges can currently be recommended as sole adjunctive treatment in sepsis and septic shock. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000542DOI Listing
December 2018
4 Reads

Regional citrate anticoagulation for continuous renal replacement therapy.

Curr Opin Crit Care 2018 Dec;24(6):450-454

Department of Anesthesiology, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.

Purpose Of Review: The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000547DOI Listing
December 2018
3 Reads

Renal replacement therapy in the ICU: intermittent hemodialysis, sustained low-efficiency dialysis or continuous renal replacement therapy?

Curr Opin Crit Care 2018 Dec;24(6):437-442

School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia.

Purpose Of Review: Severe acute kidney injury in the ICU setting often requires renal replacement therapy (RRT). Intermittent hemodialysis (IHD), hybrid forms of RRT such as sustained low-efficiency dialysis (SLED), as well as continuous renal replacement therapy (CRRT) are the three common modalities of extracorporeal RRT used in the adult ICU setting in developed countries. This review summarizes recently published data regarding comparisons of these three RRT modalities on clinical outcomes (e. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000541DOI Listing
December 2018
15 Reads

Updates in emergency airway management.

Curr Opin Crit Care 2018 Dec;24(6):525-530

Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.

Purpose Of Review: Historically, most evidence supporting emergency airway management strategies have been limited to small series, retrospective analyses and extrapolation from other settings (i.e. the operating room). Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9915
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http://dx.doi.org/10.1097/MCC.0000000000000552DOI Listing
December 2018
11 Reads

CRRT for sepsis-induced acute kidney injury.

Curr Opin Crit Care 2018 Dec;24(6):483-492

Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital.

Purpose Of Review: Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns). Read More

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http://Insights.ovid.com/crossref?an=00075198-900000000-9915
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http://dx.doi.org/10.1097/MCC.0000000000000544DOI Listing
December 2018
3 Reads

Community-acquired pneumonia as an emergency condition.

Curr Opin Crit Care 2018 Dec;24(6):531-539

Department of Pneumology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Barcelona, Spain.

Purpose Of Review: Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP.

Recent Findings: There is consistent evidence that the trend in CAP mortality has declined over time. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000550DOI Listing
December 2018
11 Reads

Continuous renal replacement therapy: individualization of the prescription.

Curr Opin Crit Care 2018 Dec;24(6):443-449

Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust.

Purpose Of Review: Continuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs.

Recent Findings: The most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000546DOI Listing
December 2018
2 Reads

Personalization of arterial pressure in the perioperative period.

Curr Opin Crit Care 2018 Dec;24(6):554-559

Department of Perioperative Medicine, Anesthesiology and Critical Care, University Teaching Hospital of Clermont-Ferrand.

Purpose Of Review: This review aims to discuss recent findings on the relationship between intraoperative arterial hypotension and organ dysfunction in surgical patients and examines the available evidence for personalizing blood pressure (BP) management as a strategy to improve patient outcome.

Recent Findings: Hypotension contributes to oxygen supply-demand mismatch and may cause an ischemia-reperfusion injury which may manifest as organ dysfunction. Evidence is accumulating suggesting that hypotension is associated with acute postoperative myocardial and kidney injury, and increased risk of mortality in surgical patients. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000548DOI Listing
December 2018
18 Reads

Risk stratification and treatment of ICU-acquired pneumonia caused by multidrug- resistant/extensively drug-resistant/pandrug-resistant bacteria.

Curr Opin Crit Care 2018 Oct;24(5):385-393

Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.

Purpose Of Review: Describe the risk factors and discuss the management of multidrug-resistant (MDR) bacteria responsible for pneumonia among critically ill patients, including methicillin-resistant Staphylococcus aureus, extended spectrum beta-lactamase-producing Enterobactericeae, carbapenem-resistant Enterobactericeae, multidrug resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.

Recent Findings: Multiple factors have been associated with infections because of MDR bacteria, including prolonged hospital stay, presence of invasive devices, mechanical ventilation, colonization with resistant pathogens, and use of broad-spectrum antibiotics. Management of these infections includes the prompt use of appropriate antimicrobial therapy, implementation of antimicrobial stewardship protocols, and targeted active microbiology surveillance. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000534DOI Listing
October 2018
12 Reads

Evolution and current status of United States Food and Drug Administration and European Medicines Agency regulatory guidance for studies of nosocomial pneumonia.

Authors:
George H Talbot

Curr Opin Crit Care 2018 Oct;24(5):379-384

Talbot Advisors LLC, Anna Maria, Florida, USA.

Purpose Of Review: Regulatory guidance for design, conduct and analysis of studies of nosocomial pneumonia, including ventilator-associated pneumonia, has undergone substantial evolution over the past three decades. This review summarizes this evolutionary process and the current status of guidance.

Recent Findings: The US Food and Drug Administration and the European Medicines Agency have taken different approaches to defining endpoints for studies of nosocomial pneumonia, especially with regard to the primary endpoint. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000524DOI Listing
October 2018
10 Reads

Do we need biomarkers for the follow-up and shortening of antibiotic treatment duration?

Curr Opin Crit Care 2018 Oct;24(5):361-369

Department of Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.

Purpose Of Review: Clinical and laboratory parameters are useful tools for the diagnosis, follow-up and evaluation of resolution, and to predict outcomes when measured at different time-points onset and serially during follow-up in patients with hospital-acquired pneumonia and/or ventilator-associated pneumonia (HAP/VAP).

Recent Findings: Both, the 2017 ERS/ESICM/ESCMID/Asociación Latino Americana de Tórax (EEEAG) and the 2016 IDSA/ATS guidelines (IAG) for the management of HAP/VAP recommend using clinical criteria alone, rather than biomarkers for diagnosis. Several studies were conducted to assess the value of serum biomarker concentration and kinetics for predicting the outcome in HAP/VAP, including C-reactive protein and procalcitonin (PCT). Read More

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http://dx.doi.org/10.1097/MCC.0000000000000540DOI Listing
October 2018
8 Reads

ICU-acquired pneumonia: is it time to use this term?

Authors:
Antoni Torres

Curr Opin Crit Care 2018 Oct;24(5):323-324

Servei de Pneumologia, Hospital Clinic, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Spain.

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http://dx.doi.org/10.1097/MCC.0000000000000539DOI Listing
October 2018
2 Reads

Epidemiology of ICU-acquired pneumonia.

Curr Opin Crit Care 2018 Oct;24(5):325-331

Department of Pneumology, Respiratory Institute, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona.

Purpose Of Review: Review of the epidemiology of ICU-acquired pneumonia, including both ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in nonventilated ICU patients, with critical review of the most recent literature in this setting.

Recent Findings: The incidence of ICU-acquired pneumonia, mainly VAP has decrease significantly in recent years possibly due to the generalized implementation of preventive bundles. However, the exact incidence of VAP is difficult to establish due to the diagnostic limitations and the methods employed to report rates. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000536DOI Listing
October 2018
2 Reads