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Current Opinion in Critical Care

Jason D Chodakowski, D Mark Courtney
PURPOSE OF REVIEW: We provide a timely update on treatment care issues facing clinicians and patients with acute pulmonary embolism accompanied by either right ventricular strain (sub-massive pulmonary embolism) or shock (massive pulmonary embolism). RECENT FINDINGS: Care and research changes over the last several years have resulted in four important trends: more consensus and accuracy in the way acute pulmonary embolism severity is described and communicated among acute care clinicians and researchers, increased availability and use of risk prediction scoring systems, increased use of advanced invasive therapy in the setting of severe right ventricular dysfunction, and emergence of multidisciplinary pulmonary embolism response teams to guide standard care decision-making...
December 2018: Current Opinion in Critical Care
Marlies Ostermann, Michael Connor, Kianoush Kashani
PURPOSE OF REVIEW: The use of extracorporeal membrane oxygenation (ECMO) is increasing rapidly. Patients on ECMO have a high risk of developing acute kidney injury (AKI) and needing renal replacement therapy (RRT). The aim of this review is to describe different strategies of combining RRT and ECMO and to outline their advantages and drawbacks. RECENT FINDINGS: Fluid overload is the most common indication for RRT during ECMO, and continuous renal replacement therapy (CRRT) is the most commonly used modality...
December 2018: Current Opinion in Critical Care
Somnath Bose, Daniel Talmor
PURPOSE OF REVIEW: Timely identification of high-risk surgical candidates facilitate surgical decision-making and allows appropriate tailoring of perioperative management strategies. This review aims to summarize the recent advances in perioperative risk stratification. RECENT FINDINGS: Use of indices which include various combinations of preoperative and postoperative variables remain the most commonly used risk-stratification strategy. Incorporation of biomarkers (troponin and natriuretic peptides), comprehensive objective assessment of functional capacity, and frailty into the current framework enhance perioperative risk estimation...
December 2018: Current Opinion in Critical Care
Olivier Joannes-Boyau, Lionel Velly, Carole Ichai
PURPOSE OF REVIEW: The consideration of acute kidney injury, its incidence and its impact on the outcome of patients has grown continuously in recent years, leading to an increase in the use of renal replacement therapy (RRT) techniques. However, the successful conduct of RRT depends on the effectiveness of the entire team, doctors and nurses. It is therefore important to know the essential elements to be implemented in the ICU to ensure optimal RRT. RECENT FINDINGS: Recent studies show that the successful conduct of a RRT session requires a good knowledge of the principles of the technique, regular basic training, identification of experts, drafting clear and well followed protocols and good communication between the various stakeholders...
December 2018: Current Opinion in Critical Care
Emmanuel Canet, Rinaldo Bellomo
PURPOSE OF REVIEW: The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI). RECENT FINDINGS: AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. AKI increases hospital stay, mortality, and chronic kidney disease, gradually with severity...
December 2018: Current Opinion in Critical Care
Thomas Rimmelé
No abstract text is available yet for this article.
December 2018: Current Opinion in Critical Care
Wesley H Self
No abstract text is available yet for this article.
December 2018: Current Opinion in Critical Care
Paolo Pelosi, Lorenzo Ball, Marcus J Schultz
PURPOSE OF REVIEW: Timely identification of surgery patients at risk of postoperative complications is important to improve the care process, including critical care. This review discusses epidemiology and impact of postoperative complications; prediction scores used to identify surgical patients at risk of complications, and the role of critical care in the postoperative management. It also discusses how critical care may change, with respect to admission to the ICU. RECENT FINDING: Optimization of postoperative outcome, next to preoperative and intraoperative optimization, consists of using risk scores to early identify patients at risk of developing complications...
December 2018: Current Opinion in Critical Care
Simone Bazurro, Lorenzo Ball, Paolo Pelosi
PURPOSE OF REVIEW: The volume of bariatric and nonbariatric surgical procedures on obese patients is dramatically increasing worldwide over the past years. In this review, we discuss the physiopathlogy of respiratory function during anesthesia in obese patients, the stratification of perioperative risk to develop intraoperative and postoperative pulmonary complications, the optimization of airway management, and perioperative ventilation, including postoperative respiratory assistance...
December 2018: Current Opinion in Critical Care
Manu Shankar Hari, Charlotte Summers
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of the immune response to major surgery, and the ways in which it may be modulated to improve postoperative outcomes. RECENT FINDINGS: Data from patients who have undergone a variety of tissue injuries (surgery, burns, sepsis, trauma) have shown the presence of a conserved 'genomic storm' that alters the leukocyte transcriptome, with upregulation of the innate immune response and concomitant downregulation of the adaptive immune response...
December 2018: Current Opinion in Critical Care
Arnaud W Thille, Jean-Pierre Frat
PURPOSE OF REVIEW: Noninvasive ventilation (NIV) is widely used in ICU patients to treat or to prevent acute respiratory failure. Whereas its physiological effects are clearly beneficial in hypercapnic patients, it could be deleterious in hypoxemic patients without hypercapnia. RECENT FINDINGS: NIV should be cautiously used in patients with de-novo respiratory failure, the vast majority of whom meet the criteria for acute respiratory distress syndrome. Spontaneous breathing with high tidal volumes may worsen lung injury in these patients, and recent findings suggest that NIV may increase the risk of mortality...
December 2018: Current Opinion in Critical Care
Thibaut Girardot, Céline Monard, Thomas Rimmelé
PURPOSE OF REVIEW: Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates. RECENT FINDINGS: Many innovations in dialysis catheters have been proposed by the industry over the past decade, including the material used, the shape of the lumens and the position of the inflow and outflow holes...
December 2018: Current Opinion in Critical Care
Jonathan D Casey, Ryan M Brown, Matthew W Semler
PURPOSE OF REVIEW: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients. RECENT FINDINGS: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults...
December 2018: Current Opinion in Critical Care
Karim Asehnoune, Mickael Vourc'h, Antoine Roquilly
PURPOSE OF REVIEW: Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival. Major surgery is associated with a predictable and usually transient systemic inflammatory response (SIRS), depending on the magnitude of the surgical trauma. An excessive SIRS syndrome participates to the development of postoperative organ dysfunction, infection and mortality. Corticosteroids may decrease the postsurgical SIRS. This review aims to discuss recent findings on the use of corticosteroids in major surgery...
December 2018: Current Opinion in Critical Care
Daniel R Frei, Paul J Young
PURPOSE OF REVIEW: Avoidance and treatment of hypoxaemia is a cornerstone of acute resuscitation and yet the optimal approach to oxygen therapy in the acute care setting is uncertain. The aim of this review is to appraise recent evidence relating to the provision of supplemental oxygen to adult patients with acute illnesses with a focus on the resuscitation phase. RECENT FINDINGS: Recent findings generally support the notion that exposure to hyperoxaemia is associated with adverse outcomes in acutely ill adults with a range of diseases and raise the possibility that liberal provision of oxygen may cause harm...
December 2018: Current Opinion in Critical Care
Thibault Michel, Hatem Ksouri, Antoine G Schneider
PURPOSE OF REVIEW: The utilization of continuous renal replacement therapy (CRRT) increases throughout the world. Technological improvements have made its administration easier and safer. However, CRRT remains associated with numerous pitfalls and issues. RECENT FINDINGS: Even if new-generation CRRT devices have built-in safety features, understanding basic concepts remains of primary importance. SUMMARY: CRRT circuits' maximum recommended lifespan (72 h) can often not be achieved...
December 2018: Current Opinion in Critical Care
Patrick M Honoré, David De Bels, Herbert D Spapen
PURPOSE OF REVIEW: This review aims to summarize the most recent advances on different membranes and cartridges used for extracorporeal blood purification in critically ill patients with sepsis or septic shock. RECENT FINDINGS: Despite positive signals from experimental, cases and small clinical studies, blood purification showed no distinct morbidity and mortality benefit in large clinical trials. SUMMARY: None of the discussed specific membranes or cartridges can currently be recommended as sole adjunctive treatment in sepsis and septic shock...
December 2018: Current Opinion in Critical Care
Detlef Kindgen-Milles, Timo Brandenburger, Thomas Dimski
PURPOSE OF REVIEW: The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques. RECENT FINDINGS: The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate...
December 2018: Current Opinion in Critical Care
Amanda Ying Wang, Rinaldo Bellomo
PURPOSE OF REVIEW: Severe acute kidney injury in the ICU setting often requires renal replacement therapy (RRT). Intermittent hemodialysis (IHD), hybrid forms of RRT such as sustained low-efficiency dialysis (SLED), as well as continuous renal replacement therapy (CRRT) are the three common modalities of extracorporeal RRT used in the adult ICU setting in developed countries. This review summarizes recently published data regarding comparisons of these three RRT modalities on clinical outcomes (e...
December 2018: Current Opinion in Critical Care
Jestin N Carlson, Henry E Wang
PURPOSE OF REVIEW: Historically, most evidence supporting emergency airway management strategies have been limited to small series, retrospective analyses and extrapolation from other settings (i.e. the operating room). Over the past year, several large, randomized clinical trials have offered new findings to inform emergency airway management techniques. RECENT FINDINGS: One large, randomized clinical trial, found improved first attempt success rates with bougie facilitated intubation compared with traditional intubation...
December 2018: Current Opinion in Critical Care
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