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
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
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
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
Michael R Pinsky, Fabio Guarracino
PURPOSE OF REVIEW: We will highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it. RECENT FINDINGS: Most septic patients show a ventriculoarterial uncoupling at the time of diagnosis with arterial elastance (Ea) greater than left ventricle (LV) end-systolic elastance (Ees), often despite arterial hypotension. Ventriculoarterial coupling levels predict the cardiovascular response to resuscitation in this heterogeneously responding population...
June 2020: Current Opinion in Critical Care
Egbert G Mik, Gianmarco M Balestra, Floor A Harms
PURPOSE OF REVIEW: To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level...
June 2020: Current Opinion in Critical Care
Matthias Noitz, Johannes Szasz, Martin W Dünser
PURPOSE OF REVIEW: Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included. RECENT FINDINGS: We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography to assess single organ perfusion...
June 2020: Current Opinion in Critical Care
Glenn M Eastwood, Alistair Nichol
PURPOSE OF REVIEW: To describe current practice, recent advances in knowledge and future directions for research related to the post return of spontaneous circulation (ROSC) ventilatory management of cardiac arrest patients. RECENT FINDINGS: Out-of-hospital cardiac arrest (OHCA) is a major public health problem with an estimated incidence of approximately one per 1000 persons per year. A priority of intensive care management of resuscitated OHCA patients is to reduce secondary reperfusion injury...
June 2020: Current Opinion in Critical Care
Mikael F Vallentin, Asger Granfeldt, Mathias J Holmberg, Lars W Andersen
PURPOSE OF REVIEW: The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. RECENT FINDINGS: Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival...
June 2020: Current Opinion in Critical Care
Rajat Kalra, Marinos Kosmopoulos, Tomaz Goslar, Ganesh Raveendran, Jason A Bartos, Demetris Yannopoulos
PURPOSE OF REVIEW: Extracorporeal cardiopulmonary resuscitation (ECPR) is a contemporary resuscitation approach that employs veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This approach is increasingly used worldwide to mitigate the widespread hemodynamic and multiorgan dysfunction that accompanies cardiac arrest. RECENT FINDINGS: In this review, the physiology of VA-ECMO and ECPR, the role of ECPR in contemporary resuscitation care, the complications associated with ECPR and VA-ECMO usage, and intensive care considerations for this population are discussed...
June 2020: Current Opinion in Critical Care
Matthias P Hilty, Can Ince
PURPOSE OF REVIEW: Identification of insufficient tissue perfusion is fundamental to recognizing circulatory shock in critically ill patients, and the primary target to restore adequate oxygen delivery. However, the concept of tissue perfusion remains ill-defined and out-of-reach for clinicians as point-of-care resuscitation target. Even though handheld vital microscopy (HVM) provides the technical prerequisites to collect information on tissue perfusion in the sublingual microcirculation, challenges in image analysis prevent quantification of tissue perfusion and manual analysis steps prohibit point-of-care application...
June 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...
June 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...
June 2020: Current Opinion in Critical Care
Thomas Kaufmann, Iwan C C van der Horst, Thomas W L Scheeren
PURPOSE OF REVIEW: To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables. RECENT FINDINGS: The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be sufficient for the majority of patients with circulatory shock...
June 2020: Current Opinion in Critical Care
Cornelia Genbrugge, Ward Eertmans, David D Salcido
PURPOSE OF REVIEW: The current review will give an overview of different possibilities to monitor quality of cardiopulmonary resuscitation (CPR) from a physiologic and a process point of view and how these two approaches can/should overlap. RECENT FINDINGS: Technology is evolving fast with a lot of opportunities to improve the CPR quality. The role of smartphones and wearables are step-by-step identified as also the possibilities to perform patient tailored CPR based on physiologic parameters...
June 2020: Current Opinion in Critical Care
Markus B Skrifvars, Anders Åneman, Koen Ameloot
PURPOSE OF REVIEW: To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics. RECENT FINDINGS: Observational data suggest that mean arterial pressure (MAP) below 65-75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve...
June 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
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