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Current Opinion in Critical Care

Matteo Bassetti, Elda Righi, Antonio Vena, Elena Graziano, Alessandro Russo, Maddalena Peghin
PURPOSE OF REVIEW: Describe the risk factors and discuss the management of multidrug-resistant (MDR) bacteria responsible for pneumonia among critically ill patients, including methicillin-resistant Staphylococcus aureus, extended spectrum beta-lactamase-producing Enterobactericeae, carbapenem-resistant Enterobactericeae, multidrug resistant Pseudomonas aeruginosa, and Acinetobacter baumannii. RECENT FINDINGS: Multiple factors have been associated with infections because of MDR bacteria, including prolonged hospital stay, presence of invasive devices, mechanical ventilation, colonization with resistant pathogens, and use of broad-spectrum antibiotics...
October 2018: Current Opinion in Critical Care
George H Talbot
PURPOSE OF REVIEW: Regulatory guidance for design, conduct and analysis of studies of nosocomial pneumonia, including ventilator-associated pneumonia, has undergone substantial evolution over the past three decades. This review summarizes this evolutionary process and the current status of guidance. RECENT FINDINGS: The US Food and Drug Administration and the European Medicines Agency have taken different approaches to defining endpoints for studies of nosocomial pneumonia, especially with regard to the primary endpoint...
October 2018: Current Opinion in Critical Care
Milagros Dianti, Carlos M Luna
PURPOSE OF REVIEW: Clinical and laboratory parameters are useful tools for the diagnosis, follow-up and evaluation of resolution, and to predict outcomes when measured at different time-points onset and serially during follow-up in patients with hospital-acquired pneumonia and/or ventilator-associated pneumonia (HAP/VAP). RECENT FINDINGS: Both, the 2017 ERS/ESICM/ESCMID/Asociación Latino Americana de Tórax (EEEAG) and the 2016 IDSA/ATS guidelines (IAG) for the management of HAP/VAP recommend using clinical criteria alone, rather than biomarkers for diagnosis...
October 2018: Current Opinion in Critical Care
Antoni Torres
No abstract text is available yet for this article.
October 2018: Current Opinion in Critical Care
Miquel Ferrer, Antoni Torres
PURPOSE OF REVIEW: Review of the epidemiology of ICU-acquired pneumonia, including both ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in nonventilated ICU patients, with critical review of the most recent literature in this setting. RECENT FINDINGS: The incidence of ICU-acquired pneumonia, mainly VAP has decrease significantly in recent years possibly due to the generalized implementation of preventive bundles. However, the exact incidence of VAP is difficult to establish due to the diagnostic limitations and the methods employed to report rates...
October 2018: Current Opinion in Critical Care
Theodore J Iwashyna, Joanne McPeake
PURPOSE OF REVIEW: The turn to evidence-based medicine in critical care has lead to a dramatic increase in the number of randomized clinical trials. Yet many of these trials are not showing differences on an appropriately prespecified primary outcome. In light of this, there have been some heated arguments as to what sorts of clinical trials should be conducted. We synthesize pragmatic recommendations from two governing bases: rigorous statistical practice and a commitment to insuring trials provide information that should help guide patient-centered decision-making...
October 2018: Current Opinion in Critical Care
Victor D Dinglas, Leeza N Faraone, Dale M Needham
PURPOSE OF REVIEW: Patients surviving critical illness frequently experience long-lasting morbidities. Consequently, researchers and clinicians are increasingly focused on evaluating and improving survivors' outcomes after hospital discharge. This review synthesizes recent research aimed at understanding the postdischarge outcomes that patients consider important (i.e., patient-important outcomes) for the purpose of advancing future clinical research in the field. RECENT FINDINGS: Across multiple types of studies, patients, family members, researchers, and clinicians have consistently endorsed physical function, cognition, and mental health as important outcomes to evaluate in future research...
October 2018: Current Opinion in Critical Care
Ignacio Martin-Loeches, Alejandro H Rodriguez, Antoni Torres
PURPOSE OF REVIEW: The International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia were published in 2017 whilst the American guidelines for Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia were launched in 2016 by the Infectious Diseases Society of America/ATS. Both guidelines made updated recommendations based on the most recent evidence sharing not only some parallelisms but also important conceptual differences...
October 2018: Current Opinion in Critical Care
Ken Hillman, Fakhri Athari, Roberto Forero
PURPOSE OF REVIEW: This review aims to discuss situations where patients would prefer to consider dying rather than survive, particularly in the context of choosing whether to be subjected to active medical management aimed at increasing their life span. RECENT FINDINGS: Obviously, there are no randomized trials on evaluating whether patients would choose death rather than life. Moreover, the topic of the review is rarely addressed in a conventional scientific way...
October 2018: Current Opinion in Critical Care
Ognjen Gajic, Sumera R Ahmad, Michael E Wilson, David A Kaufman
PURPOSE OF REVIEW: In this review, we will discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. We shall discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers. RECENT FINDINGS: Different outcome pathways after critical illness impact the patients, families and providers in multiple ways...
October 2018: Current Opinion in Critical Care
Marija Vukoja, Elisabeth D Riviello, Marcus J Schultz
PURPOSE OF REVIEW: The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs. RECENT FINDINGS: Epidemiologic studies show higher in-hospital mortality rates for critically ill patients in LMICs as compared with patients in high-income countries (HICs)...
October 2018: Current Opinion in Critical Care
Charles-Edouard Luyt, Guillaume Hékimian, Despoina Koulenti, Jean Chastre
PURPOSE OF REVIEW: Successful treatment of patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remains a difficult and complex undertaking. Better knowledge of the pathogens involved in that setting may allow reassessment of our current modalities of therapy and definition of better protocols. RECENT FINDINGS: Microorganisms responsible for HAP/VAP differ according to geographic areas, ICU patients' specific characteristics, durations of hospital and ICU stays before onset of the disease, and risk factors for MDR pathogens...
October 2018: Current Opinion in Critical Care
Amra Sakusic, Alejandro A Rabinstein
PURPOSE OF REVIEW: There is an increasing realization in the critical care community that persistent cognitive impairment is a common and disabling complication after ICU care. In this review, we discuss the best available information on the magnitude of the problem, its possible mechanisms, risk factors, management strategies and prognosis. RECENT FINDINGS: Estimates of the incidence of persistent cognitive impairment after critical illness vary widely across studies but the most solid prospective information indicates that it may occur in 20-40% of patients discharged from the ICU...
October 2018: Current Opinion in Critical Care
Otavio T Ranzani, Gennaro De Pascale, Marcelo Park
PURPOSE OF REVIEW: To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP). RECENT FINDINGS: NV-HAP is emerging as a new challenge for clinicians, particularly because VAP incidence has been decreasing. The clinical diagnosis of NV-HAP uses the classical clinical symptoms and signs. However standard evaluation of their accuracy and the evaluation of new criterion (e.g. lung ultrasound) must be conducted particularly in NV-HAP patients...
October 2018: Current Opinion in Critical Care
Michael S Niederman
PURPOSE OF REVIEW: Hospital-acquired pneumonia (HAP) is a form of nosocomial pneumonia, distinct from ventilator-associated pneumonia (VAP). This review compares HAP and VAP, highlighting differences in natural history, risk factors, and bacteriology that necessitate a different approach to the therapy of HAP, compared with VAP. RECENT FINDINGS: HAP can arise out of the ICU, or in the ICU, and can lead to severe illness, including the need for intubation and mechanical ventilation...
October 2018: Current Opinion in Critical Care
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...
October 2018: Current Opinion in Critical Care
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
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
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
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
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