Current Opinion in Critical Care

Ram M Subramanian
No abstract text is available yet for this article.
February 4, 2020: Current Opinion in Critical Care
Ramon Diaz-Arrastia, Pashtun Shahim, Danielle K Sandsmark
PURPOSE OF REVIEW: The aim of the article is to summarize recent advances in the field of molecular biomarkers in neurocritical care. RECENT FINDINGS: Advances in ultrasensitive immunoassay technology have made it possible to measure brain-derived proteins that are present at subfemtomolar concentrations in blood. These assays have made it possible to measure neurofilament light chain (NfL) in serum or plasma, and early studies indicate that NfL is a promising prognostic and pharmacodynamic biomarker across a broad range of neurologic disorders, including cardiac arrest and traumatic brain injury...
January 30, 2020: Current Opinion in Critical Care
Zainab Al Duhailib, Joanna C Dionne, Waleed Alhazzani
PURPOSE OF REVIEW: Upper gastrointestinal bleeding (UGIB) is a common condition that can lead to significant morbidity and mortality. Critical care physicians usually get involved in the care of patients with severe UGIB that is associated with hemodynamic compromise. We aim to provide the readers with evidence-based review of the management of patients with severe UGIB. RECENT FINDINGS: Proton pump inhibitors are the main pharmacologic intervention for UGIB, along with adequate resuscitation and timely endoscopic intervention...
January 30, 2020: Current Opinion in Critical Care
Annika Reintam Blaser, Todd W Rice, Adam M Deane
PURPOSE OF REVIEW: To summarize recent data regarding nutritional assessment and interventions in the ICU. RECENT FINDINGS: Current methods to assess nutritional risk do not allow identification of ICU patients who may benefit from specific nutritional intervention. Early full energy delivery does not appear to improve outcomes at the population level. Specific nutrient composition of formula has been shown to improve glycemic outcomes in patients with hyperglycemia but patient-centered outcomes are unaffected...
January 30, 2020: Current Opinion in Critical Care
Jeffrey R Vitt, Chung-Huan Sun, Peter D LeRoux, J Claude Hemphill
PURPOSE OF REVIEW: Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH...
January 30, 2020: Current Opinion in Critical Care
Massimo Sartelli
PURPOSE OF REVIEW: The review focuses on the evaluation and management of abdominal sepsis. RECENT FINDINGS: A multitude of surgical approaches towards abdominal sepsis are practized in the world and may be associated with significant morbidity and mortality rates. Despite decades of sepsis research, no specific therapies for sepsis have emerged. Without specific therapies, the management of abdominal sepsis is based on the control of the infection and organ support...
January 30, 2020: Current Opinion in Critical Care
Rebecca Allen, Babak Sarani
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of the pathophysiology of intraabdominal hypertension/compartment syndrome and to review the recent advances in the areas of evaluation and management of this disorder. RECENT FINDINGS: The incidence of intraabdominal hypertension (IAH) in intensive care units is as high as 45%, an incidence much higher than initially suspected. Despite decompressive laparotomy as a treatment, mortality in patients who developed abdominal compartment syndrome (ACS) requiring this procedure is as high as 50%...
January 30, 2020: Current Opinion in Critical Care
Chiara Robba, Giulia Bonatti, Paolo Pelosi, Giuseppe Citerio
PURPOSE OF REVIEW: The aim of this review is to provide an update on the pathophysiology and treatment of severe traumatic brain injury (TBI)-related complications on extracranial organs. RECENT FINDINGS: Extracranial complications are common and influence the outcome from TBI. Significant improvements in outcome in a sizeable proportion of patients could potentially be accomplished by improving the ability to prevent or reverse nonneurological complications such as pneumonia, cardiac and kidney failure...
January 30, 2020: Current Opinion in Critical Care
Asma M Moheet, Sarah L Livesay
PURPOSE OF REVIEW: Neurocritical care has matured as a field and there is now a growing body of literature on the subject of quality improvement in neurocritically ill patients. This review will highlight major recent contributions in this field and discuss future directions. RECENT FINDINGS: Articles published in the past 18 months have evaluated neurocritical care unit staffing, structure, and disease-specific protocols including subarachnoid hemorrhage and severe traumatic brain injury management...
April 2020: Current Opinion in Critical Care
Monisha A Kumar, Francisco G Romero, Kiruba Dharaneeswaran
PURPOSE OF REVIEW: To examine the potential benefits of early mobilization in neurocritically ill patients and to summarize the recent evidence for and against early mobilization. RECENT FINDINGS: Early ICU mobilization in medically critically ill patients may decrease ICU and hospital length of stay, increase discharge-to-home, and reduce medical costs. Whether these benefits apply to neurologically critically ill patients remains unclear, as neuro ICU patients are often excluded from trials of early mobility...
April 2020: Current Opinion in Critical Care
Michael J Souter, Matthew Kirschen
PURPOSE OF REVIEW: Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply-demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs. RECENT FINDINGS: Recipient outcomes are not worsened when transplanting organs from donors who were declared dead after traumatic brain injury...
April 2020: Current Opinion in Critical Care
Federico Romagnosi, Filippo Bongiovanni, Mauro Oddo
PURPOSE OF REVIEW: Multimodal monitoring has emerged as a novel paradigm of care in acute brain injury, and in this context the value of noninvasive devices is increasingly under scrutiny. This narrative review summarizes recent clinical investigation focused on the role of automated infrared pupillometry (AIP) and optic nerve sheath diameter (ONSD) ultrasound as novel techniques to monitor and manage neurocritical care patients. RECENT FINDINGS: AIP provides a quantitative measurement of the pupillary light reflex that is more precise and reliable than the traditional examination of the pupillary light reflex using manual flashlight lamps...
April 2020: Current Opinion in Critical Care
Tarun Bhalla, Redi Rahmani, Peter Le Roux
PURPOSE OF REVIEW: Since the development of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke (AIS), functional outcome has improved when treatment occurs within 4.5 h of stroke onset and treatment benefits are greater with earlier treatment. Endovascular revascularization also is better the sooner it is delivered. RECENT FINDINGS: The Get with the Guidelines Stroke registry found that less than one-third of treatment-eligible AIS patients receive intravenous tPA within 60 min of hospital arrival...
April 2020: Current Opinion in Critical Care
Vadivukkarasi T Jayalakshmi, William Bernal
PURPOSE OF REVIEW: The aim of this article is to provide the reader with an overview of established standards of care and to summarize important newer research findings in acute liver failure (ALF). RECENT FINDINGS: New international guidelines are now in place with recommendations for medical care and nutritional support. Large-scale retrospective studies have confirmed the low level of bleeding complications observed, despite apparently severe coagulopathy on standard laboratory testing, and the improved survival seen with continuous rather than intermittent forms of renal replacement therapy...
April 2020: Current Opinion in Critical Care
Peter Le Roux
No abstract text is available yet for this article.
April 2020: Current Opinion in Critical Care
Dev Katarey, Rajiv Jalan
PURPOSE OF REVIEW: Extracorporeal liver support (ELS) is a large unmet need in day-to-day hepatology practice. In an era of ever-improving outcomes with liver transplantation for very sick patients with either acute liver failure (ALF) or acute-on-chronic liver failure, the outcomes for similar patients who are ineligible for transplantation remains poor. Providing a bridge to recovery from these catastrophic conditions is the aim of ELS, and we aim to review the evidence to date of different ELS devices as well as look to the future of ELS device development...
April 2020: Current Opinion in Critical Care
Marek Czosnyka, Peter Hutchinson, Peter Smielewski
PURPOSE OF REVIEW: This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow. RECENT FINDINGS: The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice...
April 2020: Current Opinion in Critical Care
Micheal Strein, Scott May, Gretchen M Brophy
PURPOSE OF REVIEW: This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility. RECENT FINDINGS: Increases in prescribing of DOACs has led to the introduction of drug-specific reversal agents. The clinical trials that evaluated these agents did not include a comparator arm making it difficult to determine if they are clinically superior to nonspecific reversal agents...
April 2020: Current Opinion in Critical Care
Jody C Olson
PURPOSE OF REVIEW: ICU admissions due to complications of advanced liver disease continue to rise. Among indications for admission to the ICU in patients with cirrhosis, gastrointestinal issues such as bleeding are common. In patients in whom gastrointestinal issues are not the principal indication for ICU, gastrointestinal issues such as nutrition and ileus remain important concerns for generalized intensive care support. This review highlights current trends in management of gastrointestinal issues in patients with cirrhosis admitted to the ICU...
April 2020: Current Opinion in Critical Care
Andrew John MacDonald, Jody Olson, Constantine J Karvellas
PURPOSE OF REVIEW: Patients with cirrhosis are frequently hospitalized with acute decompensation and organ system failure - a syndrome referred to as acute on chronic liver failure (ACLF). These patients often require critical care intervention and experience significant mortality; however, established diagnostic and prognostic criteria are lacking. Given this, it remains imperative for intensivists to develop an expertise in common ACLF complications and management. RECENT FINDINGS: Liver transplantation serves as the definitive management strategy in ACLF...
April 2020: Current Opinion in Critical Care
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