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Current Opinion in Critical Care

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https://www.readbyqxmd.com/read/29601320/esophageal-pressure-monitoring-why-when-and-how
#1
Takeshi Yoshida, Laurent Brochard
PURPOSE OF REVIEW: Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to describe technical tips to adequately measure esophageal pressure at the bedside, and then update the most important clinical applications of esophageal manometry in ICU...
March 29, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29561289/antiarrhythmic-drug-therapy-during-cardiopulmonary-resuscitation-should-we-use-it
#2
Jasmeet Soar
PURPOSE OF REVIEW: The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article reviews the evidence for and against these drugs, alternatives treatments for refractory VF/pVT and aims to define the role of antiarrhythmic drugs during cardiopulmonary resuscitation (CPR). RECENT FINDINGS: A large randomized controlled trial that compared amiodarone, lidocaine and saline 0...
March 20, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29561287/understanding-the-carbon-dioxide-gaps
#3
Thomas W L Scheeren, Jannis N Wicke, Jean-Louis Teboul
PURPOSE OF REVIEW: The current review attempts to demonstrate the value of several forms of carbon dioxide (CO2) gaps in resuscitation of the critically ill patient as monitor for the adequacy of the circulation, as target for fluid resuscitation and also as predictor for outcome. RECENT FINDINGS: Fluid resuscitation is one of the key treatments in many intensive care patients. It remains a challenge in daily practice as both a shortage and an overload in intravascular volume are potentially harmful...
March 20, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29688939/in-hospital-cardiac-arrest-are-we-overlooking-a-key-distinction
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/29608456/the-pulmonary-artery-catheter-is-it-still-alive
#9
Daniel De Backer, Jean-Louis Vincent
PURPOSE OF REVIEW: The present review discusses the current role of the pulmonary artery catheter (PAC) in the hemodynamic monitoring of critically ill patients. RECENT FINDINGS: The PAC has an important role in the characterization and management of hemodynamic alterations in critically ill patients. Use of the PAC has decreased in the last 30 years because of recent advances in less invasive hemodynamic monitoring techniques, in particular transpulmonary thermodilution and echocardiography, combined with the publication of the results of several randomized trials that failed to show improvements in outcome with the use of the PAC in various settings...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29608455/extravascular-lung-water-measurements-in-acute-respiratory-distress-syndrome-why-how-and-when
#10
Takashi Tagami, Marcus Eng Hock Ong
PURPOSE OF REVIEW: Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed. RECENT FINDINGS: Although the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29601321/predicting-adverse-hemodynamic-events-in-critically-ill-patients
#11
Joo H Yoon, Michael R Pinsky
PURPOSE OF REVIEW: The art of predicting future hemodynamic instability in the critically ill has rapidly become a science with the advent of advanced analytical processed based on computer-driven machine learning techniques. How these methods have progressed beyond severity scoring systems to interface with decision-support is summarized. RECENT FINDINGS: Data mining of large multidimensional clinical time-series databases using a variety of machine learning tools has led to our ability to identify alert artifact and filter it from bedside alarms, display real-time risk stratification at the bedside to aid in clinical decision-making and predict the subsequent development of cardiorespiratory insufficiency hours before these events occur...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29561288/to-intubate-or-not-to-intubate
#12
Christopher J R Gough, Jerry P Nolan
PURPOSE OF REVIEW: Cardiac arrest mortality remains high, and the impact on outcome of most advanced life support interventions is unclear. The optimal method for managing the airway during cardiac arrest remains unknown. This review will summarize and critique recently published evidence comparing basic airway management with the use of more advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation]. RECENT FINDINGS: Systematic reviews generally document an association between advanced airway management and worse neurological outcome but they are subject to considerable bias...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29553951/monitoring-peripheral-perfusion-and-microcirculation
#13
Arnaldo Dubin, Elizabeth Henriquez, Glenn Hernández
PURPOSE OF REVIEW: Microcirculatory alterations play a major role in the pathogenesis of shock. Monitoring tissue perfusion might be a relevant goal for shock resuscitation. The goal of this review was to revise the evidence supporting the monitoring of peripheral perfusion and microcirculation as goals of resuscitation. For this purpose, we mainly focused on skin perfusion and sublingual microcirculation. RECENT FINDINGS: Although there are controversies about the reproducibility of capillary refill time in monitoring peripheral perfusion, it is a sound physiological variable and suitable for the ICU settings...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29517981/pain-management-in-neurocritical-care-an-update
#14
Athir Morad, Salia Farrokh, Alexander Papangelou
PURPOSE OF REVIEW: Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29461261/from-dysmotility-to-virulent-pathogens-implications-of-opioid-use-in-the-icu
#15
Lee-Anne Chapple, Adam Deane
PURPOSE OF REVIEW: Gastrointestinal dysmotility occurs frequently in the critically ill. Although the causes underlying dysmotility are multifactorial, both pain and its treatment with exogenous opioids are likely causative factors. The purpose of this review is to describe the effects of pain and opioids on gastrointestinal motility; outline the rationale for and evidence supporting the administration of opioid antagonists to improve dysmotility; and describe the potential influence opioids drugs have on the intestinal microbiome and infectious complications...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29432297/should-fecal-microbial-transplantation-be-used-in-the-icu
#16
Stephen A McClave, Jayshil Patel, Neal Bhutiani
PURPOSE OF REVIEW: Maintaining gut barrier defenses, modulating immune responses, and supporting the role of commensal microbiota are major factors influencing outcome in critical illness. Of these, maintaining a commensal 'lifestyle' and preventing the emergence of a virulent pathobiome may be most important in reducing risk of infection and multiple organ failure. RECENT FINDINGS: The polymeric formulas utilized for enteral nutrition in the ICU are absorbed high in the gastrointestinal tract and may not reach the microbial burden in the cecum where their effect is most needed...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29406325/neuroscience
#17
Marek A Mirski
No abstract text is available yet for this article.
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29401175/is-hemoglobin-good-for-cerebral-oxygenation-and-clinical-outcome-in-acute-brain-injury
#18
Shane W English, Lauralyn McIntyre
PURPOSE OF REVIEW: The purpose of this review is to highlight the role of hemoglobin in cerebral physiology and pathophysiology. We review the existing as well as recent evidence detailing the effects of red blood cell transfusion on cerebral oxygenation and clinical outcome. RECENT FINDINGS: Hemoglobin is a key component in oxygen delivery, and thus cerebral oxygenation. Higher hemoglobin levels and red blood cell transfusion are associated with higher cerebral oxygen delivery and decreased cerebral ischemic burden...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29401174/autophagy-should-it-play-a-role-in-icu-management
#19
Martin D Rosenthal, Phil Carrott, Frederick A Moore
PURPOSE OF REVIEW: This review is to discuss the role of autophagy in the critically ill patient population. As the understanding of autophagy continues to expand and evolve, there are certain controversies surrounding whether intensivist should allow the benefit of autophagy to supersede gold standard of insulin therapy or early nutritional support. RECENT FINDINGS: The review is relevant as the current literature seems to support under-feeding patients, and perhaps the reason these studies were positive could be prescribed to the mechanisms of autophagy...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29401173/clinical-presentation-of-autoimmune-and-viral-encephalitides
#20
Divyanshu Dubey, Michel Toledano, Andrew McKeon
PURPOSE OF REVIEW: We describe clinical and diagnostic features of various autoimmune and viral encephalitis subtypes. RECENT FINDINGS: Population-based studies have demonstrated both autoimmune and viral causes have similar prevalence and incident rates. Repertoire of autoimmune biomarkers has considerably increased with discovery of many novel neural antibodies including glial fibrillary acidic proteinα-immunoglobulin G. Similarly, with use of next generation sequencing and DNA libraries, many viral causes are being detected which would have been categorized as encephalitis of unknown cause a decade ago...
April 2018: Current Opinion in Critical Care
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