1,775 results match your criteria Current Opinion in Critical Care[Journal]


In the ICU - delirium post cardiac arrest.

Curr Opin Crit Care 2019 Apr 9. Epub 2019 Apr 9.

Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose Of Review: The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium.

Recent Findings: Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000615DOI Listing
April 2019
2 Reads

What should I use next if clinical evaluation and echocardiographic haemodynamic assessment is not enough?

Curr Opin Crit Care 2019 Apr 2. Epub 2019 Apr 2.

Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.

Purpose Of Review: To provide an integrated clinical approach to the critically ill patients in shock.

Recent Findings: The complexity behind shock mechanism has improved in the last decades; as consequence, conventional generalized practices have been questioned, in favour of different approaches, titrated to patient's individual response. Bedside clinical examination has been demonstrated to be a reliable instrument to recognize the mismatch between cardiac function and peripheral oxygen demand. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000603DOI Listing
April 2019
1 Read

An international, consensus-derived Core Outcome Set for Cardiac Arrest effectiveness trials: the COSCA initiative.

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

Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry CV4 7AL, UK.

Purpose Of Review: Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials - the COSCA initiative.

Recent Findings: The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000612DOI Listing

Haemodynamic monitoring: the why, when, which and what.

Authors:
Anthony S McLean

Curr Opin Crit Care 2019 Mar 14. Epub 2019 Mar 14.

Department of Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1097/MCC.0000000000000606DOI Listing
March 2019
12 Reads

Transpulmonary thermodilution techniques in the haemodynamically unstable patient.

Curr Opin Crit Care 2019 Mar 14. Epub 2019 Mar 14.

Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud.

Purpose Of Review: Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique.

Recent Findings: Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery catheter. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000608DOI Listing
March 2019
6 Reads

Hemodynamic monitoring in the extracorporeal membrane oxygenation patient.

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

Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, USA.

Purpose Of Review: Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow. This review discusses the various monitoring modalities relevant to the management of patients on venovenous ECMO (VV ECMO) and venoarterial (VA ECMO). We emphasize tools to judge the adequacy of perfusion, predict the response to fluid boluses, measure right ventricular function, assess left ventricular distention (for VA ECMO), and monitor the process of weaning from ECMO. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000602DOI Listing
March 2019
16 Reads
2.617 Impact Factor

Echocardiographic assessment of left ventricular diastolic pressure.

Authors:
Anthony S McLean

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

Department of Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, New South Wales, Australia.

Purpose Of Review: Knowledge of the left ventricular pressures throughout the cardiac cycle is of considerable assistance in managing a haemodynamically unstable patient. Invasive pressure measurement is the only accurate way to analyze ventricular diastolic pressures but this is not feasible outside the catheterization laboratory, whereas the use of a pulmonary artery catheter or Doppler echocardiography, using surrogate measurements, is available at the bedside. The ever-increasing trend toward noninvasive monitoring puts echocardiography at the forefront and considerable effort has been made to define its role in this setting. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000601DOI Listing
March 2019
1 Read

Assessment and management of coagulopathy in critically-ill patients with liver failure.

Curr Opin Crit Care 2019 Apr;25(2):179-186

Department of Anesthesia and Perioperative Medicine, Penn State College of Medicine, Penn State University, Hershey, Pennsylvania, USA.

Purpose Of Review: This review provides insight into our current understanding of the pathophysiology and treatment of coagulopathy associated with liver failure, and bleeding risk assessment.

Recent Findings: Patients with end-stage liver disease (ESLD) have a rebalanced coagulation profile and are at risk for both excessive clotting and bleeding. Hypercoagulability is associated with profound endothelial dysfunction and an increased concentration of liver-independent coagulation factors. Read More

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http://Insights.ovid.com/crossref?an=00075198-201904000-0001
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http://dx.doi.org/10.1097/MCC.0000000000000591DOI Listing
April 2019
6 Reads

The microbiome and nutrition in critical illness.

Curr Opin Crit Care 2019 Apr;25(2):145-149

Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, Georgia, USA.

Purpose Of Review: The present review aims to describe the relationship between nutrition and the gut microbiome in critical illness.

Recent Findings: Critical illness disrupts not only cells of human origin but also the intestinal microbiome, with a decrease in bacterial diversity and transformation into a pathobiome. Under basal conditions, nutrition profoundly alters microbial composition with significant salutatory effects on human health. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000582DOI Listing
April 2019
1 Read

Gut dysmotility in the ICU: diagnosis and therapeutic options.

Curr Opin Crit Care 2019 Apr;25(2):138-144

Intensive Care Unit.

Purpose Of Review: To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years.

Recent Findings: Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000581DOI Listing

Pharmacotherapy of sodium disorders in neurocritical care.

Curr Opin Crit Care 2019 Apr;25(2):132-137

Department of Anesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France.

Purpose Of Review: To describe the pathophysiology and pharmacotherapy of dysnatremia in neurocritical care patients.

Recent Findings: Sodium disorders may affect approximately half of the neurocritical care patients and are associated with worse neurological outcome and increased risk of death. Pharmacotherapy of sodium disorders in neurocritical care patients may be challenging and is guided by a careful investigation of water and sodium balance. Read More

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http://Insights.ovid.com/crossref?an=00075198-201904000-0000
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http://dx.doi.org/10.1097/MCC.0000000000000589DOI Listing
April 2019
10 Reads

Nutritional and metabolic supplementation for the injured brain: an update.

Curr Opin Crit Care 2019 Apr;25(2):126-131

Intensive Care Unit, Pasteur 2 Hospital, IRCAN (INSERM U1081, CNRS UMR 7284), NICE Cédex, University hospital of Nice, Nice, France.

Purpose Of Review: Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition. Read More

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http://Insights.ovid.com/crossref?an=00075198-201904000-0000
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http://dx.doi.org/10.1097/MCC.0000000000000588DOI Listing
April 2019
4 Reads

Antiseizure medications in critical care: an update.

Curr Opin Crit Care 2019 Apr;25(2):117-125

Division of Neurocritical Care, Department of Neurology.

Purpose Of Review: Seizures and status epilepticus are very common diagnoses in the critically ill patient and are associated with significant morbidity and mortality. There is an abundance of research on the utility of antiseizure medications in this setting, but limited randomized-controlled trials to guide the selection of medications in these patients. This review examines the current guidelines and treatment strategies for status epilepticus and provides an update on newer antiseizure medications in the critical care settings. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000587DOI Listing
April 2019
12 Reads

Vasoactive agents to improve brain perfusion: pathophysiology and clinical utilization.

Curr Opin Crit Care 2019 Apr;25(2):110-116

Department of Anesthesia, Surgical Intensive Care, Preclinical Emergency Medicine and Pain Therapy, University Hospital Basel.

Purpose Of Review: This review highlights the aspects of pathophysiology that make it difficult to predict the effects of any attempt to improve brain perfusion and reviews the options to improve brain perfusion according to the needs of an individual patient, focusing on the choice of a suitable threshold for cerebral perfusion pressure.

Recent Findings: Typically, vasopressors or vasodilators that do not directly influence the cerebral vascular bed are used to improve cerebral perfusion. Positive inotropic substances are rarely used, as the relationship between cardiac output and cerebral blood flow is complex and difficult to measure. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000586DOI Listing
April 2019
5 Reads

Physician factors in utilizing haemodynamic data in patient care.

Curr Opin Crit Care 2019 Feb 18. Epub 2019 Feb 18.

Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.

Purpose Of Review: To focus on the missing link between accuracy and precision of monitoring devices and effective implementation of therapeutic strategies.

Recent Findings: Haemodynamic monitoring is generally considered to be an essential part of intensive care medicine. However, randomized controlled trials fail to demonstrate improved outcome unequivocally as a result of hemodynamic monitoring. Read More

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http://dx.doi.org/10.1097/MCC.0000000000000600DOI Listing
February 2019
2 Reads

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

Curr Opin Crit Care 2019 Apr;25(2):150-156

Department of Intensive Care Medicine, Universitair Ziekenhuis Brussel, Jette.

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
April 2019
7 Reads

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

Curr Opin Crit Care 2019 Apr;25(2):192-198

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
April 2019
13 Reads

Update on the management of acute liver failure.

Curr Opin Crit Care 2019 Apr;25(2):157-164

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
April 2019
5 Reads

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

Authors:
Mauro Oddo

Curr Opin Crit Care 2019 Apr;25(2):95-96

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
April 2019
3 Reads

Acute kidney injury in cirrhosis: implications for liver transplantation.

Curr Opin Crit Care 2019 Apr;25(2):171-178

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
April 2019
15 Reads

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

Authors:
Jody C Olson

Curr Opin Crit Care 2019 Apr;25(2):165-170

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
April 2019
4 Reads

Fluids and hyperosmolar agents in neurocritical care: an update.

Curr Opin Crit Care 2019 Apr;25(2):105-109

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
April 2019
5 Reads

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

Curr Opin Crit Care 2019 Apr;25(2):97-104

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
April 2019
1 Read

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

Curr Opin Crit Care 2019 Apr;25(2):187-191

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
April 2019
10 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
8 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
5 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
5 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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402876PMC
February 2019
5 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
15 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
3 Reads

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
4 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
2 Reads

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
3 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
12 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
5 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
44 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
24 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
4 Reads

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://dx.doi.org/10.1097/MCC.0000000000000560DOI Listing
December 2018
7 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
2 Reads

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
4 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
11 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://dx.doi.org/10.1097/MCC.0000000000000555DOI Listing
December 2018
10 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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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://dx.doi.org/10.1097/MCC.0000000000000554DOI Listing
December 2018
5 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://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
8 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
3 Reads