Current Opinion in Critical Care最新文献_第6页

Monitoring effort and respiratory drive in patients with acute respiratory failure. 监测急性呼吸衰竭患者的努力和呼吸驱动。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-04-04 DOI: 10.1097/MCC.0000000000001271

Guillaume Carteaux, Rémi Coudroy

{"title":"Monitoring effort and respiratory drive in patients with acute respiratory failure.","authors":"Guillaume Carteaux, Rémi Coudroy","doi":"10.1097/MCC.0000000000001271","DOIUrl":"10.1097/MCC.0000000000001271","url":null,"abstract":"Purpose of review: Accurate monitoring of respiratory drive and inspiratory effort is crucial for optimizing ventilatory support during acute respiratory failure. This review evaluates current and emerging bedside methods for assessing respiratory drive and effort.Recent findings: While electrical activity of the diaphragm and esophageal pressure remain the reference standards for assessing respiratory drive and effort, their clinical utility is largely limited to research. At the bedside, airway occlusion maneuvers are the most useful tools: P0.1 is a reliable marker of drive and detects abnormal inspiratory efforts, while occlusion pressure (Pocc) may outperform P0.1 in identifying excessive effort. The Pressure-Muscle-Index (PMI) can help detecting insufficient inspiratory effort, though its accuracy depends on obtaining a stable plateau pressure. Other techniques, such as central venous pressure swings (ΔCVP), are promising but require further investigation. Emerging machine learning and artificial intelligence based algorithms could play a pivotal role in automated respiratory monitoring in the near future.Summary: Although Pes and EAdi remain reference methods, airway occlusion maneuvers are currently the most practical bedside tools for monitoring respiratory drive and effort. Noninvasive alternatives such as ΔCVP deserve further evaluation. Artificial intelligence and machine learning may soon provide automated solutions for bedside monitoring of respiratory drive and effort.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"302-311"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958534","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. 创伤或急诊手术后开腹护理的ICU要点。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2025-06-01 Epub Date: 2025-03-06 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":"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":"262-269"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","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

Timing of neurosurgical interventions for intracranial hypertension: the intensivists' and neurosurgeons' view. 颅内高压的神经外科干预时机：强化医师和神经外科医生的观点。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-22 DOI: 10.1097/MCC.0000000000001243

Victor Lin, Peter John Hutchinson, Angelos Kolias, Chiara Robba, Sarah Wahlster

{"title":"Timing of neurosurgical interventions for intracranial hypertension: the intensivists' and neurosurgeons' view.","authors":"Victor Lin, Peter John Hutchinson, Angelos Kolias, Chiara Robba, Sarah Wahlster","doi":"10.1097/MCC.0000000000001243","DOIUrl":"10.1097/MCC.0000000000001243","url":null,"abstract":"Purpose of review: The aim of this study was to highlight clinical considerations regarding medical versus surgical management of elevated intracranial pressure (ICP), describe limitations of medical management, and summarize evidence regarding timing of neurosurgical interventions.Recent findings: The optimal ICP management strategy remains elusive, and substantial practice variations exist. Common risks of medical treatments include hypotension/shock, cardiac arrhythmias and heart failure, acute renal failure, volume overload, hypoxemia, and prolonged mechanical ventilation.In traumatic brain injury (TBI), recent randomized controlled trials (RCT) did not demonstrate outcome benefits for early, prophylactic decompressive craniectomy, but indicate a role for secondary decompressive craniectomy in patients with refractory elevated ICP. A recent meta-analysis suggested that when an extraventricular drain is required, insertion 24 h or less post-TBI may result in better outcomes.In large ischemic middle cerebral artery strokes, pooled analyses of three RCTs showed functional outcome benefits in patients less than 60 years who underwent prophylactic DC within less than 48 h. In intracranial hemorrhage, a recent RCT suggested outcome benefits for minimally invasive hematoma evacuation within less than 24 h.Summary: More data are needed to guide ICP targets, treatment modalities, predictors of herniation, and surgical triggers; clinical decisions should consider individual patient characteristics, and account for risks of medical and surgical treatments.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"137-148"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482468","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

Gut microbiota and its impact on critical illness. 肠道菌群及其对重症的影响。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-27 DOI: 10.1097/MCC.0000000000001249

Denise Battaglini, Antoni Torres

{"title":"Gut microbiota and its impact on critical illness.","authors":"Denise Battaglini, Antoni Torres","doi":"10.1097/MCC.0000000000001249","DOIUrl":"10.1097/MCC.0000000000001249","url":null,"abstract":"Purpose of review: This narrative review discusses the mechanisms connecting gut dysbiosis to adverse clinical outcomes in critically ill patients and explores potential therapeutic strategies.Recent findings: In recent years, the study of microbiota in ICUs has gained attention because of its potential effects on patient outcomes. Critically ill patients often face severe conditions, which can compromise their immune systems and lead to opportunistic infections from bacteria typically harmless to healthy individuals. The relationship between aggressive medical treatments and microbiota composition remains unclear. Dysbiosis, characterized by reduced microbial diversity and the loss of beneficial bacteria, can lead to prolonged immunosuppression and increased pathogenic risks, contributing to infections and organ failure. Recent advancements in multiomics technologies have enhanced the understanding of host-microbe interactions and their implications in critical care.Summary: The microbiota plays an important role in shaping outcomes for critically ill patients. According to evidence, alterations in the gut and lung microbiota are associated with disease severity, mortality, and overall patient recovery. Evolving research opens possibilities for personalized medicine by tailoring treatments based on individual microbiota profiles, though clinical applications are still developing.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"189-197"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045803","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

Assessing gastrointestinal system dysfunction in intensive care. 重症监护中胃肠系统功能障碍的评估。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI: 10.1097/MCC.0000000000001248

Kaspar F Bachmann, Varsha M Asrani, Annika Reintam Blaser

引用次数: 0

The dynamic pathophysiology of post cardiac arrest brain injury: "time is brain". 心脏骤停后脑损伤的动态病理生理学：“时间就是大脑”。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-02-27 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":"10.1097/MCC.0000000000001246","url":null,"abstract":"Purpose of review: To review the time dependent nature of post-cardiac 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":"31 2","pages":"123-130"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566547","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

Gastrointestinal dysmotility in the ICU. ICU的胃肠运动障碍。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI: 10.1097/MCC.0000000000001252

Anant Vikram Pachisia, Divya Pal, Deepak Govil

{"title":"Gastrointestinal dysmotility in the ICU.","authors":"Anant Vikram Pachisia, Divya Pal, Deepak Govil","doi":"10.1097/MCC.0000000000001252","DOIUrl":"10.1097/MCC.0000000000001252","url":null,"abstract":"Purpose of review: This review aims to provide a comprehensive overview of gastrointestinal dysmotility, particularly in critically ill patients within the ICU. It highlights the pathophysiology, prevalence, and clinical implications of conditions, such as oesophageal dysmotility, gastroparesis, ileus, and Ogilvie's syndrome. By examining current diagnostic and treatment approaches, the review emphasizes the importance of recognizing and managing gastrointestinal dysmotility to improve patient outcomes.Recent finding: Recent literature indicates that up to 60% of ICU patients experience some form of gastrointestinal dysmotility, with those on mechanical ventilation being particularly at risk. The review identifies key contributors to gastrointestinal dysmotility, including inflammatory states, electrolyte imbalances, and the effects of certain medications. Nonpharmacological strategies, such as early enteral feeding, correcting electrolyte abnormalities, and mobilization are critical. Prokinetic agents have shown promise in alleviating feeding intolerance and improving gastric emptying, though their effects on overall mortality remain inconclusive.Summary: Gastrointestinal dysmotility presents a significant challenge in critically ill patients, leading to various complications that hinder recovery. Understanding the underlying pathophysiology, coupled with effective diagnostic and treatment strategies, is essential for enhancing patient care. This review underscores the need for continued research and clinical focus on gastrointestinal motility disorders in the ICU to improve health outcomes for this vulnerable population.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"179-188"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482464","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

Code-ICH: time is brain. 代码- ich：时间就是大脑。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI: 10.1097/MCC.0000000000001244

Aleksandra Yakhkind, Wenzheng Yu, Joshua N Goldstein, Stephan A Mayer

{"title":"Code-ICH: time is brain.","authors":"Aleksandra Yakhkind, Wenzheng Yu, Joshua N Goldstein, Stephan A Mayer","doi":"10.1097/MCC.0000000000001244","DOIUrl":"10.1097/MCC.0000000000001244","url":null,"abstract":"Purpose of review: Intracerebral hemorrhage (ICH) is the most devastating type of stroke resulting in severe disability and mortality. This review summarizes the emerging body of evidence supporting a new paradigm for care of patients called Code-ICH. It highlights the need for the adoption of time-based care bundles based on recent evidence, akin to those used in the management of acute ischemic stroke.Recent findings: Numerous trials aimed at decreasing hematoma expansion through single interventions have historically failed to show significant effects on primary outcomes. Time-sensitive, multifaceted, bundled care approaches have emerged with substantial promise in improving functional outcomes in patients with ICH. These bundles include early aggressive control of blood pressure and reversal of anticoagulation, strict normalization of blood sugar and temperature, early surgical evaluation, and minimizing early withdrawal of care.Summary: The paradigm of Code-ICH empowers acute care providers to continuously measure system performance, reflect on best practices, improve outcomes, and tackle disparities for patients with ICH.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"112-116"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482462","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

Pharmacological prevention of gastrointestinal bleeding in critically Ill patients. 危重患者胃肠出血的药理预防。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-04-01 Epub Date: 2025-01-27 DOI: 10.1097/MCC.0000000000001251

Adrian Wong, Sandra L Kane-Gill, Jeffrey F Barletta

{"title":"Pharmacological prevention of gastrointestinal bleeding in critically Ill patients.","authors":"Adrian Wong, Sandra L Kane-Gill, Jeffrey F Barletta","doi":"10.1097/MCC.0000000000001251","DOIUrl":"10.1097/MCC.0000000000001251","url":null,"abstract":"Purpose of review: Despite advances in critical care medicine, the incidence of clinically important upper gastrointestinal bleeding (UGIB) remains consistent. One therapy that reduces UGIB is the use of stress ulcer prophylaxis (SUP). In the past year, several key manuscripts have been published regarding SUP, providing updated recommendations for its prescription. In this review, we provide commentary on these recommendations and areas for future research.Recent findings: Risk factors for UGIB include chronic liver disease, coagulopathy, severe neurologic illness or injury, and shock. The prescription of SUP is associated with a decreased occurrence of UGIB but no benefit in mortality. Although both histamine-2 receptor antagonists and proton pump inhibitors (PPIs) are recommended for SUP, it is possible that PPIs may be associated with increased mortality in critically ill patients. The short-term use of SUP is not expected to be associated with most adverse drug events, but inappropriate continuation of SUP increases this risk.Summary: Patient-specific considerations based on recent data help with improving the prescription of SUP, although additional research is necessary. The use of artificial intelligence may be able to predict at risk patients with the potential to influence appropriate prescription of SUP and reduce the occurrence of UGIB.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"204-211"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482466","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 : 2025-04-01 Epub Date: 2025-03-06 DOI: 10.1097/MCC.0000000000001261

引用次数: 0