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...
June 19, 2020: Current Opinion in Critical Care
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) devices are increasingly used as a salvage therapy for patients with refractory cardiogenic shock. The exact place of the different TCS devices in the management of cardiogenic shock patients remains unclear and intensely debated. This article provides an overview on new cardiogenic shock classification, currently available devices, place of TCS in the management of cardiogenic shock patients, and discusses the results of recent case series and trials in this setting...
June 8, 2020: Current Opinion in Critical Care
Johan Lassus
PURPOSE OF REVIEW: Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock. RECENT FINDINGS: Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction...
June 8, 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...
June 8, 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...
June 8, 2020: Current Opinion in Critical Care
Mette M Berger, Nawfel Ben-Hamouda
PURPOSE OF REVIEW: In critical care, micronutrients remain perceived as 'quantum' part, that is, a little pertinent component of therapy. Some micronutrients have attracted more attention because of their antioxidant properties. During the last decade, some large size trials have tested their therapeutic potential, generally as 'single high-dose micronutrient intervention', with variable success. This review aims at taking stock of most recent. RECENT FINDINGS: Micronutrient blood levels are generally low in ICU patients, which has prompted the concept of replenishing or compensating deficits, or even realizing a pharmacological action...
June 8, 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...
June 8, 2020: Current Opinion in Critical Care
Eftihia Polyzogopoulou, Angelos Arfaras-Melainis, Vasiliki Bistola, John Parissis
PURPOSE OF REVIEW: Cardiogenic shock is a multifactorial and diverse entity in which inotropes are the cornerstone therapy. Although published clinical trials have focused on pharmacologic treatment of cardiogenic shock, there is lack of an established and widely accepted decision-making algorithm on the use of inotropic agents in cardiogenic shock. RECENT FINDINGS: The current review incorporates cardiogenic shock pathophysiology, inotropes and vasopressors pharmacodynamics...
June 2, 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...
June 1, 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...
June 1, 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...
June 1, 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...
June 1, 2020: Current Opinion in Critical Care
Bruno Levy, Thomas Klein, Antoine Kimmoun
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality...
June 1, 2020: Current Opinion in Critical Care
Karin Amrein, Gennaro Martucci
No abstract text is available yet for this article.
May 20, 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...
May 20, 2020: Current Opinion in Critical Care
Jan Bakker, Can Ince
PURPOSE OF REVIEW: Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. RECENT FINDINGS: Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion...
April 22, 2020: Current Opinion in Critical Care
Sara Nikravan, Pingping Song, Nibras Bughrara, José L Díaz-Gómez
PURPOSE OF REVIEW: Severe sepsis with septic shock is the most common cause of death among critically ill patients. Mortality has decreased substantially over the last decade but recent data has shown that opportunities remain for the improvement of early and targeted therapy. This review discusses published data regarding the role of focused ultrasonography in septic shock resuscitation. RECENT FINDINGS: Early categorization of the cardiovascular phenotypes with echocardiography can be crucial for timely diagnosis and targeted therapy of patients with septic shock...
April 22, 2020: Current Opinion in Critical Care
Per Nordberg, Filippo Annoni, Fabio Silvio Taccone
PURPOSE OF REVIEW: To address the impact of therapeutic hypothermia induced already during cardiopulmonary resuscitation (i.e. intra-arrest cooling) and its association with neurologic functional outcome. RECENT FINDINGS: Intra-arrest cooling is superior than post-ROSC cooling to mitigate brain injuries in experimental models of cardiac arrest. The delayed initiation of hypothermia in human studies may not have adequately addressed the underlying pathophysiology of ischemia and reperfusion...
April 22, 2020: Current Opinion in Critical Care
Rui Shi, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness. RECENT FINDINGS: Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising...
April 22, 2020: Current Opinion in Critical Care
Hans-Josef Feistritzer, Holger Thiele, Steffen Desch
PURPOSE OF REVIEW: Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related cardiogenic shock. RECENT FINDINGS: On the basis of the SHOCK trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related cardiogenic shock...
August 2020: Current Opinion in Critical Care
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