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

Firearm injury: pushing forward.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-14 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":"https://doi.org/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":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","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

Electrical impedance tomography to set positive end-expiratory pressure.

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-13 DOI: 10.1097/MCC.0000000000001255

Juliette E Francovich, Bhushan H Katira, Annemijn H Jonkman

{"title":"Electrical impedance tomography to set positive end-expiratory pressure.","authors":"Juliette E Francovich, Bhushan H Katira, Annemijn H Jonkman","doi":"10.1097/MCC.0000000000001255","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001255","url":null,"abstract":"Purpose of review: To summarize the rationale and concepts for positive end-expiratory pressure (PEEP) setting with electrical impedance tomography (EIT) and the effects of EIT-based PEEP setting on cardiopulmonary function.Recent findings: EIT allows patient-specific and regional assessment of PEEP effects on recruitability and overdistension, including its impact on ventilation-perfusion (V̇/Q) mismatch. The overdistension and collapse (OD-CL) method is the most used EIT-based approach for PEEP setting. In the RECRUIT study of 108 COVID-19 ARDS patients, the PEEP level corresponding to the OD-CL crossing point showed low overdistension and collapse (below 10% and 5%, respectively) regardless of recruitability. In a porcine model of acute respiratory distress syndrome (ARDS), it was shown that at this crossing point, respiratory mechanics (compliance, ΔP) were consistent, with adequate preload, lower right ventricular afterload, normal cardiac output, and sufficient gas exchange. A recent meta-analysis found that EIT based PEEP setting improved lung mechanics and potentially outcomes in ARDS patients. EIT thus provides critical insights beyond respiratory mechanics and oxygenation for individualized PEEP optimization. EIT-based methods for PEEP setting during assisted ventilation have also been proposed.Summary: EIT is a valuable technique to guide individualized PEEP setting utilizing cardiopulmonary information that is not captured by respiratory mechanics and oxygenation response alone.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457117","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

Management of sedation during weaning from mechanical ventilation. 机械通气断奶期间的镇静管理。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-08 DOI: 10.1097/MCC.0000000000001226

Hanna Vollbrecht, Bhakti K Patel

{"title":"Management of sedation during weaning from mechanical ventilation.","authors":"Hanna Vollbrecht, Bhakti K Patel","doi":"10.1097/MCC.0000000000001226","DOIUrl":"10.1097/MCC.0000000000001226","url":null,"abstract":"Purposes of review: Critically ill patients frequently require mechanical ventilation and often receive sedation to control pain, reduce anxiety, and facilitate patient-ventilator interactions. Weaning from mechanical ventilation is intertwined with sedation management. In this review, we analyze the current evidence for sedation management during ventilatory weaning, including level of sedation, timing of sedation weaning, analgesic and sedative choices, and sedation management in acute respiratory distress syndrome (ARDS).Recent findings: Despite a large body of evidence from the past 20 years regarding the importance of light sedation and paired spontaneous awakening and spontaneous breathing trials (SATs/SBTs) to promote ventilator weaning, recent studies show that implementation of these strategies lag in practice. The recent WEAN SAFE trial highlights the delay between meeting weaning criteria and first weaning attempt, with level of sedation predicting both delays and weaning failure. Recent studies show that targeted interventions around evidence-based practices for sedation weaning improve outcomes, though long-term sustainability remains a challenge.Summary: Light or no sedation strategies that prioritize analgesia prior to sedatives along with paired SATs/SBTs promote ventilator liberation. Dexmedetomidine may have a role in weaning for agitated patients. Further investigation is needed into optimal sedation management for patients with ARDS.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"78-85"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616357","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

How to prevent postextubation respiratory failure. 如何预防拔管后呼吸衰竭。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI: 10.1097/MCC.0000000000001230

Gonzalo Hernández, Nicholas S Hill

{"title":"How to prevent postextubation respiratory failure.","authors":"Gonzalo Hernández, Nicholas S Hill","doi":"10.1097/MCC.0000000000001230","DOIUrl":"10.1097/MCC.0000000000001230","url":null,"abstract":"Purpose of review: Postextubation respiratory support treatment approaches, indications, and subgroups of patients with different responses to those therapies are rapidly changing. Planning optimal therapy in terms of choosing devices, timing of application and selecting settings with the goal of minimizing extubation failure is becoming a challenge. This review aims to analyze all the available evidence from a clinical point of view, trying to facilitate decision making at the bedside.Recent findings: There is evidence for high flow nasal cannula support in patients at low risk of extubation failure. Noninvasive ventilation based strategies should be prioritized in patients at very high risk, who are obese or are hypercapnic at the end of a spontaneous breathing trial. Patients not included in the previous groups merit a tailored decision based on more variables.Optimizing the timing of therapy can include facilitation of extubation by transitioning to noninvasive respiratory support or prolonging a planned preventive therapy according to clinical condition.Summary: Planning postextubatin respiratory support must consider the risk for failing and the presence of some clinical conditions favoring noninvasive ventilation.Extubation can be safely accelerated by modifying screening criteria and spontaneous breathing trial settings, but there is room to increase the role of postextubation noninvasive respiratory support for this indication, always keeping in mind the dangers of delaying a needed intubation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"93-100"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616247","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

Editorial introductions. 编辑介绍。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI: 10.1097/MCC.0000000000001236

引用次数: 0

Proportional modes to hasten weaning. 比例模式加速断奶。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-12-04 DOI: 10.1097/MCC.0000000000001237

Karen J Bosma

{"title":"Proportional modes to hasten weaning.","authors":"Karen J Bosma","doi":"10.1097/MCC.0000000000001237","DOIUrl":"10.1097/MCC.0000000000001237","url":null,"abstract":"Purpose of review: The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation.Recent findings: Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are two commercially available proportional modes that have been studied in randomized controlled trials (RCTs). Although several feasibility studies were not powered to detect differences in clinical outcomes, emerging evidence suggests that both PAV and NAVA may reduce duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital mortality compared to PSV, as shown in some small, primarily single-centre studies. Recent meta-analyses suggest that PAV shortens duration of mechanical ventilation and improves weaning success rate, and NAVA may reduce ICU and hospital mortality.Summary: The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"57-69"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784294","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

Spontaneous breathing trials: how and for how long? 自主呼吸试验：如何进行，持续多久？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-10-23 DOI: 10.1097/MCC.0000000000001227

Arnaud W Thille, François Arrivé, Sylvain Le Pape

{"title":"Spontaneous breathing trials: how and for how long?","authors":"Arnaud W Thille, François Arrivé, Sylvain Le Pape","doi":"10.1097/MCC.0000000000001227","DOIUrl":"10.1097/MCC.0000000000001227","url":null,"abstract":"Purpose of review: Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.Recent findings: Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.Summary: Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"86-92"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496659","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

How to prevent and how to treat dyspnea in critically ill patients undergoing invasive mechanical ventilation. 如何预防和治疗接受有创机械通气的重症患者的呼吸困难。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-15 DOI: 10.1097/MCC.0000000000001232

Gabriel Kemoun, Alexandre Demoule, Maxens Decavèle

{"title":"How to prevent and how to treat dyspnea in critically ill patients undergoing invasive mechanical ventilation.","authors":"Gabriel Kemoun, Alexandre Demoule, Maxens Decavèle","doi":"10.1097/MCC.0000000000001232","DOIUrl":"10.1097/MCC.0000000000001232","url":null,"abstract":"Purpose of review: To summarize current data regarding the prevalence, risk factors, consequences, assessment and treatment of dyspnea in critically ill patients receiving invasive mechanical ventilation.Recent findings: In intubated patients, dyspnea is frequent, perceived as intense, and associated with unfavorable outcomes such as immediate and unbearable distress (e.g. fear of dying), prolonged weaning, and delayed severe psychological consequences ( i.e. posttraumatic stress disorders). In noncommunicative patients, dyspnea is named respiratory-related brain suffering (RRBS) and can be detected using dyspnea observations scales. Before initiating pharmacological treatments, nonpharmacological interventions may be tried as they are efficient to alleviate dyspnea.Summary: As opposed to pain, dyspnea has often been overlooked in terms of detection and management, resulting in its significant underestimation in daily practice. When it is diagnosed, dyspnea can be relieved through straightforward interventions, such as adjusting ventilator settings. Assessing dyspnea in patients undergoing invasive mechanically ventilated may be challenging, especially in noncommunicative patients (RRBS). Implementing a systematic dyspnea assessment in routine, akin to pain, could serve as a first step to reduce RRBS and prevent potential severe psychological consequences. In addition to pharmacological treatments like opioids, a promising approach is to modulate both the sensory (air on the face, trigeminal nerve stimulation) and the affective (relaxing music, hypnosis, directed empathy) components of dyspnea.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"47-56"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667282","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

How to protect the diaphragm and the lung with diaphragm neurostimulation. 如何通过横膈膜神经刺激来保护横膈膜和肺。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-18 DOI: 10.1097/MCC.0000000000001233

Mariangela Pellegrini, Mélodie Parfait, Martin Dres

{"title":"How to protect the diaphragm and the lung with diaphragm neurostimulation.","authors":"Mariangela Pellegrini, Mélodie Parfait, Martin Dres","doi":"10.1097/MCC.0000000000001233","DOIUrl":"10.1097/MCC.0000000000001233","url":null,"abstract":"Purpose of review: In the current review, we aim to highlight the evolving evidence on using diaphragm neurostimulation to develop lung and diaphragm protective mechanical ventilation.Recent findings: Positive-pressure ventilation (PPV) causes stress and strain to the lungs which leads to ventilator-induced lung injury (VILI). In addition, PPV is frequently associated with sedatives that induce excessive diaphragm unloading which contributes to ventilator-induced diaphragmatic dysfunction (VIDD). The nonvolitional diaphragmatic contractions entrained by diaphragm neurostimulation generate negative pressure ventilation, which may be a beneficial alternative or complement to PPV. Although well established as a permanent treatment of central apnea syndromes, temporary diaphragm neurostimulation rapidly evolves to prevent and treat VILI and VIDD. Experimental and small clinical studies report comprehensive data showing that diaphragm neurostimulation has the potential to mitigate VIDD and to decrease the stress and strain applied to the lungs.Summary: Scientific interest in temporary diaphragm neurostimulation has dramatically evolved in the last few years. Despite a solid physiological rationale and promising preliminary findings confirming a beneficial effect on the diaphragm and lungs, more studies and further technological advances will be needed to establish optimal standardized settings and lead to clinical implementation and improved outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"70-77"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667284","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 transition phase between controlled mechanical ventilation and weaning is our next great cause. 可控机械通气与脱机的过渡阶段是我们下一个伟大的事业。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI: 10.1097/MCC.0000000000001234

Alexandre Demoule

引用次数: 0