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Current Opinion in Critical Care

Christian E Farrier, Henry T Stelfox, Kirsten M Fiest
PURPOSE OF REVIEW: Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area. RECENT FINDINGS: Though the literature is relatively nascent, studies suggest that there is a desire to engage patients and families in critical care medicine research and clinical care, however, uncertainty exists on how to achieve this goal...
July 15, 2019: Current Opinion in Critical Care
Cristina Sarda, Pedro Palma, Jordi Rello
PURPOSE OF REVIEW: Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity. RECENT FINDINGS: Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality...
July 15, 2019: Current Opinion in Critical Care
Christopher P Robinson, Katharina M Busl
PURPOSE OF REVIEW: Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. RECENT FINDINGS: Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world...
July 11, 2019: Current Opinion in Critical Care
Bruno Levy, Julie Buzon, Antoine Kimmoun
PURPOSE OF REVIEW: Data and interventional trials regarding vasopressor and inotrope use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In this article, we review the current use of vasopressor and inotrope agents during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was not sufficient evidence to prove that any one vasopressor or inotrope was superior to another in terms of mortality...
June 3, 2019: Current Opinion in Critical Care
Mette M Berger, Claude Pichard
PURPOSE OF REVIEW: Any critical care therapy requires individual adaptation, despite standardization of the concepts supporting them. Among these therapies, nutrition care has been repeatedly shown to influence clinical outcome. Individualized feeding is the next needed step towards optimal global critical care. RECENT FINDINGS: Both underfeeding and overfeeding generate complications and should be prevented. The long forgotten endogenous energy production, maximal during the first 3 to 4 days, should be integrated in the nutrition plan, through a slow progression of feeding, as full feeding may result in early overfeeding...
May 28, 2019: Current Opinion in Critical Care
Benedikt Schrage, Dirk Westermann
PURPOSE OF REVIEW: The main purpose of this review is to highlight and summarize recently published studies on the usage of short-term mechanical circulatory support devices for treatment of cardiogenic shock. Importantly, this review will focus on percutaneously implanted devices. RECENT FINDINGS: In recent years, usage of active mechanical circulatory support devices, such as catheter-based left ventricular-assist devices and veno-arterial extracorporeal membrane oxygenation devices, has been widely adopted...
May 22, 2019: Current Opinion in Critical Care
Georg Fuernau
PURPOSE OF REVIEW: Cardiogenic shock remains beside sudden cardiac death the most outcome relevant complication of acute myocardial infarction. Over the last two decades as confirmation of the benefit of early revascularization no further relevant improvement in outcome could be achieved. Biomarkers are important for diagnosis, monitoring, and management in cardiogenic shock patients. RECENT FINDINGS: A bunch of different biomarkers have been associated with prognosis in patients with cardiogenic shock...
May 20, 2019: Current Opinion in Critical Care
David H Ingbar
PURPOSE OF REVIEW: This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. RECENT FINDINGS: The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with echocardiography and other testing...
May 20, 2019: Current Opinion in Critical Care
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications, and discusses the results of recent case series and trials. RECENT FINDINGS: VA-ECMO is utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support, and withdrawal in case of futility...
May 20, 2019: Current Opinion in Critical Care
Sean van Diepen, Holger Thiele
PURPOSE OF REVIEW: In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. RECENT FINDINGS: The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies...
May 16, 2019: Current Opinion in Critical Care
Adam M Deane, Marianne J Chapman, Yasmine Ali Abdelhamid
PURPOSE OF REVIEW: This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs. RECENT FINDINGS: Prokinetic drugs accelerate gastric emptying and, particularly in patients with gastric dysmotility and enteral feed intolerance, their use increases the delivery of enteral nutrition. However, prokinetic drugs have not been shown to improve patient-centered outcomes in trials but benefit is assumed on the basis of observational studies, which report close associations between gastric dysmotility, enteral feed intolerance and poor outcomes, and improvement in surrogate physiological outcomes when prokinetic drugs are administered...
August 2019: Current Opinion in Critical Care
Paul E Wischmeyer
PURPOSE OF REVIEW: Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. However, recently signals of risk have come from two large-scale multicenter trials evaluating GLN (and other nutrients) at high dose and as primary pharmaconutrients, not as supplementation to complete nutrition. These trials indicate a risk of increased mortality when GLN is given to patients in shock, renal failure, and early in acute phase of critical care...
August 2019: Current Opinion in Critical Care
Holger Thiele
No abstract text is available yet for this article.
August 2019: Current Opinion in Critical Care
James S Krinsley, Jean-Charles Preiser
PURPOSE OF REVIEW: To summarize the advances in literature that support the best current practices regarding glucose control in the critically ill. RECENT FINDINGS: There are differences between patients with and without diabetes regarding the relationship of glucose metrics during acute illness to mortality. Among patients with diabetes, an assessment of preadmission glycemia, using measurement of Hemoglobin A1c (HgbA1c) informs the choice of glucose targets. For patients without diabetes and for patients with low HgbA1c levels, increasing mean glycemia during critical illness is independently associated with increasing risk of mortality...
August 2019: Current Opinion in Critical Care
Christian Jung
PURPOSE OF REVIEW: Adequate tissue perfusion is of utmost importance to avoid organ failure in patients with cardiogenic shock. Within the recent years, the microcirculation, defined as the perfusion of the smallest vessels, has been identified to play a crucial role. Microcirculatory changes may include capillary flow disturbances as well as changes in the density of perfused vessels. Due to the availability of new technologies to assess the microcirculation, interesting new data came up and it is the purpose of this review to summarize recent studies in the field...
August 2019: Current Opinion in Critical Care
Matthias Kott, Wolfgang H Hartl, Gunnar Elke
PURPOSE OF REVIEW: The current review focuses on recent clinical evidence and updated guideline recommendations on the effects of enteral vs. parenteral nutrition in adult critically ill patients with (septic) shock. RECENT FINDIGS: The largest multicenter randomized-controlled trial showed that the route of nutrient supply was unimportant for 28-day and 90-day mortality, infectious morbidity and length of stay in mechanically ventilated patients with shock. The enteral route, however, was associated with lower macronutrient intake and significantly higher frequency of hypoglycemia and moderate-to-severe gastrointestinal complications...
August 2019: Current Opinion in Critical Care
Niloofar Khoshnam-Rad, Hossein Khalili
PURPOSE OF REVIEW: Although vitamin C is essentially a nontoxic vitamin; however, it is important to be aware regarding the safety of high doses before the wide clinical use. RECENT FINDINGS: Minor side effects of vitamin C have been reported, many being reported in earlier studies. High doses of vitamin C (up to 1.5 g/kg three times a week as intravenously) were safe in cancer patients with normal renal function and perfect glucose-6-phosphate dehydrogenase activity...
August 2019: Current Opinion in Critical Care
Annika Reintam Blaser, Adam M Deane, Joel Starkopf
PURPOSE OF REVIEW: To present a pragmatic approach to facilitate clinician's implementing the recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on clinical nutrition in the intensive care unit. RECENT FINDINGS: The ESPEN guidelines include 54 recommendations with a rationale for each recommendation. All data published since 1 January 2000 was reviewed and 31 meta-analyses were performed to inform these guidelines. An important aspect of the most recent ESPEN guidelines is an attempt to separate periods of critical illness into discrete - early acute, late acute and recovery - phases, with each exhibiting different metabolic profiles and requiring different strategies for nutritional and metabolic support...
August 2019: Current Opinion in Critical Care
Lisa Van Dyck, Michaël P Casaer
PURPOSE OF REVIEW: To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. RECENT FINDINGS: Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release...
August 2019: Current Opinion in Critical Care
Steffen Desch
PURPOSE OF REVIEW: Coronary revascularization compared with medical treatment alone leads to improved survival in patients with myocardial infarction (MI) and cardiogenic shock. Percutaneous coronary intervention (PCI) is the predominant mode of revascularization in clinical practice. This review discusses several aspects relevant to mechanical revascularization such as general indication, the roles of PCI and bypass surgery, percutaneous access site choice, strategy in multivessel disease and adjunctive antithrombotic therapy...
August 2019: Current Opinion in Critical Care
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