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

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

Oxygen delivery and carbon dioxide removal on venovenous extracorporeal membrane oxygenation. 静脉-静脉体外膜氧合的氧气输送和二氧化碳去除。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-01-29 DOI: 10.1097/MCC.0000000000001259

David Furfaro, Alexander Supady, Darryl Abrams

{"title":"Oxygen delivery and carbon dioxide removal on venovenous extracorporeal membrane oxygenation.","authors":"David Furfaro, Alexander Supady, Darryl Abrams","doi":"10.1097/MCC.0000000000001259","DOIUrl":"10.1097/MCC.0000000000001259","url":null,"abstract":"Purpose of review: Venovenous extracorporeal membrane oxygenation (VV-ECMO) provides gas exchange for patients with advanced respiratory failure who cannot maintain adequate oxygenation or carbon dioxide (CO 2 ) clearance through conventional mechanical ventilation. This review examines clinical applications of VV-ECMO with a focus on optimizing oxygen delivery and CO 2 removal.Recent findings: Over the past two decades, VV-ECMO utilization has expanded, now serving as a bridge to recovery in cases of severe hypoxemic and hypercapnic respiratory failure, as procedural support, and as a bridge to lung transplantation. Recent data have corroborated the role of VV-ECMO in managing acute respiratory distress syndrome (ARDS), and guidelines from the American Thoracic Society (ATS) and the European Society of Intensive Care Medicine (ESICM) now recommend it be considered for severe ARDS.Summary: This review aims to provide insights into the evolving role of VV-ECMO in the management of critical respiratory failure. Key determinants of oxygenation are discussed, particularly optimizing the ratio of VV-ECMO blood flow to cardiac output (CO). We analyze factors influencing CO 2 clearance and review available VV-ECMO configurations and their effects on gas exchange. We discuss practical targets for oxygenation and CO 2 removal in VV-ECMO, along with adjunctive techniques for refractory hypoxemia and hypercapnia.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"328-336"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566519","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 : 2025-06-01 Epub Date: 2025-04-21 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":"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":"277-284"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052052/pdf/","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":"OA","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. 临时机械循环支持患者的超声监测。

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.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":"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":"337-344"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","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

Monitoring and preserving diaphragmatic function in mechanical ventilation. 机械通气中监测和保持膈肌功能。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-04-07 DOI: 10.1097/MCC.0000000000001276

Margot Combet, Briar Coman, Irene Telias

{"title":"Monitoring and preserving diaphragmatic function in mechanical ventilation.","authors":"Margot Combet, Briar Coman, Irene Telias","doi":"10.1097/MCC.0000000000001276","DOIUrl":"10.1097/MCC.0000000000001276","url":null,"abstract":"Purpose of review: This review summarizes the evidence on clinical outcomes related to diaphragm dysfunction, providing an overview on available monitoring tools and strategies for its prevention and treatment.Recent findings: Long-term adverse functional outcomes in intensive care survivors are well documented, especially in patients with prolonged mechanical ventilation. Because diaphragm weakness is highly prevalent and strongly associated with weaning failure, a link between diaphragm weakness and adverse functional outcomes is probable. Mechanisms of critical illness-associated diaphragm weakness are complex and include ventilator-related myotrauma through various pathways (i.e. over-assistance, under-assistance, eccentric, expiratory). Given this potential clinical impact, research on preventive and therapeutic strategies is growing, including the development of ventilation strategies aiming at protecting both the lung and the diaphragm. Phrenic nerve stimulation and specific rehabilitation strategies also appear promising.Summary: Diaphragm dysfunction is associated with adverse clinical outcomes in ventilated patients; therefore, their inspiratory effort and function should be monitored. Whenever possible, and without compromising lung protection, moderate inspiratory effort should be targeted. Phrenic nerve stimulation and specific rehabilitation strategies are promising to prevent and treat diaphragm dysfunction, but further evidence is needed before widespread implementation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"293-301"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986581","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 evolving landscape of emergency care. 不断变化的急诊护理状况。

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.0000000000001268

Lewis J Kaplan

引用次数: 0

Injury induced endotheliopathy: overview, diagnosis, and management. 损伤性内皮病变：概述，诊断和管理。

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.0000000000001239

Chavi Rehani, Sarah Abdullah, Rosemary Ann Kozar

{"title":"Injury induced endotheliopathy: overview, diagnosis, and management.","authors":"Chavi Rehani, Sarah Abdullah, Rosemary Ann Kozar","doi":"10.1097/MCC.0000000000001239","DOIUrl":"10.1097/MCC.0000000000001239","url":null,"abstract":"Purpose of review: This review aims to examine recent advances in the understanding of injury-induced endotheliopathy and therapeutics to mitigate its development in critically injured patients.Recent findings: Clinical studies have clearly demonstrated that syndecan-1 ectodomains can be found in circulation after various types of trauma and injury and correlates with worse outcomes. As the mechanisms of endotheliopathy are better understood, pathologic hyperadhesive forms of von Willebrand factor, along with a relative deficiency of its cleaving enzyme, a disintegrin and metalloprotease with thrombospondin type I motifs, member 13 (ADAMTS13), have emerged as additional biomarkers. Therapeutics to date have focused primarily on the protective effects of fresh frozen plasma and its constituents to restore the glycocalyx. Human recombinant ADAMTS13 holds promise, as do synthetic variants of heparan sulfate and activated protein C, although all data to date are preclinical.Summary: Injury-induced endotheliopathy represents an important pathologic response to trauma. Key biomarkers, such as syndecan-1, can aid in the diagnosis, but testing is not yet available clinically. As the mechanisms of endotheliopathy are better understood, therapeutics are being identified and show promise. To date, plasma has been the most widely studied; however, like all therapeutics for injury-induced endotheliopathy, it has primarily been studied in the preclinical setting.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"237-243"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977955","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