Current Opinion in Critical Care最新文献_第3页

Critical illness-based chronic disease: a new framework for intensive metabolic support.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-25 DOI: 10.1097/MCC.0000000000001270

Jeffrey I Mechanick

{"title":"Critical illness-based chronic disease: a new framework for intensive metabolic support.","authors":"Jeffrey I Mechanick","doi":"10.1097/MCC.0000000000001270","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001270","url":null,"abstract":"Purpose of review: This review addresses the novel concept of critical illness as a potential chronic disease. The high clinical and economic burdens of chronic critical illness and post-ICU syndromes are mainly due to refractoriness to therapy and consequently lead to significant complications. Interventions need to be preventive in nature and therefore a robust disease model is warranted.Recent findings: There are three paradigms that are leveraged to create a new critical illness-based chronic disease (CIBCD) model: metabolic model of critical illness, intensive metabolic support (IMS; insulinization and nutrition support), and driver-based chronic disease modeling. The CIBCD model consists of four stages: risk, predisease, (chronic) disease, and complications. The principal goal of the CIBCD model is to expose early opportunities to prevent disease progression, particularly further morbidity, complications, and mortality. IMS is used to target seminal pathophysiological events such as immune-neuroendocrine axis (INA) activation and failure to downregulate INA activation because of preexisting chronic diseases and recurrent pathological insults.Summary: The CIBCD model complements our understanding of critical illness and provides needed structure to preventive actions that can improve clinical outcomes. Many research, knowledge, and practice gaps exist, which will need to be addressed to optimize and validate this model.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742369","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 future of artificial intelligence in cardiovascular monitoring.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-25 DOI: 10.1097/MCC.0000000000001272

Massimiliano Greco, Marta Lubian, Maurizio Cecconi

{"title":"The future of artificial intelligence in cardiovascular monitoring.","authors":"Massimiliano Greco, Marta Lubian, Maurizio Cecconi","doi":"10.1097/MCC.0000000000001272","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001272","url":null,"abstract":"Purpose of review: Cardiovascular monitoring is essential for managing hemodynamic instability and preventing complications in critically ill patients. Conventional monitoring approaches are limited by predefined thresholds, dependence on clinician expertise, and a lack of adaptability to individual patients. The aim of this review is to explore recent findings about the use of artificial intelligence (AI) in cardiovascular monitoring.Recent findings: AI has the potential to transform monitoring in critical care through the automated real-time analysis of extensive, high-resolution datasets, and can facilitate early detection of patient deterioration, minimize false alarms, and support patient clustering for tailored therapeutic strategies. These innovations facilitate a shift toward precision medicine, tailoring treatments based on physiological and temporal data patterns. Moreover, wearable devices can further enhance real-time patient surveillance and risk stratification, extending intensivist monitoring beyond the ICU. Despite advantages, challenges persist, including algorithm generalizability, issues with patient consent and data privacy, and the current lack of external validation. Overcoming these barriers is essential for realizing the full potential of AI in critical care and hemodynamic monitoring.Summary: The integration of continuous high-resolution monitoring with AI real-time applications has the potential to transform hemodynamic assessment, enhance clinical decision-making, and improve safety and clinical outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742375","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

Perioperative risk assessment for emergency general surgery in those with multimorbidity or frailty.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-19 DOI: 10.1097/MCC.0000000000001269

Yasmin Arda, Haytham M A Kaafarani

{"title":"Perioperative risk assessment for emergency general surgery in those with multimorbidity or frailty.","authors":"Yasmin Arda, Haytham M A Kaafarani","doi":"10.1097/MCC.0000000000001269","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001269","url":null,"abstract":"Purpose of review: This review explores advances in risk stratification tools and their applicability in identifying and managing high-risk emergency general surgery (EGS) patients.Recent findings: Traditional risk assessment tools have several limitations when applied to complex EGS patients as comorbidities are generally treated in a binary, linear and sequential fashion. Additionally, some tools are only usable in the postoperative period, and some require multidisciplinary involvement and are not suitable in an emergency setting. Frailty in particular - for which there are multiple calculators-maladaptively influences outcomes. Artificial intelligence tools, such as the machine-learning-based POTTER calculator, demonstrate superior performance by addressing nonlinear interactions among patient factors, offering a dynamic and more accurate approach to risk prediction.Summary: Integrating advanced, data-driven risk assessment tools into clinical practice can help identify and manage high-risk patients as well as forecast outcomes for EGS patients. Such tools are intended to trigger preoperative interventions as well as discussions that ensure goal-concordant care, align expectations with anticipated outcomes and support both facility and patient-relevant outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742370","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

Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-07 DOI: 10.1097/MCC.0000000000001265

Olivia Walker, Giuliano Testa, Anji E Wall

{"title":"Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death.","authors":"Olivia Walker, Giuliano Testa, Anji E Wall","doi":"10.1097/MCC.0000000000001265","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001265","url":null,"abstract":"Purpose of review: This study aims to examine the ethical and legal discourse surrounding normothermic regional perfusion (NRP) for donation after circulatory death (DCD).Recent findings: NRP is well established within Europe but faces challenges in the US and is not utilized in a variety of other countries. NRP compliance with the dead donor rule (DDR) and Uniform Declaration of Death Act (UDDA) is the most significant recently addressed US ethical and legal issue. Additionally, NRP procedures raise concerns regarding public education, informed consent, public engagement, and trust. Inconsistent NRP regulation - such as in the US- is a cause for concern with the anticipated increase in NRP frequency in support of organ recovery and transplantation. There is no single repository for NRP technical and outcome data to support practice refinement - a key aspect given practice variation between centers and countries.Summary: NRP-based organ recovery presents ethical and legal challenges to be addressed by organ donation and transplantation clinicians and organizations in conjunction with public representatives. Additional inquiry into the determination of donor circulatory death, family information needs for authorization, and coordinated regulation of NRP practice is needed to ensure that ethical and legal concerns are appropriately addressed. Public engagement is essential to bolster and preserve trust.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623774","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

When to pursue acute rib fracture fixation.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-07 DOI: 10.1097/MCC.0000000000001266

Alexandra C Ferre, Adrian Coleoglou Centeno, Daniel G Vanderploeg, Frederic M Pieracci

{"title":"When to pursue acute rib fracture fixation.","authors":"Alexandra C Ferre, Adrian Coleoglou Centeno, Daniel G Vanderploeg, Frederic M Pieracci","doi":"10.1097/MCC.0000000000001266","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001266","url":null,"abstract":"Purpose of review: This review will explore acute rib fracture management focusing on indications and timing for acute surgical stabilization of rib fractures (SSRF).Recent findings: SSRF is a well tolerated and effective approach for a variety of rib fracture patterns and is most commonly used to correct either clinical flail chest or multiple displaced fractures. Objective tools that assess for deranged pulmonary dynamics may identify patients with other fracture patterns who will also benefit from SSRF. Multimodal analgesia approaches are essential regardless of whether SSRF is pursued; intractable pain may also prompt SSRF. Hemodynamic instability precludes acute SSRF. Otherwise, SSRF should occur within 72 h of injury. Preoperative planning includes thoracic computed tomography scanning, and a preanesthetic evaluation, especially in the geriatric patient based on the presence of comorbidities. Preoperative coordination with other services that also need to address acute injuries helps condense anesthesia exposures. Acute SSRF reduces pain and in particular pulmonary complications in those with acute rib fractures.Summary: SSRF is a well tolerated and effectively acutely deployed operative technique to address specific rib fracture injury patterns. It is ideally embraced as a structured program to facilitate collaboration, coordination, and program performance evaluation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623829","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 resuscitation and deresuscitation. 复苏和人工呼吸的进展。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-07 DOI: 10.1097/MCC.0000000000001267

Olivier Pantet, François-Xavier Ageron, Tobias Zingg

{"title":"Advances in resuscitation and deresuscitation.","authors":"Olivier Pantet, François-Xavier Ageron, Tobias Zingg","doi":"10.1097/MCC.0000000000001267","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001267","url":null,"abstract":"Purpose of review: This review aims to provide a perspective on fluid resuscitation strategies and emerging trends in deresuscitation, with a particular emphasis on fluid stewardship, monitoring, and personalized fluid management.Recent findings: Recent studies underscore a paradigm shift in resuscitation strategies. Notably, aggressive plasma volume expansion has been linked to higher morbidity and mortality, favoring conservative fluid resuscitation. Dynamic parameters, such as pulse pressure variation (PPV) and stroke volume variation (SVV) outperform static markers like central venous pressure (CVP) in predicting preload responsiveness. Advances in hemodynamic monitoring and automated closed-loop fluid administration demonstrate efficacy in optimizing resuscitation. Fluid stewardship, supported by machine learning, is reshaping deresuscitation practices, and promoting negative fluid balance to reduce complications. Moreover, next-generation closed-loop systems and fluid management personalization as part of precision medicine are emerging as future directions.Summary: Advances in fluid resuscitation challenge traditional practices, with evidence favoring personalized and goal-directed strategies. Technological innovations in hemodynamic monitoring, automated fluid control, and machine learning are driving precision fluid management. Fluid stewardship and deresuscitation aim to mitigate fluid accumulation syndrome and improve patient outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623754","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

Echography monitoring in patients with temporary mechanical circulatory support.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-07 DOI: 10.1097/MCC.0000000000001263

Ouriel Saura, Guillaume Hekimian, Matthieu Schmidt

{"title":"Echography monitoring in patients with temporary mechanical circulatory support.","authors":"Ouriel Saura, Guillaume Hekimian, Matthieu Schmidt","doi":"10.1097/MCC.0000000000001263","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001263","url":null,"abstract":"Purpose of review: To examine the role of echocardiography in managing patients with refractory cardiogenic shock supported by temporary mechanical circulatory support (t-MCS) and provide practical recommendations to improve clinical practice.Recent findings: t-MCS devices are increasingly used to stabilize patients with refractory cardiogenic shock. Echocardiography, due to its accessibility and ability to assess both structural and functional aspects of heart failure, is ideally suited for daily bedside evaluation of cardiac function and t-MCS-myocardial interactions.Summary: From t-MCS initiation to liberation, echocardiography is essential to guide clinical decision-making. It aids in selecting the most appropriate t-MCS device, ensuring optimal positioning, and fine-tuning flow parameters in real-time based on native cardiac function and patient needs. Additionally, echocardiography is critical for identifying intracardiac complications and directing unloading strategies in venoarterial extracorporeal membrane oxygenation, particularly with very low residual ejection or aortic valve closure. Finally, the weaning process should be informed by comprehensive echocardiographic evaluations, aligned with international guidelines. These steps are outlined in this review, accompanied by clear and practical recommendations to enhance clinical practice.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623758","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

ICU imperatives in open abdomen management after trauma or emergency surgery.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-03-07 DOI: 10.1097/MCC.0000000000001264

Jennifer Marie Leonard, Maurizio Cecconi, Lewis J Kaplan

{"title":"ICU imperatives in open abdomen management after trauma or emergency surgery.","authors":"Jennifer Marie Leonard, Maurizio Cecconi, Lewis J Kaplan","doi":"10.1097/MCC.0000000000001264","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001264","url":null,"abstract":"Purpose of review: This review is both timely and relevant as the open abdomen approach to manage injury, emergency general surgery (EGS) conditions, as well as secondary intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) remain prevalent throughout ICUs.Recent findings: IAH is not limited to those with injury or EGS conditions, as it is increasingly recognized following cardiac surgery as well as cardiac transplantation. IAH monitoring techniques benefit from technological advances including noninvasive devices. Time to primary fascial closure (PFC) is a key determinant of patient-centered outcomes, with worse outcomes in those with delayed or failed closure attempts. Visceral edema avoidance or mitigation techniques remain controversial. Nutrition support and its impact on the gastrointestinal microbiome appear to influence infection risk and anastomotic integrity. Team-based approaches to successful as well as failed open abdomen management help optimize outcomes.Summary: These findings bear broad implications for intensive care medicine clinicians who care for open abdomen patients, as they address resuscitation, intra-abdominal pressure monitoring, and nutrition support all of which influence the likelihood of achieving PFC - a key goal regardless of whether the abdomen was initially left open after injury, EGS, or intestinal ischemia management.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623827","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 innervated gut and critical illness.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-28 DOI: 10.1097/MCC.0000000000001260

Jacob W Larsson, Peder S Olofsson, Eva Sundman

{"title":"The innervated gut and critical illness.","authors":"Jacob W Larsson, Peder S Olofsson, Eva Sundman","doi":"10.1097/MCC.0000000000001260","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001260","url":null,"abstract":"Purpose of review: This review highlights brain-gut neuroimmune interactions in the context of critical illness. Neural regulation of inflammation, gut innervation, and the brain-gut axis in critical illness are discussed.Recent findings: Recent studies indicate that the brain-gut axis and the enteric nervous system are integral to the regulation of local and systemic inflammation. Experimental evidence suggests that neural reflexes control immune responses, and specific neural signals promote gastrointestinal homeostasis. The understanding of these interactions in the clinical context remains limited, necessitating further investigation. Notably, therapeutic interventions targeting neuro-immune pathways have shown promise in preclinical models, suggesting that a better understanding of the neuro-immune crosstalk in the critically ill may potentially identify novel therapeutic targets.Summary: Critical illness involves complex organ dysfunction, not least in the gastrointestinal system. A multitude of neuroimmune interactions between the intestinal wall, immune cells, peripheral nerves and the central nervous system regulate inflammation. While experimental evidence supports the role of neural reflexes in controlling immune responses, clinical validation is lacking in the context of critical care. Future research needs to explore whether specific neural signals or mechanisms of neuro-immune crosstalk can be harnessed to restore and support gastrointestinal homeostasis in the critically ill.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566528","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 : 2025-02-28 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":"https://doi.org/10.1097/MCC.0000000000001246","url":null,"abstract":"Purpose of review: To review the time dependent nature of postcardiac 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":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566523","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