Hallie C Prescott, Jeremy B Sussman, W Joost Wiersinga
PURPOSE OF REVIEW: Critical illness survivorship is associated with new and worsening physical, cognitive, and emotional status. Survivors are vulnerable to further health set-backs, most commonly because of infection and exacerbation of chronic medical conditions. Awareness of survivors' challenges are important given the anticipated rise in critical illness survivors because of SARS-CoV-2 viral sepsis. RECENT FINDINGS: Studies continue to document challenges of critical illness survivorship...
August 6, 2020: Current Opinion in Critical Care
Matteo Bassetti, Daniele R Giacobbe, Marco Berruti, Filippo Del Puente, Antonio Vena
PURPOSE OF REVIEW: To highlight recent findings on the adequate duration of antifungal therapy in patients with invasive fungal disease (IFD). RECENT FINDINGS: Plenty of published data available suggest that there is no additional clinical benefit at a certain point after initiation of antifungal treatment in patients with confirmed IFD. Moreover, the prolonged antifungal exposure can be associated with an increased risk of side effects and toxicity as well as striking risk for developing antifungal resistance or rising unnecessary healthcare costs...
August 6, 2020: Current Opinion in Critical Care
Niccolò Buetti, Alexis Tabah, Jean-François Timsit, Walter Zingg
PURPOSE OF REVIEW: Short-term intravascular catheters are instrumental in the care of critically ill patients. Despite their benefits, they also are potential entries for systemic infections. There is a growing body of literature on catheter use and the prevention of intravascular catheter infections in intensive care. This review highlights major recent contributions to the topic and put them into perspective to recommendations on best practice procedures. RECENT FINDINGS: Many studies published in the last years have evaluated prevention strategies applying technology and addressing behavior change...
August 6, 2020: Current Opinion in Critical Care
Jonathan Thorndike, Marin H Kollef
PURPOSE OF REVIEW: The traditional approach to sepsis treatment utilizes broad-spectrum antibiotics. Unfortunately, a significant proportion of infected patients have 'culture-negative' sepsis despite appropriate microbiologic assessment. RECENT FINDINGS: There has been increased interest in the past decade on the treatment of culture-negative sepsis. Outcome data comparing culture-negative sepsis with culture-positive sepsis are mixed and it is unclear if culture-negative sepsis is a distinct entity...
August 6, 2020: Current Opinion in Critical Care
Paul E Wischmeyer, Oscar E Suman, Rosemary Kozar, Steven E Wolf, Jeroen Molinger, Amy M Pastva
PURPOSE OF REVIEW: ICU survivors frequently suffer significant, prolonged physical disability. 'ICU Survivorship', or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testosterone analogues combined with structured exercise is a promising novel intervention to improve 'ICU Survivorship'. RECENT FINDINGS: One explanation for lack of success in addressing post-ICU physical disability is most ICU patients exhibit severe testosterone deficiencies early in ICU that drives persistent catabolism despite rehabilitation efforts...
August 6, 2020: Current Opinion in Critical Care
Victor D Dinglas, Sai P S Cherukuri, Dale M Needham
PURPOSE OF REVIEW: Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers. RECENT FINDINGS: We identified 28 unique COS projects, of which 15 have published results as of May 2020...
August 6, 2020: Current Opinion in Critical Care
Rafael Cantón, Desirèe Gijón, Patricia Ruiz-Garbajosa
PURPOSE OF REVIEW: To describe current antimicrobial resistance in ESKAPE Gram-negative microorganisms and their situation in the ICUs, the implication of the so-called high-risk clones (HiRCs) involved in the spread of antimicrobial resistance as well as relevance of the COVID-19 pandemic in the potential increase of resistance. RECENT FINDINGS: Extended-spectrum and carbapenemase producing Enterobacterales and multidrug and extensive drug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii have increased worldwide...
July 27, 2020: Current Opinion in Critical Care
Despoina Koulenti, Yuchi Zhang, Paraskevi C Fragkou
PURPOSE OF REVIEW: Nosocomial pneumonia represents a significant burden even for the most resilient healthcare systems. Timely and reliable diagnosis is critical but remains a deficient field. This review critically revises the latest literature on the diagnosis of nosocomial pneumonia, including advances in imaging techniques, as well as the utility of rapid microbiological tests in establishing the etiological diagnosis. RECENT FINDINGS: Studies on low radiation computed tomography (CT) and lung ultrasound (LUS) have shown promising results for early nosocomial pneumonia diagnosis; however, further data on their sensitivity and specificity are needed, especially for picking up subtle and nonspecific radiographic findings...
July 27, 2020: Current Opinion in Critical Care
Adrian John Brink, Guy Richards
PURPOSE OF REVIEW: A major challenge in the ICU is optimization of antibiotic use. This review assesses current understanding of core best practices supporting and promoting astute antibiotic decision-making. RECENT FINDINGS: Limiting exposure to the shortest effective duration is the cornerstone of antibiotic decision-making. The decision to initiate antibiotics should include assessment of risk for resistance. This requires synthesis of patient-level data and environmental factors to determine whether delayed initiation could be considered in some patients with suspected sepsis until sensitivity data is available...
July 27, 2020: Current Opinion in Critical Care
Benoit Guery, Frédéric Barbut, Sarah Tschudin-Sutter
PURPOSE OF REVIEW: The purpose of the review is to provide all the recent data focusing on the diagnostic and treatment of Clostridioides difficile infection in patients admitted in the ICU. RECENT FINDINGS: In the ICU, diagnosis remains complicated with a large number of alternative diagnosis. The treatment classically relies on vancomycin but fidaxomicin and fecal microbiota transplantation are now potential solutions in selected indications. SUMMARY: Data on ICU-related CDI remain limited and conflicting...
July 27, 2020: Current Opinion in Critical Care
Jeroen Molinger, Amy M Pastva, John Whittle, Paul E Wischmeyer
PURPOSE OF REVIEW: Survivorship or addressing impaired quality of life (QoL) in ICU survivors has been named 'the defining challenge of critical care' for this century to address this challenge; in addition to optimal nutrition, we must learn to employ targeted metabolic/muscle assessment techniques and utilize structured, progressive ICU rehabilitative strategies. RECENT FINDINGS: Objective measurement tools such as ccardiopulmonary exercise testing (CPET) and muscle-specific ultrasound show great promise to assess/treat post-ICU physical dysfunction...
August 2020: Current Opinion in Critical Care
Pierre Singer, Yehuda D Glass, Ilya Kagan
PURPOSE OF REVIEW: Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients. RECENT FINDINGS: Larger proportion of carbohydrates than lipids is usual in most of the commercial products. However, patients suffering from sepsis and from acute kidney injury preferentially utilize lipids...
August 2020: Current Opinion in Critical Care
Anne-Françoise Rousseau, Katharina Kerschan-Schindl, Mario Scherkl, Karin Amrein
PURPOSE OF REVIEW: There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies. RECENT FINDINGS: Critical illness is associated with an increase in bone turnover and with an uncoupling between bone resorption and bone formation. This results in loss of bone mass, as highlighted by changes in bone marker serum levels and in bone mineral density...
August 2020: Current Opinion in Critical Care
Nitin Kabra, Howard A Cooper, Srihari S Naidu
PURPOSE OF REVIEW: Mortality rates for acute decompensated heart failure and cardiogenic shock remain unacceptably high despite advances in medical therapy and mechanical circulatory support. Systems designed to quickly and accurately identify and risk stratify these patients are needed in order to improve survival. RECENT FINDINGS: The Society for Cardiovascular Angiography and Interventions developed an expert consensus statement aimed at early identification and assessment of patients with advanced heart failure and cardiogenic shock...
August 2020: Current Opinion in Critical Care
Zoé Pletschette, Jean-Charles Preiser
PURPOSE OF REVIEW: Despite the lack of high-quality data for many years, the discussion on the best modality for enteral nutrition has been going on with little changes pertaining in recent guidelines. The present work aims to provide an overview on the different arguments in favour of either continuous or noncontinuous modes of enteral feed administration, emphasizing both clinical and pathophysiological aspects and comparing their relevance. RECENT FINDINGS: Different physiological effects deriving from enteral nutrition modes and that could impact on outcomes of care under critical illness settings are examined, such as glycaemic control and gastrointestinal motility...
August 2020: Current Opinion in Critical Care
Tomoko Fujii, Adam M Deane, Priya Nair
PURPOSE OF REVIEW: Sepsis is a global health issue, and there is a need for effective, low-cost adjunct metabolic treatments. Corticosteroids have been investigated in many trials for decades, and recently the administration of vitamin C, thiamine (vitamin B1), and vitamin D have been proposed as novel therapies in patients with sepsis. RECENT FINDINGS: APROCCHSS (N = 1241) and ADRENAL (N = 3800) trial reported inconsistent results in mortality outcome; however, both demonstrated a decreased duration of shock with low-dose corticosteroids...
August 2020: Current Opinion in Critical Care
Hanneke Pierre Franciscus Xaverius Moonen, Arthur Raymond Hubert Van Zanten
PURPOSE OF REVIEW: Mitochondrial dysfunction is associated with increased morbidity and mortality during and after critical illness. The concept of adaptive mitochondrial metabolic-bio-energetic downregulation rather than bio-energetic failure during the acute phase of critical illness has gained traction. As mitochondria are not able to utilize substrate during adaptive hibernation and aggressive feeding induces further harm, this condition has consequences for nutrition therapy. RECENT FINDINGS: Meeting resting energy expenditure in early critical illness is associated with enhanced oxidative stress and attenuation of autophagy, as is hyperglycemia...
August 2020: Current Opinion in Critical Care
Rosa Mendes, Luís Bento
PURPOSE OF REVIEW: Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU...
August 2020: Current Opinion in Critical Care
Karin Amrein, Gennaro Martucci
No abstract text is available yet for this article.
August 2020: Current Opinion in Critical Care
Oriol Iborra-Egea, Santi Montero, Antoni Bayes-Genis
PURPOSE OF REVIEW: Cardiogenic shock is a severe complication with mortality rates of ∼50% that requires a rapid and complex management to aid and identify the highest and lowest risk patients. To that end, novel cardiogenic shock biomarkers are needed to improve risk stratification and to personalize therapy. RECENT FINDINGS: Established biomarkers such as BNP, NT-proBNP, ST2, and troponins provide insufficient predictive value in cardiogenic shock. More recent biomarkers, including DPP3, adrenomedullin, angiopoietin 2, and the CS4P score are gaining momentum...
August 2020: Current Opinion in Critical Care
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