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Current Opinion in Critical Care

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https://www.readbyqxmd.com/read/30015635/prevention-of-hospital-acquired-pneumonia
#1
Patrick G Lyons, Marin H Kollef
PURPOSE OF REVIEW: Hospital-acquired pneumonia (HAP) is the leading cause of death from hospital-acquired infection. Little work has been done on strategies for prevention of HAP. This review aims to describe potential HAP prevention strategies and the evidence supporting them. Oral care and aspiration precautions may attenuate some risk for HAP. Oral and digestive decontamination with antibiotics may be effective but could increase risk for resistant organisms. Other preventive measures, including isolation practices, remain theoretical or experimental...
July 14, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29916835/the-modern-cardiovascular-care-unit-the-cardiologist-managing-multiorgan-dysfunction
#2
Thomas Bochaton, Eric Bonnefoy-Cudraz, Nadia Aissaoui
PURPOSE OF REVIEW: Despite many advances in the management of critically ill patients, cardiogenic shock remains a challenge because it is associated with high mortality. Even if there is no universally accepted definition of cardiogenic shock, end-perfusion organ dysfunction is an obligatory and major criterion of its definition.Organ dysfunction is an indicator that cardiogenic shock is already at an advanced stage and is undergoing a rapid self-aggravating evolution. The aim of the review is to highlight the importance to diagnose and to manage the organ dysfunction occurring in the cardiogenic shock patients by providing the best literature published this year...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29901462/changing-paradigms-in-metabolic-support-and-nutrition-therapy-during-critical-illness
#3
Arthur R H van Zanten
PURPOSE OF REVIEW: To summarize the most recent advances in acute metabolic care and critical care nutrition. RECENT FINDINGS: Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29901461/refeeding-syndrome-relevance-for-the-critically-ill-patient
#4
Rianne Boot, Kristine W A C Koekkoek, Arthur R H van Zanten
PURPOSE OF REVIEW: To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice. RECENT FINDINGS: Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29901460/mechanical-circulatory-devices-in-acute-heart-failure
#5
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. RECENT FINDINGS: Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29889132/less-or-more-hemodynamic-monitoring-in-critically-ill-patients
#6
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: Hemodynamic investigations are required in patients with shock to identify the type of shock, to select the most appropriate treatments and to assess the patient's response to the selected therapy. We discuss how to select the most appropriate hemodynamic monitoring techniques in patients with shock as well as the future of hemodynamic monitoring. RECENT FINDINGS: Over the last decades, the hemodynamic monitoring techniques have evolved from intermittent toward continuous and real-time measurements and from invasive toward less-invasive approaches...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29877879/vasodilatory-shock-in-the-icu-and-the-role-of-angiotensin-ii
#7
Brett J Wakefield, Gretchen L Sacha, Ashish K Khanna
PURPOSE OF REVIEW: There are limited vasoactive options to utilize for patients presenting with vasodilatory shock. This review discusses vasoactive agents in vasodilatory, specifically, septic shock and focuses on angiotensin II as a novel, noncatecholamine agent and describes its efficacy, safety, and role in the armamentarium of vasoactive agents utilized in this patient population. RECENT FINDINGS: The Angiotensin II for the Treatment of High-Output Shock 3 study evaluated angiotensin II use in patients with high-output, vasodilatory shock and demonstrated reduced background catecholamine doses and improved ability to achieve blood pressure goals associated with the use of angiotensin II...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29877878/trophic-or-full-nutritional-support
#8
Yaseen M Arabi, Hasan M Al-Dorzi
PURPOSE OF REVIEW: Full nutritional support during the acute phase of critical illness has traditionally been recommended to reduce catabolism and prevent malnutrition. Approaches to achieve full nutrition include early initiation of nutritional support, targeting full nutritional requirement as soon as possible and initiation of supplemental parenteral nutrition when enteral nutrition does not reach the target. RECENT FINDINGS: Existing evidence supports early enteral nutrition over delayed enteral nutrition or early parenteral nutrition...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29877877/continuous-or-intermittent-feeding-pros-and-cons
#9
Danielle E Bear, Nicholas Hart, Zudin Puthucheary
PURPOSE OF REVIEW: There has been a recent shift in the focus of providing nutrition support to critically ill adults towards enhancing recovery and promoting survivorship. With this has come an evaluation of our current approaches to nutrition support, which includes whether continuous feeding is optimal, particularly for reducing muscle wasting, but also for managing blood glucose levels and feeding intolerance and at the organizational level. This review will discuss the pros and cons of using intermittent and continuous feeding relating to several aspects of the management of critically ill adults...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29877876/critical-care-echocardiography-and-outcomes-in-the-critically-ill
#10
Karan Singh, Paul Mayo
PURPOSE OF REVIEW: Critical care echocardiography offers a comprehensive assessment of cardiac anatomy and function performed by the intensivist at point of care. This has resulted in widespread use of critical care echocardiography in ICUs leading to the question if this increased usage has resulted in improved patient outcomes. RECENT FINDINGS: Recent studies have evaluated the role of critical care echocardiography in the ICU with an emphasis on establishing accurate diagnosis and measurement of haemodynamic variables...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29877875/role-of-glucagon-in-protein-catabolism
#11
Steven E Thiessen, Jan Gunst, Greet Van den Berghe
PURPOSE OF REVIEW: Glucagon is known as a key hormone in the control of glucose and amino acid metabolism. Critical illness is hallmarked by a profound alteration in glucose and amino acid metabolism, accompanied by muscle wasting and hypoaminoacidemia. Here we review novel insights in glucagon (patho)physiology and discuss the recently discovered role of glucagon in controlling amino acid metabolism during critical illness. RECENT FINDINGS: The role of glucagon in glucose metabolism is much more complex than originally anticipated, and glucagon has shown to be a key player in amino acid metabolism...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29864039/vitamin-c-should-we-supplement
#12
Angélique M E Spoelstra-de Man, Paul W G Elbers, Heleen M Oudemans-Van Straaten
PURPOSE OF REVIEW: Hypovitaminosis C and vitamin C deficiency are very common in critically ill patients due to increased needs and decreased intake. Because vitamin C has pleiotropic functions, deficiency can aggravate the severity of illness and hamper recovery. RECENT FINDINGS: Vitamin C is a key circulating antioxidant with anti-inflammatory and immune-supporting effects, and a cofactor for important mono and dioxygenase enzymes. An increasing number of preclinical studies in trauma, ischemia/reperfusion, and sepsis models show that vitamin C administered at pharmacological doses attenuates oxidative stress and inflammation, and restores endothelial and organ function...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29847342/measuring-and-monitoring-lean-body-mass-in-critical-illness
#13
Wilhelmus G P M Looijaard, Jeroen Molinger, Peter J M Weijs
PURPOSE OF REVIEW: To help guide metabolic support in critical care, an understanding of patients' nutritional status and risk is important. Several methods to monitor lean body mass are increasingly used in the ICU and knowledge about their advantages and limitations is essential. RECENT FINDINGS: Computed tomography scan analysis, musculoskeletal ultrasound, and bioelectrical impedance analysis are emerging as powerful clinical tools to monitor lean body mass during ICU stay...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29847341/nutritional-support-in-patients-with-extracorporeal-life-support-and-ventricular-assist-devices
#14
Christian Stoppe, Ekaterina Nesterova, Gunnar Elke
PURPOSE OF REVIEW: Extracorporeal life support (ECLS) including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) provide mechanical pulmonary and circulatory support, respectively, in patients with acute pulmonary or cardiovascular failure. This review discusses recently published data regarding specific topics of nutritional support in patients with ECLS and VAD. RECENT FINDINGS: ECLS may aggravate loss of endogenous and exogenous micronutrients and macronutrients...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29846206/sepsis-induced-myocardial-dysfunction
#15
Keith R Walley
PURPOSE OF REVIEW: Sepsis leads to a complex intramyocardial inflammatory response that results in sepsis-induced myocardial dysfunction. Here, recent findings are reviewed in a physiologic context. RECENT FINDINGS: Decreased systolic contractility during sepsis limits ventricular ejection and stroke volume. Initially, this effect is compensated for by increased diastolic filling during volume resuscitation. Reduced afterload due to arterial vasodilation also compensates so that cardiac output can be maintained or increased...
August 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29688939/in-hospital-cardiac-arrest-are-we-overlooking-a-key-distinction
#16
Ari Moskowitz, Mathias J Holmberg, Michael W Donnino, Katherine M Berg
PURPOSE OF REVIEW: To review the epidemiology, peri-arrest management, and research priorities related to in-hospital cardiac arrest (IHCA) and explore key distinctions between IHCA and out-of-hospital cardiac arrest (OHCA) as they pertain to the clinician and resuscitation scientist. RECENT FINDINGS: IHCA is a common and highly morbid event amongst hospitalized patients in the United States. As compared with patients who experience an OHCA, patients who experience an IHCA tend to have more medical comorbidities, have a witnessed arrest, and be attended to by professional first responders...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29634494/assessment-of-fluid-responsiveness-recent-advances
#17
Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: In the field of prediction of fluid responsiveness, the most recent studies have focused on validating new tests, on clarifying the limitations of older ones, and better defining their modalities. RECENT FINDINGS: The limitations of pulse pressure/stroke volume variations are numerous, but recent efforts have been made to overcome these limitations, like in case of low tidal volume ventilation. Following pulse pressure/stroke volume variations, new tests have emerged which assess preload responsiveness by challenging cardiac preload through heart-lung interactions, like during recruitment manoeuvres and end-expiratory/inspiratory occlusions...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29629927/physiology-directed-cardiopulmonary-resuscitation-advances-in-precision-monitoring-during-cardiac-arrest
#18
Alexandra M Marquez, Ryan W Morgan, Catherine E Ross, Robert A Berg, Robert M Sutton
PURPOSE OF REVIEW: We review the recent advances in physiologic monitoring during cardiac arrest and offer an evidence-based framework for prioritizing physiologic targets during cardiopulmonary resuscitation (CPR). RECENT FINDINGS: Current CPR guidelines recommend a uniform approach for all patients in cardiac arrest, but newer data support a precision strategy that uses the individual patient's physiology to guide resuscitation. Coronary perfusion pressure and arterial DBP are associated with survival outcomes in recent animal and human studies...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29629926/neuroprognostication-postcardiac-arrest-translating-probabilities-to-individuals
#19
Clifton W Callaway
PURPOSE OF REVIEW: Predicting neurological recovery in patients who are comatose after cardiac arrest is an important activity during postarrest care, and this prediction can affect survival. As no early test or clinical finding perfectly predicts potential for recovery, guidelines recommend using data from multiple examinations or tests to estimate patient prognosis. RECENT FINDINGS: Studies reported accuracy of initial clinical examination, progression of clinical examination, early (<24 h) brain imaging, electroencephalography (EEG), evoked potentials, later (>24 h) brain imaging, blood markers of brain injury, and cerebral oximetry for predicting good or poor outcome...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29621027/cardiac-output-monitoring-how-to-choose-the-optimal-method-for-the-individual-patient
#20
Bernd Saugel, Jean-Louis Vincent
PURPOSE OF REVIEW: To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine. RECENT FINDINGS: In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated...
June 2018: Current Opinion in Critical Care
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