Current Opinion in Critical Care最新文献

Which cardiovascular monitoring on veno-arterial extracorporeal membrane oxygenation.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-02 DOI: 10.1097/MCC.0000000000001277

Dieter F Dauwe, Bernd Saugel, Daniel De Backer

{"title":"Which cardiovascular monitoring on veno-arterial extracorporeal membrane oxygenation.","authors":"Dieter F Dauwe, Bernd Saugel, Daniel De Backer","doi":"10.1097/MCC.0000000000001277","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001277","url":null,"abstract":"Purpose review: To discuss the hemodynamic monitoring techniques to quantify cardiac output, to assess the adequacy of perfusion, and to evaluate cardiac as well as pump preload and fluid responsiveness in patients supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Echocardiography is essential in the hemodynamic assessment of VA-ECMO patients. However, intermittent echocardiography should be complemented by continuous, potentially nurse driven, monitoring techniques. We will focus on invasive and noninvasive hemodynamic monitoring methods beyond echocardiography.Recent findings: Despite the importance of comprehensive hemodynamic monitoring in the provision of safe, adequate, and well balanced VA-ECMO support, limited data are currently available in this specific patient population. While some measurements (intravascular pressures, oxygen saturation) remain valid and provide important information on the hemodynamic state, measurements of cardiac output are invalid with many of the hemodynamic monitoring methods. Many of the routinely used monitoring methods must be interpreted with caution during VA-ECMO support.Summary: A thorough understanding of the various hemodynamic monitoring methods and the physiological interactions between VA-ECMO and patients is essential for selecting the optimal hemodynamic monitoring strategy and correctly interpreting the resulting hemodynamic measurements.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751408","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

Timing of neurosurgical interventions for intracranial hypertension: the intensivists' and neurosurgeons' view.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-22 DOI: 10.1097/MCC.0000000000001243

Victor Lin, Peter John Hutchinson, Angelos Kolias, Chiara Robba, Sarah Wahlster

{"title":"Timing of neurosurgical interventions for intracranial hypertension: the intensivists' and neurosurgeons' view.","authors":"Victor Lin, Peter John Hutchinson, Angelos Kolias, Chiara Robba, Sarah Wahlster","doi":"10.1097/MCC.0000000000001243","DOIUrl":"10.1097/MCC.0000000000001243","url":null,"abstract":"Purpose of review: The aim of this study was to highlight clinical considerations regarding medical versus surgical management of elevated intracranial pressure (ICP), describe limitations of medical management, and summarize evidence regarding timing of neurosurgical interventions.Recent findings: The optimal ICP management strategy remains elusive, and substantial practice variations exist. Common risks of medical treatments include hypotension/shock, cardiac arrhythmias and heart failure, acute renal failure, volume overload, hypoxemia, and prolonged mechanical ventilation.In traumatic brain injury (TBI), recent randomized controlled trials (RCT) did not demonstrate outcome benefits for early, prophylactic decompressive craniectomy, but indicate a role for secondary decompressive craniectomy in patients with refractory elevated ICP. A recent meta-analysis suggested that when an extraventricular drain is required, insertion 24 h or less post-TBI may result in better outcomes.In large ischemic middle cerebral artery strokes, pooled analyses of three RCTs showed functional outcome benefits in patients less than 60 years who underwent prophylactic DC within less than 48 h. In intracranial hemorrhage, a recent RCT suggested outcome benefits for minimally invasive hematoma evacuation within less than 24 h.Summary: More data are needed to guide ICP targets, treatment modalities, predictors of herniation, and surgical triggers; clinical decisions should consider individual patient characteristics, and account for risks of medical and surgical treatments.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"137-148"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482468","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 dynamic pathophysiology of post cardiac arrest brain injury: "time is brain".

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-02-27 DOI: 10.1097/MCC.0000000000001246

Chloe P Allen, Jordan D Bird, Mypinder S Sekhon

{"title":"The dynamic pathophysiology of post cardiac arrest brain injury: \"time is brain\".","authors":"Chloe P Allen, Jordan D Bird, Mypinder S Sekhon","doi":"10.1097/MCC.0000000000001246","DOIUrl":"10.1097/MCC.0000000000001246","url":null,"abstract":"Purpose of review: To review the time dependent nature of post-cardiac arrest brain injury (PCABI) while contextualizing clinical trial evidence.Recent findings: PCABI represents a dynamic entity with respect to its pathophysiology. Intuitively, PCABI pathophysiology has been characterized focusing on mechanisms associated with cerebral ischemia. Interventions that augment cerebral oxygen delivery, such as increasing mean arterial pressure, have garnered interest. Regrettably, these trials have not demonstrated improved outcomes. At the core of this conundrum is the time dependent nature of PCABI pathophysiology with trials employing interventions approximately 4-6 h after return of spontaneous circulation (ROSC). This therapeutic window is likely far past the efficacy period of resumption of oxygen delivery to the ischemic brain. Thus, we suggest compartmentalizing PCABI into four phases: circulatory arrest; intra-arrest physiology; immediate reperfusion; and delayed reperfusion. Culprit mechanisms are discussed for each phase with contextualization of recent trial results.Summary: PCABI has dynamic pathophysiology and restoration of cerebral oxygen delivery in a delayed manner from ROSC has diminished efficacy. PCABI pathophysiology must be viewed in a time dependent manner and interventions aimed at restoring cerebral oxygen delivery are likely only to be efficacious if applied immediately after ROSC.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"31 2","pages":"123-130"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566547","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

Assessing gastrointestinal system dysfunction in intensive care.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI: 10.1097/MCC.0000000000001248

Kaspar F Bachmann, Varsha M Asrani, Annika Reintam Blaser

引用次数: 0

Gut microbiota and its impact on critical illness.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-27 DOI: 10.1097/MCC.0000000000001249

Denise Battaglini, Antoni Torres

{"title":"Gut microbiota and its impact on critical illness.","authors":"Denise Battaglini, Antoni Torres","doi":"10.1097/MCC.0000000000001249","DOIUrl":"10.1097/MCC.0000000000001249","url":null,"abstract":"Purpose of review: This narrative review discusses the mechanisms connecting gut dysbiosis to adverse clinical outcomes in critically ill patients and explores potential therapeutic strategies.Recent findings: In recent years, the study of microbiota in ICUs has gained attention because of its potential effects on patient outcomes. Critically ill patients often face severe conditions, which can compromise their immune systems and lead to opportunistic infections from bacteria typically harmless to healthy individuals. The relationship between aggressive medical treatments and microbiota composition remains unclear. Dysbiosis, characterized by reduced microbial diversity and the loss of beneficial bacteria, can lead to prolonged immunosuppression and increased pathogenic risks, contributing to infections and organ failure. Recent advancements in multiomics technologies have enhanced the understanding of host-microbe interactions and their implications in critical care.Summary: The microbiota plays an important role in shaping outcomes for critically ill patients. According to evidence, alterations in the gut and lung microbiota are associated with disease severity, mortality, and overall patient recovery. Evolving research opens possibilities for personalized medicine by tailoring treatments based on individual microbiota profiles, though clinical applications are still developing.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"189-197"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045803","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

Code-ICH: time is brain.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI: 10.1097/MCC.0000000000001244

Aleksandra Yakhkind, Wenzheng Yu, Joshua N Goldstein, Stephan A Mayer

{"title":"Code-ICH: time is brain.","authors":"Aleksandra Yakhkind, Wenzheng Yu, Joshua N Goldstein, Stephan A Mayer","doi":"10.1097/MCC.0000000000001244","DOIUrl":"10.1097/MCC.0000000000001244","url":null,"abstract":"Purpose of review: Intracerebral hemorrhage (ICH) is the most devastating type of stroke resulting in severe disability and mortality. This review summarizes the emerging body of evidence supporting a new paradigm for care of patients called Code-ICH. It highlights the need for the adoption of time-based care bundles based on recent evidence, akin to those used in the management of acute ischemic stroke.Recent findings: Numerous trials aimed at decreasing hematoma expansion through single interventions have historically failed to show significant effects on primary outcomes. Time-sensitive, multifaceted, bundled care approaches have emerged with substantial promise in improving functional outcomes in patients with ICH. These bundles include early aggressive control of blood pressure and reversal of anticoagulation, strict normalization of blood sugar and temperature, early surgical evaluation, and minimizing early withdrawal of care.Summary: The paradigm of Code-ICH empowers acute care providers to continuously measure system performance, reflect on best practices, improve outcomes, and tackle disparities for patients with ICH.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"112-116"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482462","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

Gastrointestinal dysmotility in the ICU.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI: 10.1097/MCC.0000000000001252

Anant Vikram Pachisia, Divya Pal, Deepak Govil

{"title":"Gastrointestinal dysmotility in the ICU.","authors":"Anant Vikram Pachisia, Divya Pal, Deepak Govil","doi":"10.1097/MCC.0000000000001252","DOIUrl":"10.1097/MCC.0000000000001252","url":null,"abstract":"Purpose of review: This review aims to provide a comprehensive overview of gastrointestinal dysmotility, particularly in critically ill patients within the ICU. It highlights the pathophysiology, prevalence, and clinical implications of conditions, such as oesophageal dysmotility, gastroparesis, ileus, and Ogilvie's syndrome. By examining current diagnostic and treatment approaches, the review emphasizes the importance of recognizing and managing gastrointestinal dysmotility to improve patient outcomes.Recent finding: Recent literature indicates that up to 60% of ICU patients experience some form of gastrointestinal dysmotility, with those on mechanical ventilation being particularly at risk. The review identifies key contributors to gastrointestinal dysmotility, including inflammatory states, electrolyte imbalances, and the effects of certain medications. Nonpharmacological strategies, such as early enteral feeding, correcting electrolyte abnormalities, and mobilization are critical. Prokinetic agents have shown promise in alleviating feeding intolerance and improving gastric emptying, though their effects on overall mortality remain inconclusive.Summary: Gastrointestinal dysmotility presents a significant challenge in critically ill patients, leading to various complications that hinder recovery. Understanding the underlying pathophysiology, coupled with effective diagnostic and treatment strategies, is essential for enhancing patient care. This review underscores the need for continued research and clinical focus on gastrointestinal motility disorders in the ICU to improve health outcomes for this vulnerable population.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"179-188"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482464","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

Pharmacological prevention of gastrointestinal bleeding in critically Ill patients.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-27 DOI: 10.1097/MCC.0000000000001251

Adrian Wong, Sandra L Kane-Gill, Jeffrey F Barletta

{"title":"Pharmacological prevention of gastrointestinal bleeding in critically Ill patients.","authors":"Adrian Wong, Sandra L Kane-Gill, Jeffrey F Barletta","doi":"10.1097/MCC.0000000000001251","DOIUrl":"10.1097/MCC.0000000000001251","url":null,"abstract":"Purpose of review: Despite advances in critical care medicine, the incidence of clinically important upper gastrointestinal bleeding (UGIB) remains consistent. One therapy that reduces UGIB is the use of stress ulcer prophylaxis (SUP). In the past year, several key manuscripts have been published regarding SUP, providing updated recommendations for its prescription. In this review, we provide commentary on these recommendations and areas for future research.Recent findings: Risk factors for UGIB include chronic liver disease, coagulopathy, severe neurologic illness or injury, and shock. The prescription of SUP is associated with a decreased occurrence of UGIB but no benefit in mortality. Although both histamine-2 receptor antagonists and proton pump inhibitors (PPIs) are recommended for SUP, it is possible that PPIs may be associated with increased mortality in critically ill patients. The short-term use of SUP is not expected to be associated with most adverse drug events, but inappropriate continuation of SUP increases this risk.Summary: Patient-specific considerations based on recent data help with improving the prescription of SUP, although additional research is necessary. The use of artificial intelligence may be able to predict at risk patients with the potential to influence appropriate prescription of SUP and reduce the occurrence of UGIB.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"204-211"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482466","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

Editorial introductions.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-03-06 DOI: 10.1097/MCC.0000000000001261

引用次数: 0

The critical importance of time in the management of acute neurological injuries.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-03-06 DOI: 10.1097/MCC.0000000000001256

Victoria A McCredie

引用次数: 0