Current Opinion in Critical Care

Ruben Peralta, Hassan Al Thani, Sandro Rizoli
PURPOSE OF REVIEW: Coagulopathy is the derangement of hemostasis that in surgical patients may result in excessive bleeding, clotting or no measurable effect. The purpose of this review is to provide an overview of the most current evidence and practical approach to trauma- and drug-induced coagulopathy in surgical patients. RECENT FINDINGS: Early identification and timely correction of coagulopathy in surgical patients with significant bleeding is paramount to prevent death and other consequences of hemorrhage...
September 30, 2019: Current Opinion in Critical Care
Adil M Abuzeid, Terence O'Keeffe
PURPOSE OF REVIEW: Massive haemorrhage is a significant cause of mortality and morbidity in a variety of clinical settings, although most research has been related to trauma patients. Military studies from recent conflicts found that higher ratios of plasma to red blood cells (RBCs) were associated with increased survival in injured soldiers, and subsequent trials in civilian populations showed similar decreased mortality. Over the last decade, massive transfusion protocols (MTPs) have become an important component in the treatment of the massively bleeding patient...
September 30, 2019: Current Opinion in Critical Care
Adrian Wong, Antoine Vieillard-Baron, Manu L N G Malbrain
PURPOSE OF REVIEW: The use of bedside or point-of-care ultrasound (POCUS) in medical emergencies is rapidly becoming more established as an effective acute diagnostic tool. The purpose of this review is to provide an overview of the various techniques currently used that are readily available, as well as several in development. Possible caveats are also addressed. RECENT FINDINGS: Despite its widespread use, definitive studies demonstrating improved patient outcomes are limited...
September 30, 2019: Current Opinion in Critical Care
Marcelo A F Ribeiro, Alexandre Z Fonseca, Stephanie Santin
PURPOSE OF REVIEW: The current review aims to discuss the management of surgical patients in an ICU in countries where resources are limited. RECENT FINDINGS: ICU beds in low-income and middle-income countries (LMICs) are limited and also have limited human and structural resources. The working force has been described to be the costliest factor. Nevertheless, costs for intensive care in LMICs are one third from the cost reported from high-income countries. Alternative options have been described, so intensive care can be delivered outside ICU...
September 30, 2019: Current Opinion in Critical Care
Jeroen T J M van Dijck, Ronald H M A Bartels, Jan C M Lavrijsen, Gerard M Ribbers, Erwin J O Kompanje, Wilco C Peul
PURPOSE OF REVIEW: There is an urgent need to discuss the uncertainties and paradoxes in clinical decision-making after severe traumatic brain injury (s-TBI). This could improve transparency, reduce variability of practice and enhance shared decision-making with proxies. RECENT FINDINGS: Clinical decision-making on initiation, continuation and discontinuation of medical treatment may encompass substantial consequences as well as lead to presumed patient benefits...
September 30, 2019: Current Opinion in Critical Care
Tanya Anand, Lauren K Roller, Gregory J Jurkovich
PURPOSE OF REVIEW: The current review discusses the supplemental use of vitamin C as an adjunct in the management of sepsis and septic shock. RECENT FINDINGS: The antioxidant properties of vitamin C are touted to be useful in modulating the inflammatory response, decreasing vasopressor requirements, and improving resuscitation. Current resuscitation practices are focused on addressing the hemodynamic instability and ensuring adequate oxygen delivery to tissues. The conceptual framework of the use of vitamin C during a resuscitation is to modulate in a beneficial fashion the inflammatory response to sepsis while concomitantly resuscitating and treating the infection...
September 20, 2019: Current Opinion in Critical Care
Mathieu Godement, Manu L N G Malbrain, Antoine Vieillard-Baron
PURPOSE OF REVIEW: Critical care echocardiography (CCE) has become an important component of general critical care ultrasonography, and a current review of its performance is presented. RECENT FINDINGS: Basic CCE should be performed as a goal-directed examination to better identify specific signs and to answer important clinical questions concerning acute hemodynamic concerns. It has evolved in the ICU and also in the emergency department not only for improved diagnostic capability but also as an effective part of the triage process...
September 20, 2019: Current Opinion in Critical Care
Marc Lafonte, Jenny Cai, Matthew E Lissauer
PURPOSE OF REVIEW: Evaluating patient outcomes is essential in a healthcare environment focused on quality. Mortality after surgery has been considered a useful quality metric. More important than mortality rate, failure to rescue (FTR) has emerged as a metric that is important and may be improveable. The purpose of this review is to define FTR, describe patient and hospital level factors that lead to FTR, and highlight possible solutions to this problem. RECENT FINDINGS: FTR is defined as a death following a complication...
September 20, 2019: Current Opinion in Critical Care
Jean-Pierre Frat, Damien Marie, Arnaud W Thille
PURPOSE OF REVIEW: Noninvasive ventilation is strongly recommended in acute hypercapnic respiratory failure, whereas high-flow nasal oxygen therapy could be an alternative in de novo respiratory failure. RECENT FINDINGS: High-flow nasal oxygen may improve the outcome of patients de novo respiratory failure as compared with standard oxygen. Its success within 2 h after initiation is well predicted by a ROX index (ratio of SpO2/FiO2 to respiratory rate) greater than 4...
September 20, 2019: Current Opinion in Critical Care
Shawn Tejiram, Kathleen S Romanowski, Tina L Palmieri
PURPOSE OF REVIEW: Patients with severe burn injuries pose significant challenges for the intensivist. Though average burn sizes have decreased over time, severe burn injuries involving greater than 20% of the total body surface area still occur. Verified burn centers are limited, making the management of severely burn injured patients at nonspecialized ICUs likely. Current practices in burn care have increased survivability even from massive burns. It is important for intensivists to be aware of the unique complications and therapeutic options in burn critical care management...
September 17, 2019: Current Opinion in Critical Care
Usman A Tahir, Brett Carroll, Duane S Pinto
PURPOSE OF REVIEW: To highlight updates on the use of extracorporeal membrane oxygenation (ECMO) and surgical embolectomy in the treatment of massive pulmonary embolism. RECENT FINDINGS: Outcomes for surgical embolectomy for massive pulmonary embolism have improved in the recent past. More contemporary therapeutic options include catheter embolectomy, which although offer less invasive means of treating this condition, need further study. The use of ECMO as either a bridge or mainstay of treatment in patients with contraindications to fibrinolysis and surgical embolectomy, or have failed initial fibrinolysis, has increased, with data suggesting improved outcomes with earlier implementation in selected patients...
September 17, 2019: Current Opinion in Critical Care
Garrett G R J Johnson, Andrew W Kirkpatrick, Lawrence M Gillman
PURPOSE OF REVIEW: Point-of-care ultrasound (POCUS) has become an integral component of daily care in the surgical ICU. There have been many novel advancements in the past two decades, too numerous to count. Many are of critical importance to the intensive care physician, whereas others are still accumulating evidence. Without appropriate training, diligence, and incorporation of the ultrasound findings into the whole clinical picture, this technique can be gravely misused. This review examines POCUS use in the surgical ICU, as well as highlights potential hazards and common pitfalls...
September 12, 2019: Current Opinion in Critical Care
Caroline Der-Nigoghossian, Clio Rubinos, Ayham Alkhachroum, Jan Claassen
PURPOSE OF REVIEW: Status epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of continuous anesthetics or adjunctive anticonvulsant, the cause of the status epilepticus, and use of nonpharmacologic therapies. RECENT FINDINGS: Status epilepticus remains undertreated and mortality persists to be unchanged over the past 30 years...
September 12, 2019: Current Opinion in Critical Care
Lisa Smit, Kelly A Foks, Jeannette Hofmeijer, Mathieu van der Jagt
PURPOSE OF REVIEW: To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU. RECENT FINDINGS: Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management...
September 12, 2019: Current Opinion in Critical Care
Madhusudan Vijayan, Maria Avendano, Kana A Chinchilla, Belinda Jim
PURPOSE OF REVIEW: Pregnancy-related acute kidney injury (Pr-AKI) is associated with increased maternal and fetal morbidity and mortality and remains a large public health problem. RECENT FINDINGS: Pr-AKI incidence has globally decreased over time for the most part. However, the cause presents a disparity between developing and developed countries, reflecting differences in socioeconomic factors and healthcare infrastructure - with the noteworthy outlier of increased incidence in the United States and Canada...
September 12, 2019: Current Opinion in Critical Care
Bruno M Pereira
PURPOSE OF REVIEW: Abdominal compartment syndrome (ACS) is a severe complication resulting from an acute and sustained increase in intra-abdominal pressure (IAP), causing significant morbidity and mortality. Although prospective double-blinded, randomized trials, and evidence-based analysis are lacking there is new evidence that still demonstrates high morbidity and mortality in critically ill populations because of intra-abdominal hypertension (IAH) in the 21st century. The objective of this review is to alert the health professional about this important diagnosis and to highlight the latest updates proposed by the World Abdominal Compartment Society...
September 12, 2019: Current Opinion in Critical Care
Zane B Perkins, Ryan W Haines, John R Prowle
PURPOSE OF REVIEW: A summary of recent research into the epidemiology, cause, management and outcomes of trauma-associated acute kidney injury (AKI). There is an increasing focus on subtypes of AKI to better target clinical management and future research. RECENT FINDINGS: AKI associated with trauma occurs in 20-24% of patients admitted to ICU. On the basis of creatinine and/or urine output, AKI occurs in the first few days of traumatic illness. Although various associations have been identified, shock and high-volume blood transfusion are the most consistent risks for development of trauma-associated AKI...
September 9, 2019: Current Opinion in Critical Care
Fernando Caravaca-Fontán, Gema Fernández-Juárez, Manuel Praga
PURPOSE OF REVIEW: The purpose of this review is to describe the most common causes of acute interstitial nephritis (AIN), the diagnostic work-up and the therapeutic management. RECENT FINDINGS: Several case series and registries have found an increasing incidence of AIN, especially among older patients. Drug-induced AIN still represents the most common cause. Early withdrawal of the culprit drug together with corticosteroid therapy remain the mainstay of treatment, although recent studies have shown that prolonged treatment beyond 8 weeks does not further improve kidney function recovery...
September 9, 2019: Current Opinion in Critical Care
Michael C Sklar, Michael E Detsky
PURPOSE OF REVIEW: To describe techniques to facilitate safe intubation in critically ill patients. RECENT FINDINGS: Despite advances in the treatment of critically ill patients, endotracheal intubation remains a high-risk procedure associated with complications that can lead to appreciable morbidity and mortality. In addition to the usual anatomical factors that can predict a difficult intubation, incorporating pathophysiological considerations and crisis resource management may enhance safety and mitigate risk...
September 3, 2019: Current Opinion in Critical Care
Mark A Perazella
PURPOSE OF REVIEW: Medications are a relatively common cause of acute kidney injury (AKI), especially in hospitalized patients who are exposed to numerous agents. Drug-related acute tubular/tubulointerstitial injury is the most common cause of AKI associated with these agents. Toxic effects of drugs and their renal handling often lead to various forms of AKI. RECENT FINDINGS: The inherent nephrotoxicity of drugs and their transport and metabolism by the kidneys play an important role in the occurrence of acute tubular injury...
September 2, 2019: Current Opinion in Critical Care
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