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Current Opinion in Critical Care

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https://www.readbyqxmd.com/read/27906709/looking-closer-at-acute-respiratory-distress-syndrome-the-role-of-advanced-imaging-techniques
#1
Giacomo Bellani, Jean-Jaques Rouby, Jean-Michel Constantin, Antonio Pesenti
PURPOSE OF REVIEW: Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging. RECENT FINDINGS: Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes...
November 30, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27906708/acute-respiratory-distress-syndrome-mimics-the-role-of-lung-biopsy
#2
Mylène Aublanc, Sophie Perinel, Claude Guérin
PURPOSE OF REVIEW: Acute respiratory distress syndrome (ARDS) mimics is a condition looking like ARDS but that does not fulfill every criterion according to the recent Berlin definition. The purpose of this review is to better delineate ARDS mimics, to discuss why the complete diagnosis of ARDS is important, and to make a brief overview on the role of open lung biopsy in this setting. RECENT FINDINGS: Recent autopsy and lung biopsy data from ARDS patients compared lung histologic findings with the new Berlin definition of ARDS...
November 30, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#3
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27898438/rescue-therapies-for-acute-respiratory-distress-syndrome-what-to-try-first
#4
Onnen Moerer, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure adequate oxygenation and survival. This review provides a summary and assessment of treatment options that can be beneficial when the standard approach fails. RECENT FINDINGS: 'Life-threatening' conditions or refractory hypoxemia during mechanical ventilation are more a matter of personal rating than an objective diagnosis based on defined and/or unanimously agreed thresholds that would mandate the use of rescue therapies...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27898437/how-best-to-set-the-ventilator-on-extracorporeal-membrane-lung-oxygenation
#5
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Extracorporeal respiratory support in patients with acute respiratory distress syndrome is applied either as rescue maneuver for life-threatening hypoxemia or as a tool to reduce the harm of mechanical ventilation. Depending on the blood and gas flow, extracorporeal support may completely substitute the natural lung as a gas exchanger (high-flow venovenous bypass) or reduce the need for mechanical ventilation, enabling the removal of a fraction of the metabolically produced CO2...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27898436/golden-anniversary-of-the-acute-respiratory-distress-syndrome-still-much-work-to-do
#6
Jesús Villar, Arthur S Slutsky
PURPOSE OF REVIEW: Over the past 50 years, we have developed a conceptual model of the acute respiratory distress syndrome (ARDS), and have witnessed significant advances in the care of patients with ARDS. In this commentary, we will discuss recent published articles reporting or suggesting new conceptual models for diagnosis, classification, stratification, prevention, ventilatory management, pharmacologic treatment, and outcome prediction of ARDS. RECENT FINDINGS: This review is a tribute to all clinicians and investigators that have contributed to a better understanding of ARDS...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27875410/should-we-use-driving-pressure-to-set-tidal-volume
#7
Domenico L Grieco, Lu Chen, Martin Dres, Laurent Brochard
PURPOSE OF REVIEW: Ventilator-induced lung injury (VILI) can occur despite use of tidal volume (VT) limited to 6 ml/kg of predicted body weight, especially in patients with a smaller aerated compartment (i.e. the baby lung) in which, indeed, tidal ventilation takes place. Because respiratory system static compliance (CRS) is mostly affected by the volume of the baby lung, the ratio VT/CRS (i.e. the driving pressure, ΔP) may potentially help tailoring interventions on VT setting. RECENT FINDINGS: Driving pressure is the ventilatory variable most strongly associated with changes in survival and has been shown to be the key mediator of the effects of mechanical ventilation on outcome in the acute respiratory distress syndrome...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27875409/extracorporeal-membrane-oxygenation-beyond-rescue-therapy-for-acute-respiratory-distress-syndrome
#8
Alain Combes, Nicolas Bréchot, Charles-Edouard Luyt, Matthieu Schmidt
PURPOSE OF REVIEW: This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. RECENT FINDINGS: Successful VV-ECMO treatment in patients with extremely severe influenza A(H1N1)-associated acute respiratory distress syndrome (ARDS) and positive results of the CESAR trial have led to an exponential use of the technology in recent years...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27875408/diagnosing-acute-respiratory-distress-syndrome-in-resource-limited-settings-the-kigali-modification-of-the-berlin-definition
#9
Elisabeth D Riviello, Egide Buregeya, Theogene Twagirumugabe
PURPOSE OF REVIEW: The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27820707/resuscitative-endovascular-balloon-occlusion-of-the-aorta-promise-practice-and-progress
#10
Zane B Perkins, Robbie A Lendrum, Karim Brohi
PURPOSE OF REVIEW: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and highlight priority areas for further research. RECENT FINDINGS: REBOA is a feasible method of achieving temporary aortic occlusion and can be performed rapidly, with a high degree of success, in the emergency setting (including at the scene of injury) by appropriately trained clinicians...
November 4, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27811561/haemostatic-resuscitation-in-trauma-the-next-generation
#11
Jakob Stensballe, Sisse R Ostrowski, Pär I Johansson
PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27811560/advanced-extracorporeal-therapy-in-trauma
#12
David Zonies, Matthias Merkel
PURPOSE OF REVIEW: The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described. RECENT FINDINGS: ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65-79%. Despite the high bleeding risk, extracorporeal membrane oxygenation (ECMO) may be safely implemented in trauma patients based on a strict protocol-driven policy...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27811559/rib-fractures-in-trauma-patients-does-operative-fixation-improve-outcome
#13
Peter Majak, Pål A Næss
PURPOSE OF REVIEW: Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. RECENT FINDINGS: Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27811558/renal-protection-in-the-21st-century
#14
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: Among critically ill patients, acute kidney injury (AKI) is still a common and serious complication with a tremendous impact on short-term and long-term outcomes. The objective of this review is to discuss strategies for renal protection and prevention of AKI in ICU patients. RECENT FINDINGS: It is fundamental to identify patients at risk for AKI as soon as possible and as accurately as possible. In order to achieve these goals, translational approaches implementing new biomarkers have shown promising results...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27805960/resuscitative-endovascular-balloon-occlusion-of-the-aorta-promise-practice-and-progress
#15
Zane B Perkins, Robbie A Lendrum, Karim Brohi
PURPOSE OF REVIEW: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and highlight priority areas for further research. RECENT FINDINGS: REBOA is a feasible method of achieving temporary aortic occlusion and can be performed rapidly, with a high degree of success, in the emergency setting (including at the scene of injury) by appropriately trained clinicians...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27805959/editorial-introductions
#16
(no author information available yet)
No abstract text is available yet for this article.
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27763923/the-multidisciplinary-nature-of-trauma-care-also-in-the-intensive-care-unit
#17
Christina Gaarder, Kjetil Sunde
No abstract text is available yet for this article.
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27763922/why-are-patients-still-getting-and-dying-from-acute-kidney-injury
#18
John A Kellum
PURPOSE OF REVIEW: Acute kidney injury is common and is associated with increased morbidity and mortality. Rates of acute kidney injury in most settings remain high and in some settings are increasing. Moreover, outcomes associated with acute kidney injury remain relatively poor. This review focuses on recent advances in understanding of acute kidney injury and discusses possible interventions based on these advances. RECENT FINDINGS: Acute kidney injury is not a disease with a single etiology and clinical course but rather a loose collection of syndromes whose unifying phenotype is an acute loss of glomerular filtration...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27755116/blood-products-and-procoagulants-in-traumatic-bleeding-use-and-evidence
#19
Henna Wong, Nicola Curry, Simon J Stanworth
PURPOSE OF REVIEW: Death from uncontrolled haemorrhage is one of the leading causes of trauma-related mortality and is potentially preventable. Advances in understanding the mechanisms of trauma-induced coagulopathy (TIC) have focused attention on the role of blood products and procoagulants in mitigating the sequelae of TIC and how these therapies can be improved. RECENT FINDINGS: A host of preclinical and clinical studies have evaluated blood product availability and efficacy in trauma...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27749357/contemporary-thromboprophylaxis-of-trauma-patients
#20
Philbert Y Van, Martin A Schreiber
PURPOSE OF REVIEW: The traumatically injured patient is at high risk for developing venous thromboembolism. Clinical practice guidelines developed by the American College of Chest Physicians and the Eastern Association for the Surgery of Trauma recognize the importance of initiating thromboprophylaxis, but the guidelines lack specific recommendations regarding the timing and dose of pharmacologic thromboprophylaxis. We review the literature regarding initiation of thromboprophylaxis in different injuries, the use of inferior vena cava filters, laboratory monitoring, dosing regimens, and the use of antiplatelet therapy...
December 2016: Current Opinion in Critical Care
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