Current Opinion in Critical Care最新文献_第4页

Cardiac and systemic inflammation in cardiogenic shock. 心源性休克的心脏和全身炎症。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1097/MCC.0000000000001286

Guillaume Théry, Nadia Aissaoui, Olfa Hamzaoui

引用次数: 0

Impaired muscle metabolism in the ICU: interrogating the underlying pathophysiology. ICU肌肉代谢受损：探究其潜在病理生理。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-08-01 Epub Date: 2025-05-16 DOI: 10.1097/MCC.0000000000001285

Lee-Anne S Chapple, Gordon S Lynch, Olav Rooyackers

{"title":"Impaired muscle metabolism in the ICU: interrogating the underlying pathophysiology.","authors":"Lee-Anne S Chapple, Gordon S Lynch, Olav Rooyackers","doi":"10.1097/MCC.0000000000001285","DOIUrl":"10.1097/MCC.0000000000001285","url":null,"abstract":"Purpose of review: Accelerated muscle wasting in critically ill patients contributes to poor recovery outcomes. Critical care guidelines recommend delivering higher protein doses; yet, increasing evidence suggests harm from higher protein doses.Recent findings: Definitive randomised controlled trials in critically ill adults have reported signals of harm from higher protein administration compared to lower protein doses or standard of care, with significant results pertaining to reduced health-related quality of life and worse outcomes in sub-groups of acute kidney injury and higher illness severity. Physiological data demonstrate anabolic resistance to dietary protein and elevated rates of protein degradation. Recent human studies propose novel mechanisms to explain these results, including inflammation, apoptosis, and deranged concentrations of vitamin D and intramuscular zinc. Preclinical models may elucidate mechanisms core to muscle wasting: 'micro muscles' cell culture systems can assess muscle loss in response to nutrient administration; and both rodent and large animal models allow for mechanistic interrogation of muscle metabolism in response to feeding.Summary: Higher protein doses alone are unlikely to attenuate muscle wasting. Understanding mechanisms for anabolic resistance and increased protein degradation, employing preclinical models, will support the development of targeted strategies to prevent muscle loss during critical illness.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"363-369"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309634","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

Biologic rationale and evidence for high-dose hydroxocobalamin in septic shock. 大剂量羟钴胺素治疗感染性休克的生物学原理和证据。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-08-01 Epub Date: 2025-06-04 DOI: 10.1097/MCC.0000000000001289

Jayshil J Patel, Jason Carr, Rodney Willoughby

{"title":"Biologic rationale and evidence for high-dose hydroxocobalamin in septic shock.","authors":"Jayshil J Patel, Jason Carr, Rodney Willoughby","doi":"10.1097/MCC.0000000000001289","DOIUrl":"10.1097/MCC.0000000000001289","url":null,"abstract":"Purposes of review: The inflammatory response in sepsis raises circulatory levels of gaseous transmitters (gasotransmitters) nitric oxide (NO) and hydrogen sulfide (H 2 S), both of which generate and sustain septic shock. Current best practices, including early intravenous fluid, early antibiotics, and vasopressor support, do not target gasotransmitters. A single 5-g dose of intravenous hydroxocobalamin (high-dose HOC) is a safe intervention that targets circulating gasotransmitters. In this review, we provide an overview of the role of gasotransmitters in septic shock, outline the rationale for high-dose HOC in septic shock, and summarize clinical evidence for high-dose HOC in septic shock.Recent findings: NO and H 2 S are elevated early in septic shock, activate inflammatory pathways, and higher levels correlate with greater severity of illness. Preclinical evidence demonstrates high-dose HOC improves outcomes in models of septic shock by scavenging circulating NO and H 2 S. Multiple case series and a Phase IIa trial show that high-dose HOC is a safe intervention that reduces vasopressor dose in adults with septic shock. Without high-level evidence, clinicians across the United States are using high-dose HOC for adults with septic shock.Summary: High-dose HOC is a promising, nontoxic intervention that targets the pathophysiologic pathway of septic shock. Despite compelling observational and Phase IIa trial data, a pivotal phase III trial testing high-dose HOC in adults with septic shock is required before widespread use can be recommended.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"387-392"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301267","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

Microaxial flow-pump support in patients with cardiogenic shock: a review of the literature. 心源性休克患者的微轴流泵支持：文献综述。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1097/MCC.0000000000001279

Tobias T Krause, Nikos Werner, Juergen Leick

引用次数: 0

Mechanical circulatory support after cardiac arrest. 心脏骤停后的机械循环支持。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-07-14 DOI: 10.1097/MCC.0000000000001296

Johannes Grand, Nanna Louise Junker Udesen, John Bro-Jeppesen

{"title":"Mechanical circulatory support after cardiac arrest.","authors":"Johannes Grand, Nanna Louise Junker Udesen, John Bro-Jeppesen","doi":"10.1097/MCC.0000000000001296","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001296","url":null,"abstract":"Purpose of review: Mechanical circulatory support (MCS) is increasingly used in cardiogenic shock, yet evidence for its benefit in postcardiac arrest patients remains limited and controversial. This review discusses recent randomized trials and evolving concepts in hemodynamic phenotyping and patient selection.Recent findings: MCS devices - such as intra-aortic balloon pump (IABP), microaxial flow pump (mAFP), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) - distinct indications, risks, and limitations. Although mAFP demonstrated improved survival in infarct-related cardiogenic shock, no MCS device has showed positive results in cardiac arrest patients. Similarly, early VA-ECMO initiation for refractory cardiac arrest has not shown a survival benefit in unselected patients and is associated with significant complications. Mixed shock states and transient myocardial dysfunction are common after cardiac arrest as well as hypoxic brain injury, complicating decision-making and highlighting the need for individualized approaches.Summary: MCS use after cardiac arrest should not be used routinely. In selected patients with cardiogenic shock based on advanced hemodynamic phenotyping, MCS can be considered balancing the risk of postarrest severe hypoxic brain injury. Future research should focus on improving patient selection, understanding shock phenotypes, and optimizing timing and modality of support to improve outcomes in this critically ill population.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783701","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