Jan J de Waele
No abstract text is available yet for this article.
January 5, 2021: Current Opinion in Critical Care
Verena Rass, Raimund Helbok
PURPOSE OF REVIEW: Delayed cerebral ischaemia (DCI) complicates the clinical course of patients with subarachnoid haemorrhage (SAH) in 20--30% and substantially worsens outcome. In this review, we intended to describe a multimodal diagnostic approach based on underlying mechanisms of DCI and provide treatment options with a special focus on the most recently published literature. RECENT FINDINGS: Symptomatic vasospasm refers to clinical deterioration in the presence of vasospasm whereas DCI constitutes multiple causes...
January 5, 2021: Current Opinion in Critical Care
Ashley A Miniet, Jocelyn R Grunwell, Craig M Coopersmith
PURPOSE OF REVIEW: Although the gut microbiome plays a crucial role in the maintenance of health, it is hypothesized to drive morbidity and mortality in critically ill patients. This review describes the relationship between the gut microbiome and the immune system in critical illness. RECENT FINDINGS: The gut microbiome is converted to a pathobiome in the ICU, characterized by decreased microbial diversity and pathogen predominance. These changes are induced by a pathologic microenvironment and are further exacerbated by common medical treatments initiated in the ICU...
January 5, 2021: Current Opinion in Critical Care
Jussi P Posti, Rahul Raj, Teemu M Luoto
PURPOSE OF REVIEW: To provide an overview on recent advances in the field of assessment and monitoring of patients with severe traumatic brain injury (sTBI) in neurocritical care from a neurosurgical point of view. RECENT FINDINGS: In high-income countries, monitoring of patients with sTBI heavily relies on multimodal neurocritical parameters, nonetheless clinical assessment still has a solid role in decision-making. There are guidelines and consensus-based treatment algorithms that can be employed in both absence and presence of multimodal monitoring in the management of patients with sTBI...
December 30, 2020: Current Opinion in Critical Care
Paul E Wischmeyer
No abstract text is available yet for this article.
December 30, 2020: Current Opinion in Critical Care
Hasan M Al-Dorzi, Yaseen M Arabi
PURPOSE OF REVIEW: This review focuses on the current literature on the epidemiology and prevention of stress-induced clinically important gastrointestinal bleeding in ICU patients. RECENT FINDINGS: The incidence of stress-induced clinically important gastrointestinal bleeding in critically ill patients seems to be decreasing. Observational studies and an exploratory randomized controlled trial suggest that early enteral nutrition may be effective in preventing gastrointestinal bleeding in patients who are not at high risk...
December 30, 2020: Current Opinion in Critical Care
Annika Reintam Blaser, Stefan Acosta, Yaseen M Arabi
PURPOSE OF REVIEW: To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. RECENT FINDINGS: A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present...
December 30, 2020: Current Opinion in Critical Care
Sabrina Hernandez, Katherine Kittelty, Carol L Hodgson
PURPOSE OF REVIEW: To describe recent literature evaluating the effectiveness of early rehabilitation in neurocritical care patients. RECENT FINDINGS: There is a drive for early rehabilitation within the ICU; however, there are unique considerations for the neurocritically ill patient that include hemiplegia, cognitive impairments and impaired conscious state that can complicate rehabilitation. Additionally, neurological complications, such as hemorrhage expansion and cerebral edema can lead to the risk of further neurological damage...
December 30, 2020: Current Opinion in Critical Care
Philippe Montravers, Maksud Assadi, Aurélie Gouel-Cheron
PURPOSE OF THE REVIEW: Timely and adequate management are the key priorities in the care of peritonitis. This review focuses on the cornerstones of the medical support: source control and antiinfective therapies. RECENT FINDINGS: Peritonitis from community-acquired or healthcare-associated origins remains a frequent cause of admission to the ICU. Each minute counts for initiating the proper management. Late diagnosis and delayed medical care are associated to dramatically increased mortality rates...
December 30, 2020: Current Opinion in Critical Care
Ignacio Martin-Loeches, Alan Blake, Daniel Collins
PURPOSE OF REVIEW: We have highlighted the recent advances in infection in neurocritical care. RECENT FINDINGS: Central nervous system (CNS) infections, including meningitis, encephalitis and pyogenic brain infections represent a significant cause of ICU admissions. We underwent an extensive review of the literature over the last several years in order to summarize the most important points in the diagnosis and treatment of severe infections in neurocritical care...
December 30, 2020: Current Opinion in Critical Care
Gaetano Florio, Alberto Zanella, Antonio Pesenti
PURPOSE OF REVIEW: The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries' healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons. RECENT FINDINGS: Appropriate separate paths for infected and noninfected patients and prompt isolation of infected critical patients in dedicated ICUs play a pivotal role in limiting the contagions and optimizing resources during pandemics...
December 10, 2020: Current Opinion in Critical Care
Giacomo Grasselli, Emanuele Cattaneo, Vittorio Scaravilli
PURPOSE OF REVIEW: To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19. RECENT FINDINGS: Early reports suggested that COVID-19 is an 'atypical ARDS' with profound hypoxemia with normal respiratory system compliance (Crs). Contrarily, several more populated analyses showed that COVID-19 ARDS has pathophysiological features similar to non-COVID-19 ARDS, with reduced Crs, and high heterogeneity of respiratory mechanics, hypoxemia severity, and lung recruitability...
December 10, 2020: Current Opinion in Critical Care
Fabienne D Simonis, Nicole P Juffermans, Marcus J Schultz
PURPOSE OF REVIEW: Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs. RECENT FINDINGS: Use of low tidal volume during operative ventilation decreases postoperative pulmonary complications (PPC)...
December 10, 2020: Current Opinion in Critical Care
Gabriele Via, Francesco Vasques, Arif Hussain, Nicholas A Barrett, Luigi Camporota
PURPOSE OF REVIEW: Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients...
December 10, 2020: Current Opinion in Critical Care
Takeshi Yoshida, Yuji Fujino
PURPOSE OF REVIEW: A growing evidence shows that injurious spontaneous breathing, either too weak or too strong, may injure lung and diaphragm. The purpose of review is to understand why we need monitoring for safe spontaneous breathing, and to know the target value of each monitoring to preserve safe spontaneous breathing during assisted ventilation. RECENT FINDINGS: Lung protection sometimes goes counter to diaphragm protection. For instance, silence of respiratory muscle activity is necessary to minimize lung injury from vigorous spontaneous effort in acute respiratory distress syndrome, but it may also have a risk of diaphragm atrophy...
December 3, 2020: Current Opinion in Critical Care
Matthieu Jabaudon, Raiko Blondonnet, Lorraine B Ware
PURPOSE OF REVIEW: This article provides an overview of protein biomarkers for acute respiratory distress syndrome (ARDS) and their potential use in future clinical trials. RECENT FINDINGS: The protein biomarkers studied as indices of biological processes involved in the pathogenesis of ARDS may have diagnostic and/or prognostic value. Recently, they also proved useful for identifying ARDS phenotypes and assessing heterogeneity of treatment effect in retrospective analyses of completed clinical trials...
December 3, 2020: Current Opinion in Critical Care
Arnaud W Thille, Rémi Coudroy, Jean-Pierre Frat
PURPOSE OF REVIEW: High-flow nasal oxygen and noninvasive ventilation (NIV) are two strategies representing an alternative to standard oxygen in the management of respiratory failure. RECENT FINDINGS: Although high-flow nasal oxygen has shown promising results in patients with de-novo acute respiratory failure, further large clinical trials are needed to determine the best oxygenation strategy. As NIV may have deleterious effects, especially in patients generating strong inspiratory efforts, protective NIV using higher levels of positive-end expiratory pressure, more prolonged sessions and additional interfaces such as helmets should be assessed in the future...
December 3, 2020: Current Opinion in Critical Care
Hector Gonzalez, Shahd Horie, John G Laffey
PURPOSE OF REVIEW: Advances in our understanding of the pathophysiology and biology of ARDS has identified a number of promising cellular and pharmacological therapies. These emerging therapeutics can modulate the immune response, reduce epithelial injury, target endothelial and vascular dysfunction, have anticoagulant effects, and enhance ARDS resolution. RECENT FINDINGS: Mesenchymal stromal cell therapy shows promise in earlier phase clinical testing, whereas a number of issues regarding clinical translation, such as donor and effect variability, are currently being optimized to enable larger scale clinical trials...
December 3, 2020: Current Opinion in Critical Care
John A Harvin, Lillian S Kao
PURPOSE OF REVIEW: Acute pain management in the surgical ICU is imperative. Effective acute pain management hastens a patient's return to normal function and avoid the negative sequelae of untreated acute pain. Traditionally, opioids have been the mainstay of acute pain management strategies in the surgical ICU, but alternative medications and management strategies are increasingly being utilized. RECENT FINDINGS: Extrapolating from lessons learned from enhanced recovery after surgery protocols, surgical intensivists are increasingly utilizing multimodal pain regimens (MMPRs) in critically ill surgical patients recovering from major surgical procedures and injuries...
October 23, 2020: Current Opinion in Critical Care
Sheila Nainan Myatra
PURPOSE OF REVIEW: To provide an evidence-based approach to improve first pass success in tracheal intubation while maintaining patient safety in the critically ill. RECENT FINDINGS: Despite advances in the management of critically ill patients, tracheal intubation in these patients remains a high-risk procedure associated with increased morbidity and mortality. Recent interventions to enhance patient safety and improve first pass success in tracheal intubation emphasize reducing repeated attempts at tracheal intubation, oxygen desaturation and cardiovascular collapse during airway management by optimizing patient physiology to mitigate risks and reduce complications...
February 1, 2021: Current Opinion in Critical Care
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