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

Factors affecting critical care outcomes in the emergency department. 影响急诊科重症监护结果的因素

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-07-03 DOI: 10.1097/MCC.0000000000001300

Taylor M Fontenot, Ioana Antonescu, Heatherlee Bailey

{"title":"Factors affecting critical care outcomes in the emergency department.","authors":"Taylor M Fontenot, Ioana Antonescu, Heatherlee Bailey","doi":"10.1097/MCC.0000000000001300","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001300","url":null,"abstract":"Purpose of review: Emergency department (ED) outcomes of the critically ill and injured patient are intricately linked with timeliness of care, advances in resuscitation skills and technology, and the cohesive function of a dedicated team of multiprofessionals. This review highlights the most recent developments in ED resuscitation and their impact on outcomes for critically ill and injured patients, emphasizing the crucial interplay between technological advancements, organizational strategies, and team dynamics in optimizing emergency care.Recent findings: The literature reveals notable enhancements in resuscitation techniques and protocols, integrating technologic advances, such as artificial intelligence and machine learning, which have shown promising improvement in efficiency, diagnostics, and timeliness to therapeutics. Optimization of the physical ED environment to expedite delivery of care, with an emphasis on effective communication, standardized protocols and guidelines, and teamwork are crucial elements in improving overall patient outcomes. Significant challenges persist, despite these advancements, particularly in ED overcrowding, clinician burnout, and delays in definitive treatment.Summary: The findings highlight the importance of a collaborative multidisciplinary approach to resuscitation in the ED. Implementing a multifaceted approach involving technology, diagnostic accuracy, therapeutic interventions, and education offers an opportunity to improve outcomes in the ED. Future research should continue to focus strategies to address the systematic issues that impact overall patient care in the emergency setting.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625553","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

Corticosteroids in septic shock: a double-edged sword. 皮质类固醇治疗感染性休克：一把双刃剑。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-27 DOI: 10.1097/MCC.0000000000001297

Jane Y Wang, Marin H Kollef

{"title":"Corticosteroids in septic shock: a double-edged sword.","authors":"Jane Y Wang, Marin H Kollef","doi":"10.1097/MCC.0000000000001297","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001297","url":null,"abstract":"Purpose of review: Corticosteroid therapy remains controversial in the management of septic shock. The putative benefits of glucocorticoids on immunomodulation and rescue of hypothalamic-pituitary-adrenal (HPA) axis dysregulation has made it an attractive target for clinical research. However, conflicting trial results have introduced uncertainty into clinical guidance, while risk of harm continues to be a concern. This review summarizes and interprets the current body of evidence for the role of corticosteroid therapy in septic shock and suggests future directions for continued investigation.Recent findings: Updated guidelines continue to recommend corticosteroids in septic shock, but more robust data for corticosteroids have emerged in community acquired pneumonia (CAP) and acute respiratory distress syndrome (ARDS), which may account for some of the benefit seen in trials on septic shock. Systematic reviews have suggested potential benefits of combination therapy with fludrocortisone, but further research is needed. Significant variation exists in corticosteroid prescribing practices across providers and ICU settings.Summary: Many uncertainties remain regarding utility of corticosteroids in septic shock. However, they remain a tool for refractory shock in appropriate patients where benefits outweigh harm. Future research should focus on individualized approaches to corticosteroid therapy.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526764","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

Prediction of functional outcome after traumatic brain injury: a narrative review. 外伤性脑损伤后功能预后的预测：叙述性回顾。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-13 DOI: 10.1097/MCC.0000000000001290

Carolina Iaquaniello, Emanuela Scordo, Chiara Robba

{"title":"Prediction of functional outcome after traumatic brain injury: a narrative review.","authors":"Carolina Iaquaniello, Emanuela Scordo, Chiara Robba","doi":"10.1097/MCC.0000000000001290","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001290","url":null,"abstract":"Purpose of review: To synthesize current evidence on prognostic factors, tools, and strategies influencing functional outcomes in patients with traumatic brain injury (TBI), with a focus on the acute and postacute phases of care.Recent findings: Key early predictors such as Glasgow Coma Scale (GCS) scores, pupillary reactivity, and computed tomography (CT) imaging findings remain fundamental in guiding clinical decision-making. Prognostic models like IMPACT and CRASH enhance early risk stratification, while outcome measures such as the Glasgow Outcome Scale-Extended (GOS-E) provide structured long-term assessments. Despite their utility, heterogeneity in assessment approaches and treatment protocols continues to limit consistency in outcome predictions. Recent advancements highlight the value of fluid biomarkers like neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP), which offer promising avenues for improved accuracy. Additionally, artificial intelligence models are emerging as powerful tools to integrate complex datasets and refine individualized outcome forecasting.Summary: Neurological prognostication after TBI is evolving through the integration of clinical, radiological, molecular, and computational data. Although standardized models and scales remain foundational, emerging technologies and therapies - such as biomarkers, machine learning, and neurostimulants - represent a shift toward more personalized and actionable strategies to optimize recovery and long-term function.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309684","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

Monitoring response to prone positioning. 监测对俯卧定位的反应。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-01-03 DOI: 10.1097/MCC.0000000000001238

Claude Guérin, Giacomo Grasselli

{"title":"Monitoring response to prone positioning.","authors":"Claude Guérin, Giacomo Grasselli","doi":"10.1097/MCC.0000000000001238","DOIUrl":"10.1097/MCC.0000000000001238","url":null,"abstract":"Purpose of review: The increasing use of prone position, in intubated patients with acute respiratory distress syndrome as well as in patients with acute hypoxemic respiratory failure receiving noninvasive respiratory support, mandates a better definition and monitoring of the response to the manoeuvre. This review will first discuss the definition of the response to prone positioning, which is still largely based on its effect on oxygenation. We will then address monitoring respiratory and hemodynamic responses to prone positioning in intubated patients. Finally, we will also discuss monitoring inspiratory effort in nonintubated patients with acute hypoxemic respiratory failure who breathe spontaneously and receive noninvasive respiratory support.Recent findings: The response to prone positioning should be enriched by data pertaining to lung protection beyond oxygenation. These include trans-pulmonary pressure, driving pressure, mechanical power, distribution of aeration and ventilation and assessment of potential for lung recruitment before the pronation.Summary: The implications of present findings are to: better select those patients who will benefit from proning in physiological terms, better indicate the timing of onset and end of the sessions, and strengthen the relationship between physiological response and patient outcome.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"312-318"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977958","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

Firearm injury: pushing forward. 火器伤：向前推进。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-02-13 DOI: 10.1097/MCC.0000000000001262

Joseph A Kern, Elinore J Kaufman

{"title":"Firearm injury: pushing forward.","authors":"Joseph A Kern, Elinore J Kaufman","doi":"10.1097/MCC.0000000000001262","DOIUrl":"10.1097/MCC.0000000000001262","url":null,"abstract":"Purpose of review: Recognition of firearm injury as a public health challenge increasingly garners mainstream acceptance, accompanied by increased federal funding for firearm research and federal coordination for firearm injury prevention and response. This review summarizes recent developments relevant to firearm injury epidemiology, prevention, and outcomes.Recent findings: Interpersonal firearm violence reached a 30-year peak during the COVID-19 pandemic, but the last 2 years have indicated some improvement. Here, we offer updates regarding firearm injury epidemiology, including disparities according to race, ethnicity, age, sex, and geography. This review summarizes recent literature on risk and protective factors for firearm injury, including aspects related to existing or emerging public policy. New data on the long-term costs and outcomes of firearm injury show pervasive effects, while studies on violence intervention programming, mental health interventions, and coordinated care for survivors of injury offer the potential to improve patient recovery. Lastly, enhanced firearm data infrastructure may yield higher quality research and enable more effective prevention and recovery interventions.Summary: Recent findings underscore the multifactorial contributors to the far-reaching public health challenge of firearm injury. Clinicians, researchers, and policy makers must appreciate both the acute and long-term broad consequences of this epidemic to develop, deploy, and evaluate effective interventions to reduce firearm injury harm.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"244-251"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566515","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. 多病或体弱者急诊普外科围手术期风险评估

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub 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":"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":"252-261"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","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

Cardiopulmonary monitoring in critical care: navigating without instruments is not an option. 危重监护中的心肺监护：没有仪器导航是不可行的。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-05-01 DOI: 10.1097/MCC.0000000000001273

Matthieu Schmidt

引用次数: 0

Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death. 循环性死亡后常温区域灌注捐献的伦理和法律考虑。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-03-06 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":"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":"285-290"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","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. 何时进行急性肋骨骨折固定。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-03-06 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":"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":"270-276"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","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

Which cardiovascular monitoring on veno-arterial extracorporeal membrane oxygenation. 其中心血管监测对静脉-动脉体外膜氧合。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-04-01 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":"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":"345-353"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","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