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Current Opinion in Critical Care

Matthias Kott, Wolfgang H Hartl, Gunnar Elke
PURPOSE OF REVIEW: The current review focuses on recent clinical evidence and updated guideline recommendations on the benefits of enteral vs. parenteral nutrition in adult critically ill patients with (septic) shock. RECENT FINDIGS: The largest multicenter randomized-controlled trial showed that the route of nutrient supply was unimportant for 28-day and 90-day mortality, infectious morbidity and length of stay in mechanically ventilated patients with shock. The enteral route, however, was associated with lower macronutrient intake and significantly higher frequency of hypoglycemia and moderate-to-severe gastrointestinal complications...
May 16, 2019: Current Opinion in Critical Care
Niloofar Khoshnam-Rad, Hossein Khalili
PURPOSE OF REVIEW: Although vitamin C is essentially a nontoxic vitamin; however, it is important to be aware regarding the safety of high doses before the wide clinical use. RECENT FINDINGS: Minor side effects of vitamin C have been reported, many being reported in earlier studies. High doses of vitamin C (up to 1.5 g/kg three times a week as intravenously) were safe in cancer patients with normal renal function and perfect glucose-6-phosphate dehydrogenase activity...
May 16, 2019: Current Opinion in Critical Care
Annika Reintam Blaser, Adam M Deane, Joel Starkopf
PURPOSE OF REVIEW: To present a pragmatic approach to facilitate clinician's implementing the recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on clinical nutrition in the intensive care unit. RECENT FINDINGS: The ESPEN guidelines include 54 recommendations with a rationale for each recommendation. All data published since 1 January 2000 was reviewed and 31 meta-analyses were performed to inform these guidelines. An important aspect of the most recent ESPEN guidelines is an attempt to separate periods of critical illness into discrete - early acute, late acute and recovery - phases, with each exhibiting different metabolic profiles and requiring different strategies for nutritional and metabolic support...
May 16, 2019: Current Opinion in Critical Care
Lisa Van Dyck, Michaël P Casaer
PURPOSE OF REVIEW: To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. RECENT FINDINGS: Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release...
May 16, 2019: Current Opinion in Critical Care
Sean van Diepen, Holger Thiele
PURPOSE OF REVIEW: In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. RECENT FINDINGS: The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies...
May 16, 2019: Current Opinion in Critical Care
Steffen Desch
PURPOSE OF REVIEW: Coronary revascularization compared with medical treatment alone leads to improved survival in patients with myocardial infarction (MI) and cardiogenic shock. Percutaneous coronary intervention (PCI) is the predominant mode of revascularization in clinical practice. This review discusses several aspects relevant to mechanical revascularization such as general indication, the roles of PCI and bypass surgery, percutaneous access site choice, strategy in multivessel disease and adjunctive antithrombotic therapy...
May 10, 2019: Current Opinion in Critical Care
Bilal A Jalil, Karim El-Kersh
PURPOSE OF REVIEW: Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis. RECENT FINDINGS: The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last two decades...
May 10, 2019: Current Opinion in Critical Care
Sundar Krishnan, Gregory A Schmidt
PURPOSE OF REVIEW: Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow. This review discusses the various monitoring modalities relevant to the management of patients on venovenous ECMO (VV ECMO) and venoarterial (VA ECMO). We emphasize tools to judge the adequacy of perfusion, predict the response to fluid boluses, measure right ventricular function, assess left ventricular distention (for VA ECMO), and monitor the process of weaning from ECMO...
March 5, 2019: Current Opinion in Critical Care
Laurie J Morrison
PURPOSE OF REVIEW: The purpose of the review is to briefly describe the derivation, validation and implementation of the Termination of Resuscitation Rules for out-of-hospital adult cardiac arrest and to describe the controversies surrounding implementation that have been recently published. RECENT FINDINGS: New guidelines, new interventions that alter baseline survival, the use of eCPR and issues related to duration of CPR have minimal impact on the sustainability and application of the TOR rule...
June 2019: Current Opinion in Critical Care
Daniel De Backer
PURPOSE OF REVIEW: The present review discusses the current role of microcirculatory assessment in the hemodynamic monitoring of critically ill patients. RECENT FINDINGS: Videomicroscopic techniques have demonstrated that microvascular perfusion is altered in critically ill patients, and especially in sepsis. These alterations are associated with organ dysfunction and poor outcome. Handheld microscopes can easily be applied on the sublingual area of critically ill patients...
June 2019: Current Opinion in Critical Care
Stephen J Huang
PURPOSE OF REVIEW: Bedside cardiac output (CO) measurement is an important part of routine hemodynamic monitoring in the differential diagnosis of circulatory shock and fluid management. Different choices of CO measurement devices are available. The purpose of this review is to review the importance of CO [or stroke volume (SV)] measurement and to discuss the various methods (devices) used in determination of CO. RECENT FINDINGS: CO measurement devices can be classified into two types: those use simple physical principles with minimal assumptions, and those predicting CO via mathematical modelling with a number of assumptions...
June 2019: Current Opinion in Critical Care
Paul E Marik, Maxwell Weinmann
PURPOSE OF REVIEW: Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock. RECENT FINDINGS: Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality...
June 2019: Current Opinion in Critical Care
Liesbeth W Boyce, Paulien H Goossens, Véronique R Moulaert, Gemma Pound, Caroline M van Heugten
PURPOSE OF REVIEW: Most survivors of out-of-hospital cardiac arrest (OHCA) suffer from cardiologic symptoms and approximately half of them experience cognitive problems because of hypoxic brain damage. Symptoms of anxiety and depression are also common. This review aims to give an overview of recent literature on rehabilitation treatment aiming at improvement of quality of life after OHCA. RECENT FINDINGS: Existing cognitive screening tools are now validated for OHCA survivors...
June 2019: Current Opinion in Critical Care
Erik Blennow Nordström, Gisela Lilja
PURPOSE OF REVIEW: Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest. RECENT FINDINGS: Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments...
June 2019: Current Opinion in Critical Care
Tobias Cronberg
PURPOSE OF REVIEW: Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury...
June 2019: Current Opinion in Critical Care
Florence Dumas, Wulfran Bougouin, Alain Cariou
PURPOSE OF REVIEW: There is a need for an early assessment of outcome in patients with return of spontaneous circulation after cardiac arrest. During the last decade, several models were developed in order to identify predictive factors that may facilitate prognostication and stratification of outcome. RECENT FINDINGS: In addition to prognostication tools that are used in intensive care, at least five scores were recently developed using large datasets, based on simple and immediately available parameters, such as circumstances of arrest and early in-hospital indicators...
June 2019: Current Opinion in Critical Care
Christina S Boncyk, Kimberly F Rengel, Pratik P Pandharipande, Christopher G Hughes
PURPOSE OF REVIEW: The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium. RECENT FINDINGS: Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality...
June 2019: Current Opinion in Critical Care
Antonio Messina, Massimiliano Greco, Maurizio Cecconi
PURPOSE OF REVIEW: To provide an integrated clinical approach to the critically ill patients in shock. RECENT FINDINGS: The complexity behind shock mechanism has improved in the last decades; as consequence, conventional generalized practices have been questioned, in favour of different approaches, titrated to patient's individual response. Bedside clinical examination has been demonstrated to be a reliable instrument to recognize the mismatch between cardiac function and peripheral oxygen demand...
June 2019: Current Opinion in Critical Care
Kirstie L Haywood, Laura Whitehead, Gavin D Perkins
PURPOSE OF REVIEW: Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials - the COSCA initiative. RECENT FINDINGS: The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described...
June 2019: Current Opinion in Critical Care
Anthony S McLean
No abstract text is available yet for this article.
June 2019: Current Opinion in Critical Care
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