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Critical Care Clinics

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https://www.readbyqxmd.com/read/29149945/caring-for-sepsis-patients-an-update
#1
EDITORIAL
Manu Shankar-Hari, Mervyn Singer
No abstract text is available yet for this article.
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149944/management-of-sepsis-induced-immunosuppression
#2
REVIEW
Fabienne Venet, Thomas Rimmelé, Guillaume Monneret
It is now well established that profound immunosuppression develops within a few days after sepsis onset in patients. This should be considered additional organ failure because it is associated with increased rate of nosocomial infections, mortality, and long-term complications, thus constituting the rationale for immunomodulation in patients. Nevertheless, the demonstration of the efficacy of such therapeutic strategy in improving deleterious outcomes in sepsis remains to be made. Results from clinical trials based on interleukin 7 and granulocyte macrophage colony-stimulating factor immunoadjuvant therapies in septic shock patients are expected for 2018...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149943/endocrine-and-metabolic-alterations-in-sepsis-and-implications-for-treatment
#3
REVIEW
Catherine Ingels, Jan Gunst, Greet Van den Berghe
Sepsis induces profound neuroendocrine and metabolic alterations. During the acute phase, the neuroendocrine changes are directed toward restoration of homeostasis, and also limit unnecessary energy consumption in the setting of restricted nutrient availability. Such changes are probably adaptive. In patients not recovering quickly, a prolonged critically ill phase may ensue, with different neuroendocrine changes, which may represent a maladaptive response. Whether stress hyperglycemia should be aggressively treated or tolerated remains a matter of debate...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149942/mechanisms-of-organ-dysfunction-in-sepsis
#4
REVIEW
Rachel Pool, Hernando Gomez, John A Kellum
Sepsis-associated organ dysfunction involves multiple responses to inflammation, including endothelial and microvascular dysfunction, immune and autonomic dysregulation, and cellular metabolic reprogramming. The effect of targeting these mechanistic pathways on short- and long-term outcomes depends highly on the timing of therapeutic intervention. Furthermore, there is a need to understand the adaptive or maladaptive character of these mechanisms, to discover phase-specific biomarkers to guide therapy, and to conceptualize these mechanisms in terms of resistance and tolerance...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149941/pathophysiology-of-septic-shock
#5
REVIEW
James A Russell, Barret Rush, John Boyd
Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Hypovolemia is common and crystalloid is recommended for fluid resuscitation...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149940/immune-activation-in-sepsis
#6
REVIEW
Andrew Conway-Morris, Julie Wilson, Manu Shankar-Hari
Sepsis is caused by a dysregulated host response to infection. Immune responses determine the characteristics of sepsis. The body's protection against infection involves danger signal surveillance and recognition from nonself, effector functions in response to sensing danger signals, homeostatic regulation, and generation of immunologic memory. During sepsis, the immune system is activated by pathogen-associated and host-derived molecular patterns. Detecting these molecular patterns generates multisystem responses...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149939/improving-long-term-outcomes-after-sepsis
#7
REVIEW
Hallie C Prescott, Deena Kelly Costa
Although acute survival from sepsis has improved in recent years, a large fraction of sepsis survivors experience poor long-term outcomes. In particular, sepsis survivors have high rates of weakness, cognitive impairment, hospital readmission, and late death. To improve long-term outcomes, in-hospital care should focus on early, effective treatment of sepsis; minimization of delirium, distress, and immobility; and preparing patients for hospital discharge. In the posthospital setting, medical care should focus on addressing new disability and preventing medical deterioration, providing a sustained period out of the hospital to allow for recovery...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149938/novel-interventions-what-s-new-and-the-future
#8
REVIEW
Jean-Louis Vincent, David Grimaldi
Despite decades of sepsis research, no specific therapies for sepsis have emerged and current management still relies on source control, antibiotics, and organ support. With improved understanding of sepsis pathophysiology and the development of new techniques to enable better characterization of patients with sepsis, clinical trials are beginning to better target new interventions at those patients most likely to respond. This article discusses advances in sepsis therapeutics designed to improve endothelial cell function, purify the blood to help restore immune homeostasis, and provide immunostimulation for patients with immune exhaustion...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149937/personalizing-sepsis-care
#9
REVIEW
Mervyn Singer
Sepsis describes a broad-based syndrome covering many infectious agents, affecting various sites in patients of differing age, gender, and comorbidity and resulting in varying degrees and combinations of organ dysfunction. Protocolized care with rigid goals may suit populations, assuming the evidence-lite recommendations are beneficial, but not necessarily individual patients. A personalized approach to management is rational and preferable. Other than clinical heterogeneity, a range of biological signatures exist in sepsis, and these fluctuate over the disease course...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149936/epidemiology-and-outcomes
#10
REVIEW
Bourke Tillmann, Hannah Wunsch
Sepsis is a global public health concern. Internationally it contributes to more than 5 million deaths annually. Although rates are variable between countries, over the past 40 years reported incidence has continued to increase. Aside from potential differences in patient populations, the variation in reported rates also reflects differences in identification strategies, access to health care, and awareness of the diagnosis. Factors such as age, sex, socioeconomic status, comorbid disease, and type and site of infection impact the development of and outcomes from sepsis...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149935/biomarkers-in-sepsis
#11
REVIEW
Tjitske S R van Engelen, Willem Joost Wiersinga, Brendon P Scicluna, Tom van der Poll
A biomarker is a characteristic by which a (patho)physiologic process can be identified. Biomarkers can be of diagnostic value (to discriminate infection from noninfectious conditions or to determine the causative pathogen), of prognostic value (assigning risk profiles and predict outcome), and in the future may be of theranostic value (aid in selection and monitoring of therapy). Systems biology provides a promising tool for the discovery of novel biomarkers. Biomarkers can be the key to personalized targeted treatment in the future clinical management of sepsis...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149934/common-sense-approach-to-managing-sepsis
#12
REVIEW
Anders Perner, Lars B Holst, Nicolai Haase, Peter B Hjortrup, Morten H Møller
Sepsis results in many deaths, prolonged suffering among survivors and relatives, and high use of resources both in developed and developing countries. The updated Surviving Sepsis Campaign guidelines should aid clinicians in improving the identification and management of these patients, but many uncertainties remain because most of the guidance is based on low-quality evidence. This article discusses how to use some of the specific items of the guidelines together with a common-sense approach to aid clinical management of patients with sepsis while trying to balance the potential benefit and harm of the items...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149933/nutrition-therapy-in-sepsis
#13
REVIEW
Paul E Wischmeyer
Sepsis is characterized by early massive catabolism, lean body mass (LBM) loss, and escalating hypermetabolism persisting for months to years. Early enteral nutrition should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein and moderated nonprotein calories, as well-nourished patients can generate reasonable endogenous energy. After resuscitation, increasing protein/calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential, and parenteral nutrition can be safely added when enteral nutrition is failing based on preillness malnutrition...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149932/sepsis-definitions-a-work-in-progress
#14
REVIEW
John C Marshall
The word, sepsis, dates back more than 2 millennia but has, over the past 2 centuries, come to be applied first to the clinical state evoked by invasive infection and, more recently, to describe the syndrome resulting from the host response to infection. Further refinements embodied in the recently published Sepsis-3 definition underline the concept of a dysregulated immune response resulting in potentially modifiable life-threatening organ dysfunction. This review summarizes the evolution and limitations of efforts to characterize a common and complex disorder...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/28887936/extracorporeal-membrane-oxygenation
#15
EDITORIAL
Nitin Puri, Michael Baram, Nicholas C Cavarocchi
No abstract text is available yet for this article.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887935/medication-complications-in-extracorporeal-membrane-oxygenation
#16
REVIEW
Ami G Shah, Michelle Peahota, Brandi N Thoma, Walter K Kraft
The need for extracorporeal membrane oxygenation (ECMO) therapy is a marker of disease severity for which multiple medications are required. The therapy causes physiologic changes that impact drug pharmacokinetics. These changes can lead to exposure-driven decreases in efficacy or increased incidence of side effects. The pharmacokinetic changes are drug specific and largely undefined for most drugs. We review available drug dosing data and provide guidance for use in the ECMO patient population.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887934/transport-while-on-extracorporeal-membrane-oxygenation-support
#17
REVIEW
Kyle C Niziolek, Thomas J Preston, Erik C Osborn
Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887933/staffing-equipment-monitoring-considerations-for-extracorporeal-membrane-oxygenation
#18
REVIEW
David C Fitzgerald, Edward M Darling, Monika F Cardona
Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887932/issues-in-the-intensive-care-unit-for-patients-with-extracorporeal-membrane-oxygenation
#19
REVIEW
Hitoshi Hirose, Harrison T Pitcher, Michael Baram, Nicholas C Cavarocchi
The care of patients on extracorporeal corporeal oxygenation support takes a coordinated effort among the team of nurses, midlevel providers, perfusionists, respiratory therapists, pharmacists, and physicians. Attention on the details of the circuitry and its interactions with the patient, the resolution of the disease process and the ongoing plan of care, and unique issues in the intensive care unit are crucial for success.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887931/extracorporeal-membrane-oxygenation-management-techniques-to-liberate-from-extracorporeal-membrane-oxygenation-and-manage-post-intensive-care-unit-issues
#20
REVIEW
Joseph B Zwischenberger, Harrison T Pitcher
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique when patients require pulmonary and/or cardiac support for days to weeks for recovery, bridge to decision, or transplantation. Due to complications associated with ECMO, it is best to stay on ECMO as little time as necessary. Foremost is weaning from ECMO, but the post-ECMO period recapitulates the entire field of critical care. Identified issues include (1) potential for systemic inflammatory response syndrome post-decannulation; (2) post-ECMO complications, such as deep vein thrombosis, wounds, renal failure, and stroke; (3) delirium; (4) posttraumatic stress disorder; (5) rehabilitation; and (6) end of life...
October 2017: Critical Care Clinics
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