Fernando Jose da Silva Ramos, Flávio Geraldo Rezende de Freitas, Flavia Ribeiro Machado
PURPOSE OF REVIEW: To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates. RECENT FINDINGS: In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings...
July 20, 2021: Current Opinion in Critical Care
Gary E Weissman, Vincent X Liu
PURPOSE OF REVIEW: Patients, surrogate decision makers, and clinicians face weighty and urgent decisions under uncertainty in the ICU, which could be aided by risk prediction. Although emerging artificial intelligence/machine learning (AI/ML) algorithms could reduce uncertainty surrounding these life and death decisions, certain criteria must be met to ensure their bedside value. RECENT FINDINGS: Although ICU severity of illness scores have existed for decades, these tools have not been shown to predict well or to improve outcomes for individual patients...
July 9, 2021: Current Opinion in Critical Care
Joanne McPeake, Carla M Sevin, Mark E Mikkelsen
PURPOSE OF THE REVIEW: Intensive care unit (ICU) survivorship has gained significant attention over the course of the COVID-19 pandemic. In this review, we summarize the contemporary literature in relation to the epidemiology and management of post-ICU problems. RECENT FINDINGS: Survivors of critical illness can have complex physical, social, emotional and cognitive needs in the months following hospital discharge. Emerging evidence has shown that pre-ICU characteristics such as educational attainment, alongside in-ICU factors such as delirium, may contribute to worsening outcomes...
July 9, 2021: Current Opinion in Critical Care
George L Anesi, Meeta Prasad Kerlin
PURPOSE OF REVIEW: Resource limitation, or capacity strain, has been associated with changes in care delivery, and in some cases, poorer outcomes among critically ill patients. This may result from normal variation in strain on available resources, chronic strain in persistently under-resourced settings, and less commonly because of acute surges in demand, as seen during the coronavirus disease 2019 (COVID-19) pandemic. RECENT FINDINGS: Recent studies confirmed existing evidence that high ICU strain is associated with ICU triage decisions, and that ICU strain may be associated with ICU patient mortality...
July 8, 2021: Current Opinion in Critical Care
Jonathan D Casey, Katherine R Courtright, Todd W Rice, Matthew W Semler
PURPOSE OF REVIEW: This review describes the learning healthcare system paradigm, recent examples, and future directions. Patients, clinicians, and health systems frequently encounter decisions between available treatments, technologies, and healthcare delivery methods with little or no evidence about the comparative effectiveness and safety of the available options. Learning healthcare systems endeavor to recognize such knowledge gaps, integrate comparative effectiveness research - including clinical trials - into clinical care to address the knowledge gaps, and seamlessly implement the results into practice to improve care and patient outcomes...
July 6, 2021: Current Opinion in Critical Care
Bram Rochwerg, Leticia Kawano-Dourado, Nida Qadir
PURPOSE OF REVIEW: If developed using rigorous methods and produced in a timely manner, clinical practice guidelines have the potential to improve patient outcomes. Although the COVID-19 pandemic has highlighted the challenges involved in generating reliable clinical guidance, it has also provided an opportunity to address these challenges. RECENT FINDINGS: New research addressing drugs for COVID-19 is being produced at unprecedented rates. Incorporating this new knowledge into patient care can be daunting for the average clinician...
July 6, 2021: Current Opinion in Critical Care
Pietro Bertini, Fabio Guarracino
PURPOSE OF REVIEW: We describe the pathophysiology of cardiogenic shock (CS), from the main pathways to the inflammatory mechanisms and the proteomic features. RECENT FINDINGS: Although the classical pathophysiological pathways underlying CS, namely reduced organ perfusion due to inadequate cardiac output and peripheral vasoconstriction, have been well-established for a long time, the role of macro-and micro-hemodynamics in the magnitude of the disease and its prognosis has been investigated extensively only over the last few years...
May 25, 2021: Current Opinion in Critical Care
Mette M Berger, Marcus Broman, Lui Forni, Marlies Osterman, Elisabeth De Waele, Paul E Wischmeyer
PURPOSE OF REVIEW: Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation. RECENT FINDINGS: A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed...
May 25, 2021: Current Opinion in Critical Care
Elisabeth De Waele, Joop Jonckheer, Paul Wischmeyer
PURPOSE OF REVIEW: Review recent literature on the role of indirect calorimetry in critical care nutrition management. RECENT FINDINGS: Critical illness demands objective, targeted nutritional therapy to prevent adverse effects of underfeeding/over feeding. Thus, all recent societal guidelines recommend indirect calorimetry use to determine energy needs. Very recently, indirect calorimetry technology has finally evolved to allow for accurate, simple, and routine utilization in a wider range of ICU patients...
May 14, 2021: Current Opinion in Critical Care
John Whittle, Iñigo San-Millán
PURPOSE OF REVIEW: Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET). RECENT FINDINGS: Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function...
May 11, 2021: Current Opinion in Critical Care
Isabel M van Ruijven, Sandra N Stapel, Jeroen Molinger, Peter J M Weijs
PURPOSE OF REVIEW: The loss of muscle mass in critically ill patients contributes to morbidity and mortality, and results in impaired recovery of physical functioning. The number of publications on the topic is increasing. However, there is a lack of consistent methodology and the most optimal methodology remains unclear, hampering its broad use in clinical practice. RECENT FINDINGS: There is a large variety of studies recently published on the use of ultrasound for assessment of muscle mass...
May 11, 2021: Current Opinion in Critical Care
Tyler J VanDyck, Michael R Pinsky
PURPOSE OF REVIEW: Cardiogenic shock remains a major cause of mortality today. With recent advancements in invasive mechanical support strategies, reperfusion practice, and a new classification scheme is proposed for cardiogenic shock, an updated review of the latest hemodynamic monitoring techniques is important. RECENT FINDINGS: Multiple recent studies have emerged supporting the use of pulmonary artery catheters in the cardiogenic shock population. Data likewise continues to emerge on the use of echocardiography and biomarker measurement in the care of these patients...
August 1, 2021: Current Opinion in Critical Care
Jacob C Jentzer, Meir Tabi, Barry Burstein
PURPOSE OF REVIEW: Cardiogenic shock continues to carry a high mortality, and recent randomized trials have not identified novel therapies that improve survival. Early optimization of patients with confirmed or suspected cardiogenic shock is crucial, as patients can quickly transition from a hemodynamic shock state to a treatment-resistant hemometabolic shock state, where accumulated metabolic derangements trigger a self-perpetuating cycle of worsening shock. RECENT FINDINGS: We describe a structured ABCDE approach involving stabilization of the airway, breathing and circulation, followed by damage control and etiologic assessment...
May 6, 2021: Current Opinion in Critical Care
Hanneke Pierre Franciscus Xaverius Moonen, Arthur Raymond Hubert Van Zanten
PURPOSE OF REVIEW: Insight into body composition is of great value in the ICU. Bioelectric impedance analysis (BIA) is the most applicable bedside technique. However, bioimpedance has not been validated in the critically ill, and the interpretation of the measurements poses challenges. This review discusses the potential clinical applications of BIA and explores caveats and solutions to its use in the intensive care setting. RECENT FINDINGS: A correlation is repeatedly found between raw impedance parameters, fluid ratios, overhydration, and adverse outcome of critical illness...
May 6, 2021: Current Opinion in Critical Care
Fabio Guarracino
No abstract text is available yet for this article.
August 1, 2021: Current Opinion in Critical Care
Karin Amrein, Magdalena Hoffmann, Elisabeth Lobmeyr, Gennaro Martucci
PURPOSE OF REVIEW: To summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19. RECENT FINDINGS: Vitamin D is a strong predictor for worse outcomes in critically ill patients, and as well in COVID-19. The vitamin D content in typical nutrition regimes is lower than what is recommended for the general population. Although its supplementation has been shown to reduce respiratory tract infections, asthma exacerbations and mortality risk in noncritically ill patients, its role in the acute setting is not yet clear...
August 1, 2021: Current Opinion in Critical Care
Alexandria Page, Luke Flower, John Prowle, Zudin Puthucheary
PURPOSE OF REVIEW: Assess current potential catabolism-biomarkers to characterize patients developing prolonged critical illness. RECENT FINDINGS: A raised urea-to-creatinine ratio (UCR) during critical illness is negatively associated with muscle mass with greater increases in UCR seen patients developing persistent critical illness. Similarly, sarcopenia index (a ratio of creatinine to cystatin-c concentrations) correlates well to muscle mass in intensive care populations...
August 1, 2021: Current Opinion in Critical Care
Paul E Wischmeyer
No abstract text is available yet for this article.
August 1, 2021: Current Opinion in Critical Care
David D Berg, Erin A Bohula, David A Morrow
PURPOSE OF REVIEW: Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. The purpose of this review is to describe the contemporary epidemiology of cardiogenic shock, including trends in clinical outcomes and recent efforts to refine risk assessment...
August 1, 2021: Current Opinion in Critical Care
Jan Gunst, Michael P Casaer, Lies Langouche, Greet Van den Berghe
PURPOSE OF REVIEW: To summarize the clinical evidence for beneficial effects of ketones, ketogenic diets and intermittent fasting in critical illness, and to review potential mechanisms behind such effects. RECENT FINDINGS: Recent evidence demonstrates that activation of a metabolic fasting response may be beneficial to recover from critical insults. Potential protective mechanisms are, among others, activation of ketogenesis and of damage removal by autophagy. Novel feeding strategies, including ketone supplements, ketogenic diets and intermittent fasting regimens, can activate these pathways - at least partially - in critically ill patients...
August 1, 2021: Current Opinion in Critical Care
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