Current Opinion in Critical Care

PURPOSE OF REVIEW: To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients. RECENT FINDINGS: IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves...

PURPOSE OF REVIEW: Physical rehabilitation and mobilization interventions aim to reduce the incidence of intensive care unit (ICU)-acquired weakness and subsequently reduce morbidity in critically ill patients. This chapter will explore the evidence for physical rehabilitation and mobilization with an emphasis on patient-centred outcomes selected in randomized controlled trials. This is particularly pertinent at a time when clinicians are deciding how to implement physical rehabilitation and mobilization into the treatment of critically ill patients...

PURPOSE OF REVIEW: In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. RECENT FINDINGS: Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face...

PURPOSE OF REVIEW: Disparities are common within healthcare, and critical illness is no exception. This review summarizes recent literature on health disparities within respiratory failure, focusing on race, ethnicity, socioeconomic status, and sex. RECENT FINDINGS: Current evidence indicates that Black patients have higher incidence of respiratory failure, while the relationships among race, ethnicity, and mortality remains unclear. There has been renewed interest in medical device bias, specifically pulse oximetry, for which data demonstrate patients with darker skin tones may be at risk for undetected hypoxemia and worse outcomes...

PURPOSE OF REVIEW: To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences. RECENT FINDINGS: Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant...

PURPOSE OF REVIEW: The increasing incidence of drug-resistant Candida brings a new challenge to the treatment of invasive candidiasis. Although cross-resistance among azoles and echinocandins was generally uncommon, reports of multidrug-resistant (MDR) Candida markedly increased in the last decade. The purpose of this review is to understand mechanisms and risk factors for resistance and how to tackle antifungal resistance. RECENT FINDINGS: The paper describes the action of the three main classes of antifungals - azoles, echinocandins and polyenes - and Candida's mechanisms of resistance...

PURPOSE OF REVIEW: Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU. RECENT FINDINGS: In critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19...

PURPOSE OF REVIEW: Staphylococcus aureus is a significant human pathogen, causing a variety of infections, from skin and soft tissue infections to endocarditis, bone and joint infections and deep tissue abscesses. Mortality from S. aureus bacteraemia remains high, without major therapeutic advances in recent decades. RECENT FINDINGS: In recent years, optimized dosing of antibiotics is increasingly being recognized as a cornerstone of management for severe infections including S...

PURPOSE OF REVIEW: The incidence of necrotizing soft-tissue infections (NSTI) has increased during recent decades. These infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. This review will focus on practical approaches to management of NSTI focusing on antibiotic therapies and optimizing the management of group A streptococcus (GAS)-associated NSTIs. RECENT FINDINGS: Antibiotic therapy for NSTI patients faces several challenges as the rapid progression of NSTIs mandates broad-spectrum agents with bactericidal action...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

PURPOSE OF REVIEW: The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines. RECENT FINDINGS: Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence...

PURPOSE OF REVIEW: Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures. RECENT FINDINGS: The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing...

PURPOSE OF REVIEW: This article aims to provide an updated review on the epidemiology and outcomes of severe meningoencephalitis. RECENT FINDINGS: Meningoencephalitis is a critical medical condition characterized by inflammation in both the meninges and brain parenchyma. Bacterial, viral, or fungal infections are common causes, although noninfectious factors, such as autoimmune causes, can also contribute. In patients requiring intensive care, meningoencephalitis is associated with a severe prognosis, including mortality rates ranging from 11 to 25% and functional disability in 15-25% of survivors...

PURPOSE OF REVIEW: In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades. RECENT FINDINGS: In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily...

PURPOSE OF REVIEW: Antimicrobial resistance (AMR) in Gram-negative bacteria (GNB) poses a significant global health concern, contributing to increased infections, mortality rates, and healthcare costs. This review discusses the main clinical manifestations, therapeutic options, and recent findings in managing antibiotic-resistant GNB, with a focus on difficult-to-treat infections. RECENT FINDINGS: Difficult-to-treat resistance (DTR) is a novel classification that identifies GNB exhibiting intermediate or resistant phenotypes to first-line agents in the carbapenem, beta-lactam, and fluoroquinolone categories...

PURPOSE OF REVIEW: Digital technologies may address known physical and psychological barriers to recovery experienced by intensive care survivors following hospital discharge and provide solutions to care fragmentation and unmet needs. The review highlights recent examples of digital technologies designed to support recovery of survivors of critically illness. RECENT FINDINGS: Despite proliferation of digital technologies supporting health in the community, there are relatively few examples for intensive care survivors...

No abstract text is available yet for this article.

PURPOSE OF REVIEW: To better understand the established associations between hypocalcaemia and clinical outcomes, we synopsize the mechanisms involved in hypocalcaemia in the critically ill. We also provide an overview of the current evidence on managing hypocalcaemia in critical illness. RECENT FINDINGS: Hypocalcaemia is reported to occur in 55-85% of ICU patients. It appears to be associated with poor outcomes. It appears to be associated with poor outcomes, but it may be a marker rather than a direct cause of disease severity...

PURPOSE OF REVIEW: Cardiogenic shock (CS) results in persistently high short-term mortality and a lack of evidence-based therapies. Several trials of novel interventions have failed to show an improvement in clinical outcomes despite promising preclinical and physiologic principles. In this review, we highlight the challenges of CS trials and provide suggestions for the optimization and harmonization of their design. RECENT FINDINGS: CS clinical trials have been plagued by slow or incomplete enrolment, heterogeneous or nonrepresentative patient cohorts, and neutral results...