Current Opinion in Critical Care最新文献_第10页

Does targeted temperature management at 33 °C improve outcome after cardiac arrest? 33 °C的目标体温管理能否改善心脏骤停后的预后？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-10-21 DOI: 10.1097/MCC.0000000000001214

Markus B Skrifvars, Benjamin S Abella

{"title":"Does targeted temperature management at 33 °C improve outcome after cardiac arrest?","authors":"Markus B Skrifvars, Benjamin S Abella","doi":"10.1097/MCC.0000000000001214","DOIUrl":"10.1097/MCC.0000000000001214","url":null,"abstract":"Purpose of review: Following successful resuscitation from cardiac arrest, a complex set of pathophysiologic processes are acutely triggered, leading to substantial morbidity and mortality. Postarrest management remains a major challenge to critical care providers, with few proven therapeutic strategies to improve outcomes. One therapy that has received substantial focus is the intentional lowering of core body temperature for a discrete period of time following resuscitation. In this review, we will discuss the key trials and other evidence surrounding TTM and present opposing arguments, one 'against' the use of postarrest TTM and another 'for' the use of this therapeutic approach.Recent findings: Targeted temperature management, has been a topic of enormous controversy, as recently a number of clinical trials show conflicting results on the effect of TTM. Fundamental questions, about the dosing of TTM (e.g. use at 33 °C versus higher temperatures), or the use of TTM at all (as opposed to passive fever avoidance), remain active topics of global discussion. Systematic reviews on this topic also show variable results.Summary: There are several arguments for and against the use of TTM targeting 33 °C for alleviating brain injury after cardiac arrest. More studies are on the way that will hopefully provide more robust evidence and hopefully allow for consensus on this important topic.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"618-623"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496657","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 perspectives of drug related kidney diseases and disorders. 与药物有关的肾脏疾病和失调的新视角。

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.0000000000001210

Sandra L Kane-Gill

{"title":"New perspectives of drug related kidney diseases and disorders.","authors":"Sandra L Kane-Gill","doi":"10.1097/MCC.0000000000001210","DOIUrl":"10.1097/MCC.0000000000001210","url":null,"abstract":"Purpose of review: The aim of this review is to provide a discussion of new perspectives for up-to-date definitions, a contemporary classification system, and the potential role of stress and damage biomarkers in the context of drug related kidney diseases and disorders.Recent findings: Acute kidney disease (AKD) is a term recently introduced in the literature describing an abnormality in kidney structure and function that lasts for less than 3 months. Drugs in the context of AKD is described as a new perspective; referred to as drug induced AKD. A framework that includes drugs into the 2X2 classification schema for acute kidney injury (AKI) is provided. Finally, stress and damage biomarkers are examined to assess risk of drug associated AKI (D-AKI), differentiate which drugs cause AKI, differentiate drugs from other etiologies and assess the prognosis of D-AKI.Summary: Consistent definitions should be adopted with consideration to drug related diseases and disorders. Drug management can be guided using novel biomarkers to isolate a possible drug cause in the presence of more than one nephrotoxin or a nondrug cause, assisting with the diagnosis of pseudo-AKI, and deciding the likelihood AKI recovery. Furthermore, stress and damage kidney biomarkers provide the opportunity to detect subclinical AKI for early intervention in patients at high-risk for severe AKI.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"563-570"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582295","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

New ultrasound techniques for acute kidney injury diagnostics. 用于急性肾损伤诊断的超声波新技术。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI: 10.1097/MCC.0000000000001216

Rory McDonald, James Watchorn, Sam Hutchings

{"title":"New ultrasound techniques for acute kidney injury diagnostics.","authors":"Rory McDonald, James Watchorn, Sam Hutchings","doi":"10.1097/MCC.0000000000001216","DOIUrl":"10.1097/MCC.0000000000001216","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) is common in critical illness and associated with adverse outcomes. Imaging, specifically ultrasound, is increasingly finding a role in AKI diagnostics. This includes the assessment of arterial and venous blood flow, tissue perfusion and the condition of the renal parenchyma. This review provides an update on ultrasound techniques and their application to AKI in critical care.Recent findings: Advances have been made in arterial and venous Doppler, contrast enhanced ultrasound (CEUS) and shear wave elastography (SWE). Doppler and CEUS techniques offer benefit in terms of AKI diagnosis and in identifying patients at risk. In addition, through the demonstration of altered flow or impaired perfusion, these techniques provide information on the pathophysiology of AKI, offering potential for targeted intervention. Renal SWE, an emerging technique, assesses tissue stiffness potentially allowing exploration of the role of venous congestion in the pathogenesis of AKI.Summary: Ultrasound continues to demonstrate great promise in the diagnosis and management of AKI, offering a noninvasive means to diagnose perfusion deficits and assess response to treatments. Further research, with standardization of techniques, may allow multifaceted renal ultrasound assessment in the critically ill for more accurate diagnosis and tailored intervention in AKI.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"571-576"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582296","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

Emergency airway management in the post anesthesia care unit. 麻醉后护理病房的紧急气道管理。

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.0000000000001200

Bart Spruijt, Johannes M Huitink

{"title":"Emergency airway management in the post anesthesia care unit.","authors":"Bart Spruijt, Johannes M Huitink","doi":"10.1097/MCC.0000000000001200","DOIUrl":"10.1097/MCC.0000000000001200","url":null,"abstract":"Purpose of review: Airway management is one of the most challenging aspects in the field of anesthesia. This is also the case when an emergency airway situation arises in the postoperative patient. These airway procedures are often classified as advanced with high complexity. This article aims to address emergency airway management in the post anesthesia care unit.Recent findings: The way in which care and supervision are organized in the post anesthesia care unit (PACU) varies between hospitals. Airway management in the PACU has typical challenges related to the team, the location itself, and assembling the necessary equipment for airway rescue. Crew resource management is an important aspect of care in these situations.Summary: This article focuses on emergency airway management in the post anesthesia-care unit. A questionnaire for risk assessment and improvement of quality of care is presented. Different types of emergencies are discussed, i.e., due to medication, medical conditions (e.g., obstructive sleep apnea, pulmonary problems, stridor), procedural related emergencies (e.g., neurosurgery, head and neck surgery) and cardiac arrest. Each specific cause of emergency needs a different approach. A PACU airway rescue flowchart is presented.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"637-644"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153282","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

Protective hemodynamics: a novel strategy to manage blood pressure. 保护性血液动力学：管理血压的新策略。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-07 DOI: 10.1097/MCC.0000000000001205

Filippo D'Amico, Giovanni Landoni

引用次数: 0

Renal dysfunction in surgical patients. 手术病人的肾功能障碍。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-02 DOI: 10.1097/MCC.0000000000001203

Hendrik Booke, Alexander Zarbock, Melanie Meersch

{"title":"Renal dysfunction in surgical patients.","authors":"Hendrik Booke, Alexander Zarbock, Melanie Meersch","doi":"10.1097/MCC.0000000000001203","DOIUrl":"10.1097/MCC.0000000000001203","url":null,"abstract":"Purpose of review: To provide an overview of the current diagnostic criteria for acute kidney injury (AKI) including their limitations and to discuss prevention and treatment approaches in the perioperative setting.Recent findings: AKI is common in the perioperative period and is associated with worse short- and long-term outcomes. Current definitions of AKI have several limitations and lead to delayed recognition of kidney dysfunction which is why novel diagnostic approaches by using renal biomarkers may be helpful. In general, prevention of the development and progression of AKI is vital as a causal treatment for AKI is currently not available. Optimization of kidney perfusion and avoidance of nephrotoxic drugs reduce the occurrence of AKI in surgical patients. Angiotensin II as a new vasopressor, the use of remote ischemic preconditioning, and amino acids may be approaches with a positive effect on the kidneys.Summary: Evidence suggests that the implementation of supportive measures in patients at high risk for AKI might reduce the occurrence of AKI. Novel biomarkers can help allocating resources by detecting patients at high risk for AKI.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"645-654"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153357","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

Re-evaluating intra-cardiac arrest adjunctive medications and routes of drug administration. 重新评估心脏骤停时的辅助用药和给药途径。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-07 DOI: 10.1097/MCC.0000000000001206

Peter C Lind, Mikael F Vallentin, Asger Granfeldt, Lars W Andersen

{"title":"Re-evaluating intra-cardiac arrest adjunctive medications and routes of drug administration.","authors":"Peter C Lind, Mikael F Vallentin, Asger Granfeldt, Lars W Andersen","doi":"10.1097/MCC.0000000000001206","DOIUrl":"10.1097/MCC.0000000000001206","url":null,"abstract":"Purpose of review: This narrative review summarizes the evidence for the most commonly used intra-cardiac arrest adjunctive medications and routes of administration and discusses promising new therapies from preclinical animal models.Recent findings: Large trials on the administration of calcium as well as the combination of vasopressin and glucocorticoids during cardiac arrest have been published. Calcium administration during cardiopulmonary resuscitation does not improve outcomes and might cause harm. Vasopressin and glucocorticoid administration during cardiopulmonary resuscitation improve the chance of return of spontaneous circulation but has uncertain effects on survival. We identified a total of seven ongoing clinical trials investigating the potential role of bicarbonate, of vasopressin and glucocorticoids, and of intravenous versus intraosseous vascular access. Several medications such as levosimendan and inhaled nitric oxide show promise in preclinical studies, and clinical trials are either planned or actively recruiting.Summary: Large trials on intra-cardiac arrest administration of calcium and vasopressin with glucocorticoids have been performed. Several trials are ongoing that will provide valuable insights into the potential benefit of other intra-cardiac arrest medications such as bicarbonate as well as the potential benefit of intravenous or intraosseous vascular access.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"587-596"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153356","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

Acute diarrhea in the hospitalized immunocompromised patient: what is new on diagnostic and treatment? 住院免疫力低下患者的急性腹泻：诊断和治疗的新进展？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-10-01 Epub Date: 2024-07-19 DOI: 10.1097/MCC.0000000000001191

Natalia E Castillo Almeida, Carlos A Gomez

{"title":"Acute diarrhea in the hospitalized immunocompromised patient: what is new on diagnostic and treatment?","authors":"Natalia E Castillo Almeida, Carlos A Gomez","doi":"10.1097/MCC.0000000000001191","DOIUrl":"10.1097/MCC.0000000000001191","url":null,"abstract":"Purpose of review: This article aims to provide an intuitive framework for diagnosing and managing healthcare-associated diarrhea (HCAD) in the immunocompromised (IC) host.Recent findings: Our understanding of diarrhea in hospitalized IC patients has significantly evolved. However, the challenge lies in distinguishing between these patients' numerous causes of diarrhea. The incorporation of gastrointestinal (GI) multiplex polymerase chain reaction (PCR) panels has led to a paradigm shift in our approach to diarrhea. However, using these panels judiciously is of utmost importance, as their misuse can lead to over-testing, overtreatment, and increased hospital costs. We propose a stepwise diagnostic algorithm that ensures diagnostic stewardship, optimal patient care, and resource utilization.Summary: Diarrhea is a common complication in hospitalized IC patients and is associated with significant morbidity and rare mortality. The advent of new diagnostics, such as GI multiplex PCR panels, holds promise in facilitating the detection of recognized pathogens and may allow for improved outcomes using pathogen-targeted therapy.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"456-462"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733743","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

Outcomes after acute kidney injury and critical illness. 急性肾损伤和危重病后的疗效。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-10-01 Epub Date: 2024-06-19 DOI: 10.1097/MCC.0000000000001183

Rachel Jeong, Ryan Haines, Marlies Ostermann

{"title":"Outcomes after acute kidney injury and critical illness.","authors":"Rachel Jeong, Ryan Haines, Marlies Ostermann","doi":"10.1097/MCC.0000000000001183","DOIUrl":"10.1097/MCC.0000000000001183","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) in critical illness is common, and survivors are faced with a host of adverse outcomes. In this article, we review the current landscape of outcomes and care in survivors of AKI and critical illness.Recent findings: Follow-up care of survivors of AKI and critical illness is prudent to monitor for and mitigate the risk of adverse outcomes. Observational data have suggested improvement in outcomes with nephrology-based follow-up care, and recent interventional studies demonstrate similar findings. However, current post-AKI care is suboptimal with various challenges, such as breakdowns in the transition of care during hospital episodes and into the community, barriers for patients in follow-up, and lack of identification of high-risk patients for nephrology-based follow-up. Tools predictive of renal nonrecovery and long-term outcomes may help to identify high-risk patients who may benefit the most from nephrology-based care post-AKI.Summary: Follow-up care of survivors of AKI and critical illness may improve outcomes and there is a need to prioritize transitions of care into the community. Further research is needed to elucidate the best ways to risk-stratify and manage post-AKI survivors to improve outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"502-509"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874432","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

Patients with severe infections: how to improve their clinical management? 重症感染患者：如何改善临床管理？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-10-01 Epub Date: 2024-09-05 DOI: 10.1097/MCC.0000000000001193

Andre C Kalil

引用次数: 0