journal

Current Opinion in Critical Care | Page 2

journal
https://read.qxmd.com/read/31688164/nutrition-in-surgical-patients-how-soon-is-too-soon
#21
Muhammad Khan, Rifat Latifi
PURPOSE OF REVIEW: Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes. RECENT FINDINGS: Early nutrition support during the postoperative course may be the most important step that can be taken toward preventing subsequent malnutrition-related complications...
December 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31574014/caring-for-the-surgical-patient-with-limited-icu-resources
#22
Marcelo A F Ribeiro, Alexandre Z Fonseca, Stephanie Santin
PURPOSE OF REVIEW: The current review aims to discuss the management of surgical patients in an ICU in countries where resources are limited. RECENT FINDINGS: ICU beds in low-income and middle-income countries (LMICs) are limited and also have limited human and structural resources. The working force has been described to be the costliest factor. Nevertheless, costs for intensive care in LMICs are one third from the cost reported from high-income countries. Alternative options have been described, so intensive care can be delivered outside ICU...
December 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31524721/acute-kidney-injury-in-hematopoietic-stem-cell-transplantation
#23
Rimda Wanchoo, Brian R Stotter, Ruthee L Bayer, Kenar D Jhaveri
PURPOSE OF REVIEW: Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality. RECENT FINDINGS: Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD)...
December 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31524719/persistent-pollutants-focus-on-perfluorinated-compounds-and-kidney
#24
Fiorenza Ferrari, Anita Orlando, Zaccaria Ricci, Claudio Ronco
PURPOSE OF REVIEW: There is increasing interest in the environmental and human damage caused by pollutants. Big efforts are continuously made to monitor their levels and identify safe thresholds. For this purpose, an essential step is to prioritize harmful substances and understand their effect on human body. Perfluorinated compounds (PFCs) deserve particular attention because of their wide diffusion and potential correlation with different diseases including glucose intolerance, hyperlipidaemia, thyroid diseases, gestational diabetes mellitus and hypertension, testicular and genitourinary cancer as well as impaired kidney function...
December 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31464728/strategies-to-effect-change-in-the-icu
#25
David J Wallace
PURPOSE OF REVIEW: To provide an update on implementation efforts in the care of critically ill patients, with a focus on work published in the last 2 years. RECENT FINDINGS: Only half of surveyed members of the multidisciplinary care team in the ICU were aware of the Choosing Wisely campaign, and of those that were, approximately one-third reported no implementation of the recommendations. Barriers to implementation of the ABCDE bundle extend to beyond patient-level domains, and include clinician-related, protocol-related, and other domains...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31369411/optimizing-therapy-of-bloodstream-infection-due-to-extended-spectrum-%C3%AE-lactamase-producing-enterobacteriaceae
#26
Carlota Gudiol, Guillermo Cuervo, Jordi Carratalà
PURPOSE OF REVIEW: Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, because of the alarming emergence or carbapenem resistance, interest in effective alternatives has emerged. The present review summarizes the findings published on the antibiotics currently available for treatment of patients with an ESBL-E bloodstream infection (BSI)...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31369410/optimal-and-responsible-use-of-antibiotics
#27
Pieter Depuydt, Jan J De Waele
PURPOSE OF REVIEW: In this review, we focus on the dual face of antibiotic therapy in the critically ill that must harmonize the need for early, appropriate and adequate antibiotic therapy in the individual-infected patient with the obligation to limit antibiotic selection pressure as much as possible to preserve its future potential. RECENT FINDINGS: Recent articles have highlighted and detailed the various aspects, which determine antibiotic efficacy, and have identified adjunctive treatments, such as source control, which impact outcome...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31361685/deadoption-of-low-value-practices-in-the-icu
#28
Christopher M Fung, Robert C Hyzy
PURPOSE OF REVIEW: Change of practice in the ICU, particularly the discontinuation of approaches, which are no longer felt to be beneficial, can be challenging. This review will examine this issue and outline current thinking regarding how to best approach it. RECENT FINDINGS: Practices in medicine that do not provide patients benefit and possibly cause harm exist throughout medicine and are called low-value practices. Some low-value practices have successfully been removed from the ICU whereas others remain...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31361684/historic-review-of-long-term-outcomes-research
#29
Christian Rylander
PURPOSE OF REVIEW: This review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research. RECENT FINDINGS: The postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31361683/diagnosing-invasive-pulmonary-aspergillosis-in-icu-patients-putting-the-puzzle-together
#30
Stijn Blot, Jordi Rello, Despoina Koulenti
PURPOSE OF REVIEW: The approach to diagnose invasive pulmonary aspergillosis in the absence of lung biopsy in ICU patients is reviewed. This approach should be based on four pillars: mycology, medical imaging, underlying conditions, and acute disease expression. RECENT FINDINGS: Diagnosing invasive pulmonary aspergillosis in the absence of histopathologic evidence is a matter of probability weighting. Initiating antifungal therapy in an early phase and with a lower likelihood of disease might outweigh further diagnostic workout with further delay in appropriate treatment...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31356238/challenges-in-conducting-long-term-outcomes-studies-in-critical-care
#31
M Elizabeth Wilcox, E Wesley Ely
PURPOSE OF REVIEW: Evaluating longer term mortality, morbidity, and quality of life in survivors of critical illness is a research priority. This review details the challenges of long-term follow-up studies of critically ill patients and highlights recently proposed methodological solutions. RECENT FINDINGS: Barriers to long-term follow-up studies of critical care survivors include high rates of study attrition because of death or loss to follow-up, data missingness from experienced morbidity, and lack of standardized outcome as well as reporting of key covariates...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31335383/population-enrichment-for-critical-care-trials-phenotypes-and-differential-outcomes
#32
Manu Shankar-Hari, Gordon D Rubenfeld
PURPOSE OF REVIEW: Sepsis and acute respiratory distress syndrome (ARDS) are two heterogenous acute illnesses where numerous RCTs have indeterminate results. We present a narrative review on the recent developments in enriching patient populations for future sepsis and ARDS trials. RECENT FINDINGS: Many researchers are actively pursuing enrichment strategies to reduce heterogeneity to increase the sensitivity of future trials. Enrichment refers to the use of measurable patient characteristics, known before randomisation, to refine trial populations...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31335382/defining-standard-of-practice-pros-and-cons-of-the-usual-care-arm
#33
Federico Angriman, Marie-Hélène Masse, Neill K J Adhikari
PURPOSE OF REVIEW: The aim of this review is to describe the use of usual care arms in randomized trials. RECENT FINDINGS: Randomization of patients to an experimental or a control arm remains paramount for the estimation of average causal effects. Selection of the control arm is as important as the definition of the intervention, and it might include a placebo control, specific standards of care, protocolized usual care, or unrestricted clinical practice. Usual care control arms may enhance generalizability, clinician acceptability of the protocol, patient recruitment, and ensure community equipoise, while at the same time introducing significant variability in the care delivered in the control group...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31335380/how-should-we-treat-acinetobacter-pneumonia
#34
Rosario Amaya-Villar, José Garnacho-Montero
PURPOSE OF REVIEW: To describe recent data about Acinetobacter baumannii pneumonia epidemiology and the therapeutic options including adjunctive nebulized therapy. RECENT FINDINGS: A. baumannii is a major cause of nosocomial pneumonia in certain geographic areas affecting mainly debilitated patients, with prolonged hospitalization and broad-spectrum antimicrobials. Inappropriate empirical treatment has clearly been associated with increased mortality in A. baumannii pneumonia...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31313682/in-the-pursuit-of-partnership-patient-and-family-engagement-in-critical-care-medicine
#35
Christian E Farrier, Henry T Stelfox, Kirsten M Fiest
PURPOSE OF REVIEW: Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area. RECENT FINDINGS: Though the literature is relatively nascent, studies suggest that there is a desire to engage patients and families in critical care medicine research and clinical care, however, uncertainty exists on how to achieve this goal...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31313681/severe-influenza-overview-in-critically-ill-patients
#36
Cristina Sarda, Pedro Palma, Jordi Rello
PURPOSE OF REVIEW: Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity. RECENT FINDINGS: Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31306182/meningitis-and-encephalitis-management-in-the-icu
#37
Christopher P Robinson, Katharina M Busl
PURPOSE OF REVIEW: Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. RECENT FINDINGS: Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world...
October 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31567292/initial-management-of-severe-burn-injury
#38
Shawn Tejiram, Kathleen S Romanowski, Tina L Palmieri
PURPOSE OF REVIEW: Patients with severe burn injuries pose significant challenges for the intensivist. Though average burn sizes have decreased over time, severe burn injuries involving greater than 20% of the total body surface area still occur. Verified burn centers are limited, making the management of severely burn injured patients at nonspecialized ICUs likely. Current practices in burn care have increased survivability even from massive burns. It is important for intensivists to be aware of the unique complications and therapeutic options in burn critical care management...
September 17, 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31567291/massive-pulmonary-embolism-embolectomy-or-extracorporeal-membrane-oxygenation
#39
Usman A Tahir, Brett Carroll, Duane S Pinto
PURPOSE OF REVIEW: To highlight updates on the use of extracorporeal membrane oxygenation (ECMO) and surgical embolectomy in the treatment of massive pulmonary embolism. RECENT FINDINGS: Outcomes for surgical embolectomy for massive pulmonary embolism have improved in the recent past. More contemporary therapeutic options include catheter embolectomy, which although offer less invasive means of treating this condition, need further study. The use of ECMO as either a bridge or mainstay of treatment in patients with contraindications to fibrinolysis and surgical embolectomy, or have failed initial fibrinolysis, has increased, with data suggesting improved outcomes with earlier implementation in selected patients...
September 17, 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31524722/ultrasound-in-the-surgical-icu-uses-abuses-and-pitfalls
#40
Garrett G R J Johnson, Andrew W Kirkpatrick, Lawrence M Gillman
PURPOSE OF REVIEW: Point-of-care ultrasound (POCUS) has become an integral component of daily care in the surgical ICU. There have been many novel advancements in the past two decades, too numerous to count. Many are of critical importance to the intensive care physician, whereas others are still accumulating evidence. Without appropriate training, diligence, and incorporation of the ultrasound findings into the whole clinical picture, this technique can be gravely misused. This review examines POCUS use in the surgical ICU, as well as highlights potential hazards and common pitfalls...
September 12, 2019: Current Opinion in Critical Care
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