Current Opinion in Critical Care最新文献

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-04 DOI: 10.1097/MCC.0000000000001237

Karen J Bosma

{"title":"Proportional modes to hasten weaning.","authors":"Karen J Bosma","doi":"10.1097/MCC.0000000000001237","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001237","url":null,"abstract":"Purpose of review: The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation.Recent findings: Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are two commercially available proportional modes that have been studied in randomized controlled trials (RCTs). Although several feasibility studies were not powered to detect differences in clinical outcomes, emerging evidence suggests that both PAV and NAVA may reduce duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital mortality compared to PSV, as shown in some small, primarily single-centre studies. Recent meta-analyses suggest that PAV shortens duration of mechanical ventilation and improves weaning success rate, and NAVA may reduce ICU and hospital mortality.Summary: The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The uncertainty principle: a novel approach to optimizing trials in critical care. 不确定性原则：优化重症监护试验的新方法。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI: 10.1097/MCC.0000000000001220

Jacob Vine, Ari Moskowitz, Michael W Donnino

引用次数: 0

Acute kidney injury subphenotyping and personalized medicine. 急性肾损伤亚表型和个性化医疗。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-13 DOI: 10.1097/MCC.0000000000001212

Melanie Meersch, Timo Mayerhöfer, Michael Joannidis

{"title":"Acute kidney injury subphenotyping and personalized medicine.","authors":"Melanie Meersch, Timo Mayerhöfer, Michael Joannidis","doi":"10.1097/MCC.0000000000001212","DOIUrl":"10.1097/MCC.0000000000001212","url":null,"abstract":"Purpose of review: This review discusses novel concepts of acute kidney injury (AKI), including subphenotyping, which may facilitate the development of target treatment strategies for specific subgroups of patients to achieve precision medicine.Recent findings: AKI is a multifaceted syndrome with a major impact on morbidity and mortality. As efforts to identify treatment strategies have largely failed, it is becoming increasingly apparent that there are different subphenotypes that require different treatment strategies. Various ways of subphenotyping AKI have been investigated, including the use of novel renal biomarkers, machine learning and artificial intelligence, some of which have already been implemented in the clinical setting. Thus, novel renal biomarkers have been recommended for inclusion in new definition criteria for AKI and for the use of biomarker bundled strategies for the prevention of AKI. Computational models have been explored and require future research.Summary: Subphenotyping of AKI may provide a new understanding of this syndrome and guide targeted treatment strategies in order to improve patient outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"555-562"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying the high-risk surgical patient. 识别高风险手术病人。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI: 10.1097/MCC.0000000000001209

Javier Ripollés-Melchor, César Aldecoa

引用次数: 0

Fluid management of acute kidney injury. 急性肾损伤的输液治疗。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1097/MCC.0000000000001211

Alison Fahey, Patrick J Neligan, Bairbre McNicholas

{"title":"Fluid management of acute kidney injury.","authors":"Alison Fahey, Patrick J Neligan, Bairbre McNicholas","doi":"10.1097/MCC.0000000000001211","DOIUrl":"10.1097/MCC.0000000000001211","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) is commonly encountered in critical care medicine as is intravenous fluid therapy. It is accepted that there is interplay between fluid use and AKI, both potentially positive and negative. An understanding of the physiological rationale for fluid is important to help clinicians when considering fluid therapy in patients with, or at risk for AKI; this includes understanding choice of fluid, method of monitoring, administration and clinical sequelae.Recent findings: There is increasing interest in combining both static and dynamic measures to assess fluid balance, fluid responsiveness effects of fluid therapy, which are areas requiring ongoing study to translate this theory into clinically useful practice at the bedside. Whilst the debate of choice of crystalloid in ICU practice continues, further evidence for benefits for balanced solutions emerges in the form of international guidelines and patient data meta-analysis of previously performed trials.Summary: This review assesses the physiological rationale for fluid use in ICU cohorts with AKI of various types, as well as a systematic approach for choice of fluid therapy using a number of different variables, which aims to help guide clinicians in managing fluid use and fluid balance in critically ill patients with AKI.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"548-554"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Developments in the epidemiology of calcium channel blocker poisoning and implications for management. 钙通道阻滞剂中毒流行病学的发展及其对管理的影响。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI: 10.1097/MCC.0000000000001218

Michael D Simpson, Jon B Cole

{"title":"Developments in the epidemiology of calcium channel blocker poisoning and implications for management.","authors":"Michael D Simpson, Jon B Cole","doi":"10.1097/MCC.0000000000001218","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001218","url":null,"abstract":"Purpose of review: The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.Recent findings: Amlodipine is now the most common CCB involved in poisoning. High-dose insulin is a potent inotrope and vasodilator; as such, it should be used cautiously, and typically in conjunction with vasopressors, as it theoretically may worsen vasodilation in amlodipine poisoning. High-dose insulin is best used when some degree of cardiogenic shock is suspected. Venoarterial extracorporeal membrane oxygenation utilization in CCB poisoning appears to be increasing, but high flow rates may be needed to combat amlodipine-induced vasoplegia. Intravenous lipid emulsion cannot be routinely recommended but may have a role in peri-arrest situations. Adjunct treatments such as angiotensin II, methylene blue, and hydroxocobalamin offer theoretical benefit but warrant further study.Summary: Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"603-610"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advances in critical care nephrology through artificial intelligence. 通过人工智能推进重症肾病学的发展。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-08-30 DOI: 10.1097/MCC.0000000000001202

Wisit Cheungpasitporn, Charat Thongprayoon, Kianoush B Kashani

{"title":"Advances in critical care nephrology through artificial intelligence.","authors":"Wisit Cheungpasitporn, Charat Thongprayoon, Kianoush B Kashani","doi":"10.1097/MCC.0000000000001202","DOIUrl":"10.1097/MCC.0000000000001202","url":null,"abstract":"Purpose of review: This review explores the transformative advancement, potential application, and impact of artificial intelligence (AI), particularly machine learning (ML) and large language models (LLMs), on critical care nephrology.Recent findings: AI algorithms have demonstrated the ability to enhance early detection, improve risk prediction, personalize treatment strategies, and support clinical decision-making processes in acute kidney injury (AKI) management. ML models can predict AKI up to 24-48 h before changes in serum creatinine levels, and AI has the potential to identify AKI sub-phenotypes with distinct clinical characteristics and outcomes for targeted interventions. LLMs and generative AI offer opportunities for automated clinical note generation and provide valuable patient education materials, empowering patients to understand their condition and treatment options better. To fully capitalize on its potential in critical care nephrology, it is essential to confront the limitations and challenges of AI implementation, including issues of data quality, ethical considerations, and the necessity for rigorous validation.Summary: The integration of AI in critical care nephrology has the potential to revolutionize the management of AKI and continuous renal replacement therapy. While AI holds immense promise for improving patient outcomes, its successful implementation requires ongoing training, education, and collaboration among nephrologists, intensivists, and AI experts.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"533-541"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiac arrest and microcirculatory dysfunction: a narrative review. 心脏骤停与微循环功能障碍：叙述性综述。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI: 10.1097/MCC.0000000000001219

Max S Kravitz, John H Lee, Nathan I Shapiro

{"title":"Cardiac arrest and microcirculatory dysfunction: a narrative review.","authors":"Max S Kravitz, John H Lee, Nathan I Shapiro","doi":"10.1097/MCC.0000000000001219","DOIUrl":"10.1097/MCC.0000000000001219","url":null,"abstract":"Purpose of review: This review provides an overview of the role of microcirculation in cardiac arrest and postcardiac arrest syndrome through handheld intravital microscopy and biomarkers. It highlights the importance of microcirculatory dysfunction in postcardiac arrest outcomes and explores potential therapeutic targets.Recent findings: Sublingual microcirculation is impaired in the early stage of postarrest and is potentially associated with increased mortality. Recent work suggests that the proportion of perfused small vessels is predictive of mortality. Microcirculatory impairment is consistently found to be independent of macrohemodynamic parameters. Biomarkers of endothelial cell injury and endothelial glycocalyx degradation are elevated in postarrest settings and may predict mortality and clinical outcomes, warranting further studies. Recent studies of exploratory therapies targeting microcirculation have shown some promise in animal models but still require significant research.Summary: Although research continues to suggest the important role that microcirculation may play in postcardiac arrest syndrome and cardiac arrest outcomes, the existing studies are still limited to draw any definitive conclusions. Further research is needed to better understand microcirculatory changes and their significance to improve cardiac arrest care and outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"611-617"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New drugs on the horizon for acute kidney injury. 治疗急性肾损伤的新药即将问世。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-20 DOI: 10.1097/MCC.0000000000001217

Louis Mourisse, Peter Pickkers

{"title":"New drugs on the horizon for acute kidney injury.","authors":"Louis Mourisse, Peter Pickkers","doi":"10.1097/MCC.0000000000001217","DOIUrl":"10.1097/MCC.0000000000001217","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) is a frequent and serious complication in critically ill patients. Currently, no effective therapy to prevent or treat AKI is available. This review highlights recently published developments on pharmacological treatments that aim to prevent AKI or to alleviate the severity of AKI in critical ill patients.Recent findings: Studies on pharmacological interventions aimed to improve hemodynamics, renal perfusion, to mediate inflammation-associated renal damage and to reduce oxidative stress are presented, including several observational studies and randomized trials focused on the potential renal protective effects in relevant patient populations. Different existing and novel compounds are being investigated for the effects on renal endpoints and several show potential to prevent or alleviate the occurrence of AKI. It is now acknowledged that different underlying pathophysiological processes are relevant in the development of AKI. Recognition of these sub-endotypes of AKI and knowledge of the therapeutic target of different compounds is of paramount importance to select the right patient for the right treatment at the right time.Summary: The discovery of reno-protective therapies is hampered by the timely detection and recognition of the overriding mechanism of AKI. Nevertheless, several compounds are under investigation, which hold promise for a future treatment.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"577-582"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cerebral oximetry in high-risk surgical patients: where are we? 高危手术患者的脑氧饱和度：我们进展到哪里了？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-04 DOI: 10.1097/MCC.0000000000001204

Rosalia Navarro-Perez, Nekane Romero-García, Camilla Paolessi, Chiara Robba, Rafael Badenes

{"title":"Cerebral oximetry in high-risk surgical patients: where are we?","authors":"Rosalia Navarro-Perez, Nekane Romero-García, Camilla Paolessi, Chiara Robba, Rafael Badenes","doi":"10.1097/MCC.0000000000001204","DOIUrl":"10.1097/MCC.0000000000001204","url":null,"abstract":"Purpose of review: This review aims to summarize the latest evidence on the role of near-infrared spectroscopy (NIRS) in monitoring cerebral oxygenation in high-risk surgical patients, including both cardiac and noncardiac surgeries, and to present a new algorithm for its application.Recent findings: NIRS effectively measures brain oxygen saturation noninvasively, proving valuable in cardiac surgeries to reduce neurological complications, though its impact on nonneurological outcomes is less clear. In noncardiac surgeries, NIRS can help prevent complications like postoperative cognitive dysfunction, particularly in high-risk and major surgeries. Studies highlight the variability of cerebral oxygenation impacts based on surgical positions, with mixed results in positions like the beach chair and sitting positions. A structured algorithm for managing cerebral desaturation has been proposed to optimize outcomes by addressing multiple factors contributing to blood oxygen content and delivery.Summary: Despite its limitations, including spatial resolution and interindividual variability, NIRS is a useful tool for intraoperative cerebral monitoring. Further studies are needed to confirm its broader applicability in noncardiac surgeries, but current evidence supports its role in reducing postoperative complications especially in cardiac surgeries.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"672-678"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0