Current Opinion in Critical Care最新文献_第7页

Future for cardiogenic shock research. 心源性休克研究的未来。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-05-28 DOI: 10.1097/MCC.0000000000001169

Jacob Eifer Møller, Holger Thiele, Christian Hassager

引用次数: 0

The enteroendocrine axis and its effect on gastrointestinal function, nutrition, and inflammation. 肠内分泌轴及其对胃肠功能、营养和炎症的影响。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-06-13 DOI: 10.1097/MCC.0000000000001175

Jordan D Philpott, K Marco Rodriguez Hovnanian, Margaret Stefater-Richards, Nilesh M Mehta, Enid E Martinez

{"title":"The enteroendocrine axis and its effect on gastrointestinal function, nutrition, and inflammation.","authors":"Jordan D Philpott, K Marco Rodriguez Hovnanian, Margaret Stefater-Richards, Nilesh M Mehta, Enid E Martinez","doi":"10.1097/MCC.0000000000001175","DOIUrl":"10.1097/MCC.0000000000001175","url":null,"abstract":"Purpose of review: Gastrointestinal (GI) dysfunction limits enteral nutrition (EN) delivery in critical illness and contributes to systemic inflammation. The enteroendocrine (EE) axis plays an integral role in this interface between nutrition, inflammation, and GI function in critical illness. In this review, we present an overview of the EE system with a focus on its role in GI inflammation and function.Recent findings: Enteroendocrine cells have been primarily described in their role in macronutrient digestion and absorption. Recent research has expanded on the diverse functions of EE cells including their ability to sense microbial peptides and metabolites and regulate immune function and inflammation. Therefore, EE cells may be both affected by and contribute to many pathophysiologic states and interventions of critical illness such as dysbiosis , inflammation, and alternative EN strategies. In this review, we present an overview of EE cells including their growing role in nonnutrient functions and integrate this understanding into relevant aspects of critical illness with a focus on EN.Summary: The EE system is key in maintaining GI homeostasis in critical illness, and how it is impacted and contributes to outcomes in the setting of dysbiosis , inflammation and different feeding strategies in critical illness should be considered.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"290-297"},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316907","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

Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions. 并发心源性休克的急性心肌梗死患者在表现和预后方面的性别差异：对当代数据的批判性回顾和对未来方向的展望。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-05-27 DOI: 10.1097/MCC.0000000000001166

Emily Smith, Jacqueline E Tamis-Holland

{"title":"Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions.","authors":"Emily Smith, Jacqueline E Tamis-Holland","doi":"10.1097/MCC.0000000000001166","DOIUrl":"10.1097/MCC.0000000000001166","url":null,"abstract":"Purpose of review: Cardiogenic shock (CS) is a devasting complicating of acute myocardial infarction (AMI), associated with significant mortality. Prior studies have reported sex differences in the presentation, management and outcomes of patients with AMI and CS. These differences are likely due to a variety of factors influencing therapeutic decision-making and impacting survival. This review highlights the more contemporary studies exploring differences in women and men with AMI-CS, providing a critical perspective towards understanding the factors that might lead to these differences and outlining potential opportunities to reduce disparities in treatment and improve survival for women with AMI-CS.Recent findings: Recent reports demonstrate that women with AMI-CS are older than men and have more cardiovascular comorbidities. When examining an unselected population of patients with AMI-CS, women receive less aggressive treatment compared to men and have poorer outcomes. However, when examining a selected population of patients with AMI-CS treated with mechanical circulatory support (MCS) and/or admitted to centers that implement CS protocols to manage AMI-CS, these sex-based differences in outcomes are largely mitigated.Summary: Standardizing protocols for the diagnosis and treatment of patients with AMI-CS, with an emphasis on early revascularization and appropriate invasive therapies, can improve outcomes in women and narrow the gender gap.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"344-353"},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260255","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

Nutrition during noninvasive respiratory support. 无创呼吸支持期间的营养。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI: 10.1097/MCC.0000000000001171

Pierre Singer, Eyal Robinson, Moran Hellerman-Itzhaki

{"title":"Nutrition during noninvasive respiratory support.","authors":"Pierre Singer, Eyal Robinson, Moran Hellerman-Itzhaki","doi":"10.1097/MCC.0000000000001171","DOIUrl":"10.1097/MCC.0000000000001171","url":null,"abstract":"Purpose of review: The use of noninvasive techniques [noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen therapy] to support oxygenation and/or ventilation in patients with respiratory failure has become widespread, even more so since the coronavirus disease 2019 pandemic. The use of these modalities may impair the patient's ability to eat. \"To breath or to eat\" may become a dilemma. In this review, we identify the patients at risk of malnutrition that require medical nutritional therapy and understand the mechanisms of function of the devices to better give adapted nutritional indications for noninvasive ventilation or high flow nasal cannula.Recent findings: The Global Leadership Initiative for Malnutrition has been validated in the Intensive Care setting and can be used in patients requiring NIV. Many patients are underfed when receiving noninvasive ventilation therapies. HFNC may impair the swallowing ability and increase dysphagia while NIV may improve the swallowing reflexes. New technology preventing reflux and ensuring enteral feeding efficacy may increase the medical nutrition therapy safety and provide near-target energy and protein provision.Summary: The patient requiring noninvasive ventilation presents one of the most challenging nutritional challenges. The main steps to improve nutrition administration are to assess nutritional status, evaluate the presence of dysphagia, choose the most adequate tool of respiratory support, and adapt nutritional therapy (oral, enteral, or parenteral) accordingly.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"311-316"},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261641","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

Vitamin C for all? 维生素 C 全民共享？

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-05-20 DOI: 10.1097/MCC.0000000000001161

Angelique de Man, Micah T Long, Christian Stoppe

{"title":"Vitamin C for all?","authors":"Angelique de Man, Micah T Long, Christian Stoppe","doi":"10.1097/MCC.0000000000001161","DOIUrl":"10.1097/MCC.0000000000001161","url":null,"abstract":"Purpose of review: Vitamin C can be a potential adjunctive treatment option for critically ill individuals due to its pleiotropic effects as electron donor in many enzymatic reactions throughout the body. Recently, several important randomized controlled trials (RCTs) investigating vitamin C in critically ill patients have been published.Recent findings: Two recent large RCTs administering high-dose vitamin C to patients with sepsis and COVID-19 showed signs of harm. Though performed at high standard, these trials had several limitations. Recent studies in cardiac surgery and burns showed decreased cardiac enzymes and improved clinical outcomes after cardiac surgery, and decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns. Vitamin C may hold benefit in the management of other ischemia/reperfusion injury populations, including postcardiac arrest patients and after solid organ transplantation. Currently, covering basal vitamin C requirements during critical illness is recommended, though the exact dose remains to be determined.Summary: Future work should address optimal vitamin C timing, since early versus late drug administration are likely distinct, and duration of therapy, where withdrawal-induced injury is possible. Additionally accurate assessment of body stores with determination of individual vitamin requirements is crucial to ascertain patient and subgroups most likely to benefit from vitamin C.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"298-304"},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260418","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 - cardiogenic shock. 社论--心源性休克。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-07-04 DOI: 10.1097/MCC.0000000000001180

Jan Belohlavek

引用次数: 0

Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality. 受保护的心脏手术：战略性机械循环支持以改善开胸手术后的死亡率。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI: 10.1097/MCC.0000000000001179

Leonardo Salazar, Roberto Lorusso

{"title":"Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality.","authors":"Leonardo Salazar, Roberto Lorusso","doi":"10.1097/MCC.0000000000001179","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001179","url":null,"abstract":"Purpose of review: To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS).Recent findings: P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of \"protected cardiac surgery\" emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy.Summary: This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 4","pages":"385-391"},"PeriodicalIF":3.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491200","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 CO2 kinetics as a marker of cardiopulmonary efficiency. 监测二氧化碳动力学作为心肺效率的标志。

IF 3.3 3区医学

Current Opinion in Critical Care Pub Date : 2024-06-01 Epub Date: 2024-03-28 DOI: 10.1097/MCC.0000000000001156

Fernando Suarez Sipmann, Juan Antonio Sanchez Giralt, Gerardo Tusman

{"title":"Monitoring CO2 kinetics as a marker of cardiopulmonary efficiency.","authors":"Fernando Suarez Sipmann, Juan Antonio Sanchez Giralt, Gerardo Tusman","doi":"10.1097/MCC.0000000000001156","DOIUrl":"10.1097/MCC.0000000000001156","url":null,"abstract":"Purpose of review: To describe current and near future developments and applications of CO2 kinetics in clinical respiratory and cardiovascular monitoring.Recent findings: In the last years, we have witnessed a renewed interest in CO2 kinetics in relation with a better understanding of volumetric capnography and its derived parameters. This together with technological advances and improved measurement systems have expanded the monitoring potential of CO2 kinetics including breath by breath continuous end-expiratory lung volume and continuous noninvasive cardiac output. Dead space has slowly been gaining relevance in clinical monitoring and prognostic evaluation. Easy to measure dead space surrogates such as the ventilatory ratio have demonstrated a strong prognostic value in patients with acute respiratory failure.Summary: The kinetics of carbon dioxide describe many relevant physiological processes. The clinical introduction of new ways of assessing respiratory and circulatory efficiency based on advanced analysis of CO2 kinetics are paving the road to a long-desired goal in clinical monitoring of critically ill patients: the integration of respiratory and circulatory monitoring during mechanical ventilation.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 3","pages":"251-259"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851993","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

Challenges with medical tourism. 医疗旅游的挑战。

IF 3.3 3区医学

Current Opinion in Critical Care Pub Date : 2024-06-01 Epub Date: 2024-03-11 DOI: 10.1097/MCC.0000000000001148

Helena C Maltezou, Androula Pavli

{"title":"Challenges with medical tourism.","authors":"Helena C Maltezou, Androula Pavli","doi":"10.1097/MCC.0000000000001148","DOIUrl":"10.1097/MCC.0000000000001148","url":null,"abstract":"Purpose of review: With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months.Recent findings: There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years.Summary: Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"224-230"},"PeriodicalIF":3.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027556","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 emergency management of the critically Ill and injured. 危重病人和伤员急救管理的进展。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2024-06-01 Epub Date: 2024-05-01 DOI: 10.1097/MCC.0000000000001153

Heatherlee Bailey

引用次数: 0