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Current Opinion in Critical Care

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https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#1
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension because of depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension of when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoid fluid overload...
May 13, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28402986/no-small-matter-pediatric-resuscitation
#2
Taylor McCormick, Kevin McVaney, Paul E Pepe
PURPOSE OF REVIEW: To present advancements in pediatric cardiac arrest research, highlighting articles most relevant to clinical practice published since the latest international guidelines for cardiopulmonary resuscitation (CPR). RECENT FINDINGS: Clinical trials examining targeted temperature management in children support avoidance of hyperthermia for both pediatric in-hospital cardiac arrest (PIHCA) and out-of-hospital cardiac arrest (POHCA), but no statistically significant outcome differences were confirmed comparing 33 and 36 °C in the limited populations studied...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28402985/the-past-present-and-future-of-ventilation-during-cardiopulmonary-resuscitation
#3
Mary P Chang, Ahamed H Idris
PURPOSE OF REVIEW: To evaluate the past and present literature on ventilation during out of hospital cardiac arrest, highlighting research that has informed current guidelines. RECENT FINDINGS: Previous studies have studied what are optimal compression-to-ventilation ratios, ventilation rates, and methods of ventilation. Continuous chest compression cardiopulmonary resuscitation (CPR) has not shown to provide a significant survival benefit over the traditional 30 : 2 CPR...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28398910/ebm-vs-ebm-combining-evidence-based-and-experienced-based-medicine-in-resuscitation-research
#4
Paul E Pepe, Tom P Aufderheide
PURPOSE OF REVIEW: To discuss the clear rationale for evidence-based medicine (EvBM) in the challenging realms of resuscitation research, yet also provide case examples in which even the well designed, multicentered randomized clinical trial may have had unrecognized limitations, and thus misleading results. This is where experienced-based medicine (ExBM) helps to resolve the issue. RECENT FINDINGS: Recent publications have brought to task the conclusions drawn from various clinical trials of resuscitative interventions...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28398909/resuscitating-resuscitation-an-overview
#5
Paul E Pepe
No abstract text is available yet for this article.
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28398908/evolution-and-revolution-in-cardiopulmonary-resuscitation
#6
Ray Fowler, Mary P Chang, Ahamed H Idris
PURPOSE OF REVIEW: To discuss the evolution of the technique of cardiopulmonary resuscitation (CPR), including presenting important research that has made substantial improvements in patient outcome. RECENT FINDINGS: The last half century has seen the arising of guidelines for performing CPR increasingly based on good scientific evidence. Improvements in the technique, including teaching citizens 'compressions only CPR', have simplified the process of rescue while improving survival...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28398907/cardiopulmonary-monitoring-of-shock
#7
James Simmons, Corey E Ventetuolo
PURPOSE OF REVIEW: We will briefly review the classification of shock and the hallmark features of each subtype. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls, and practical considerations of each method. RECENT FINDINGS: As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and noninvasive tests such as passive leg raising have gained popularity...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28383297/supportive-technology-in-the-resuscitation-of-out-of-hospital-cardiac-arrest-patients
#8
Scott T Youngquist, Kenneth A Scheppke, Paul E Pepe
PURPOSE OF REVIEW: To discuss the increasing value of technological tools to assess and augment the quality of cardiopulmonary resuscitation (CPR) and, in turn, improve chances of surviving out-of-hospital cardiac arrest (OHCA). RECENT FINDINGS: After decades of disappointing survival rates, various emergency medical services systems worldwide are now seeing a steady rise in OHCA survival rates guided by newly identified 'sweet spots' for chest compression rate and chest compression depth, aided by monitoring for unnecessary pauses in chest compressions as well as methods to better ensure full-chest recoil after compressions...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28379867/metrics-save-lives-value-and-hurdles-faced
#9
Jeffrey M Goodloe, Ahamed H Idris
PURPOSE OF REVIEW: Affirmation of the importance of precision in fundamentals of resuscitation practices with improving neurologically intact survival from sudden cardiac arrest, correlated with both measurements of resuscitation metrics generically and recently further refined metric parameters specifically. RECENT FINDINGS: Quality of baseline cardiopulmonary resuscitation (CPR) in historic intervention trials may not be 'high quality' as once assumed. Optimal chest compression rates are within the narrow spectrum of 106-108/min for adults...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28346232/the-future-is-now-neuroprotection-during-cardiopulmonary-resuscitation
#10
Johanna C Moore, Jason A Bartos, Timothy R Matsuura, Demetris Yannopoulos
PURPOSE OF REVIEW: Survival with favorable neurological function after cardiac arrest remains low. The purpose of this review is to identify recent advances that focus on neuroprotection during cardiopulmonary resuscitation (CPR). RECENT FINDINGS: Multiple strategies have been shown to enhance neuroprotection during CPR. Brain perfusion during CPR is increased with therapies such as active compression decompression CPR and intrathoracic pressure regulation that improve cardiac preload and decrease intracranial pressure...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28323720/neuroprognostication-after-cardiac-arrest-in-the-light-of-targeted-temperature-management
#11
Mauro Oddo, Hans Friberg
PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28323719/passive-leg-raising-for-assessment-of-volume-responsiveness-a-review
#12
Jaume Mesquida, Guillem Gruartmoner, Ricard Ferrer
PURPOSE OF REVIEW: To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness prediction. RECENT FINDINGS: It has been well established that either insufficient or excessive fluid administration derives in worse outcomes in critically ill patients, highlighting that a more accurate assessment of fluid management is required. Accordingly, several cardiovascular indices have been tested to improve our ability to predict patients' response to fluid loading at the bedside, the so-called functional hemodynamic monitoring...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28306558/monitoring-of-the-physical-exam-in-sepsis
#13
Radu Postelnicu, Laura Evans
PURPOSE OF REVIEW: Monitoring of mental status and peripheral circulatory changes can be accomplished noninvasively in patients in the ICU. Emphasis on physical examination in conditions such as sepsis have gained increased attention as these evaluations can often serve as a surrogate marker for short-term treatment efficacy of therapeutic interventions. Sepsis associated encephalopathy and mental status changes correlate with worse prognosis in patients. Evaluation of peripheral circulation has been shown to be a convenient, easily accessible, and accurate marker for prognosis in patients with septic shock...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28234784/editorial-neuroscience
#14
Raimund Helbok
No abstract text is available yet for this article.
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28234783/is-there-still-a-role-for-hypothermia-in-neurocritical-care
#15
Florian Frank, Gregor Broessner
PURPOSE OF REVIEW: Therapeutic hypothermia (i.e. induced body core temperature ≈ 33-35°C) in neurological patients with cerebrovascular disease and traumatic brain injury is a controversially discussed issue in the literature. In this review, we have included the most recently published research covering the use of therapeutic hypothermia and targeted temperature management in neurologic diseases and translated the results into a clinical decision support for the professional healthcare community...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28207602/spreading-depolarization-monitoring-in-neurocritical-care-of-acute-brain-injury
#16
Jed A Hartings
PURPOSE OF REVIEW: Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential. RECENT FINDINGS: Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28207601/advanced-monitoring-in-traumatic-brain-injury-microdialysis
#17
Keri L H Carpenter, Adam M H Young, Peter J Hutchinson
PURPOSE OF REVIEW: Here, we review the present state-of-the-art of microdialysis for monitoring patients with severe traumatic brain injury, highlighting the newest developments. Microdialysis has evolved in neurocritical care to become an established bedside monitoring modality that can reveal unique information on brain chemistry. RECENT FINDINGS: A major advance is recent consensus guidelines for microdialysis use and interpretation. Other advances include insight obtained from microdialysis into the complex, interlinked traumatic brain injury disorders of electrophysiological changes, white matter injury, inflammation and metabolism...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28207600/advancements-in-the-critical-care-management-of-status-epilepticus
#18
Andrew Bauerschmidt, Andrew Martin, Jan Claassen
PURPOSE OF REVIEW: Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. RECENT FINDINGS: Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28169858/central-nervous-system-infections-in-immunocompromised-patients
#19
Romain Sonneville, Eric Magalhaes, Geert Meyfroidt
PURPOSE OF REVIEW: Although rare, central nervous system (CNS) infections are increasingly being recognized in immunocompromised patients. The goal of the present review is to provide a practical diagnostic approach for the intensivist, and to briefly discuss some of the most prevalent conditions. RECENT FINDINGS: Immunocompromised patients presenting with new neurological symptoms should always be suspected of a CNS infection. These infections carry a poor prognosis, especially if intracranial hypertension, severely altered mental status or seizures are present...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28169857/intersection-of-prognosis-and-palliation-in-neurocritical-care
#20
Michael Rubin, Jordan Bonomo, J Claude Hemphill
PURPOSE OF REVIEW: Difficult discussions regarding end-of-life care are common in neurocritical care. Because of a patient's neurological impairment, decisions regarding continuing or limiting aggressive care must often be made by patients' families in conjunction with medical providers. This review provides perspective on three major aspects of this circumstance: prognostication, family-physician discussions, and determination of death (specifically as it impacts on organ donation). RECENT FINDINGS: Numerous studies have now demonstrated that prediction models developed from populations of brain-injured patients may be misleading when applied to individual patients...
April 2017: Current Opinion in Critical Care
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