Current Opinion in Critical Care最新文献_第8页

Spontaneous breathing-induced lung injury in mechanically ventilated patients. 机械通气患者自发呼吸引起的肺损伤。

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.0000000000001231

Taiki Hoshino, Takeshi Yoshida

{"title":"Spontaneous breathing-induced lung injury in mechanically ventilated patients.","authors":"Taiki Hoshino, Takeshi Yoshida","doi":"10.1097/MCC.0000000000001231","DOIUrl":"10.1097/MCC.0000000000001231","url":null,"abstract":"Purpose of review: Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury.Recent findings: Recent clinical and experimental studies have shown that vigorous spontaneous breathing during mechanical ventilation can potentially injure the lungs due to high transpulmonary pressure, the Pendelluft phenomenon, increased pulmonary perfusion, and patient-ventilator asynchrony. A definitive approach to minimize spontaneous breathing-induced lung injury is the systemic use of neuromuscular blocking agents; however, there is a risk of muscle atrophy. Alternatively, partial paralysis, bilateral phrenic nerve blockade, and sedatives may be useful for decreasing force generation from the diaphragm while maintaining muscle function. A higher positive end-expiratory pressure (PEEP) and prone positioning may reduce force generation from the diaphragm by decreasing neuromechanical efficiency.Summary: Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"5-11"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616358","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 respiratory muscles effort during mechanical ventilation. 监测机械通气过程中呼吸肌的用力情况。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-14 DOI: 10.1097/MCC.0000000000001229

Julien P van Oosten, Evangelia Akoumianaki, Annemijn H Jonkman

{"title":"Monitoring respiratory muscles effort during mechanical ventilation.","authors":"Julien P van Oosten, Evangelia Akoumianaki, Annemijn H Jonkman","doi":"10.1097/MCC.0000000000001229","DOIUrl":"10.1097/MCC.0000000000001229","url":null,"abstract":"Purpose of review: To summarize basic physiological concepts of breathing effort and outline various methods for monitoring effort of inspiratory and expiratory muscles.Recent findings: Esophageal pressure (Pes) measurement is the reference standard for respiratory muscle effort quantification, but various noninvasive screening tools have been proposed. Expiratory occlusion pressures (P0.1 and Pocc) could inform about low and high effort and the resulting lung stress, with Pocc outperforming P0.1 in identifying high effort. The pressure muscle index during an inspiratory hold could unveil inspiratory muscle effort, however obtaining a reliable inspiratory plateau can be difficult. Surface electromyography has the potential for inspiratory effort estimation, yet this is technically challenging for real-time assessment. Expiratory muscle activation is common in the critically ill warranting their assessment, that is, via gastric pressure monitoring. Expiratory muscle activation also impacts inspiratory effort interpretation which could result in both under- and overestimation of the resulting lung stress. There is likely a future role for machine learning applications to automate breathing effort monitoring at the bedside.Summary: Different tools are available for monitoring the respiratory muscles' effort during mechanical ventilation - from noninvasive screening tools to more invasive quantification methods. This could facilitate a lung and respiratory muscle-protective ventilation approach.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"12-20"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667288","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

Does patient-ventilator asynchrony really matter? 患者与呼吸机不同步真的重要吗？

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.0000000000001225

Mattia Docci, Antenor Rodrigues, Sebastian Dubo, Matthew Ko, Laurent Brochard

{"title":"Does patient-ventilator asynchrony really matter?","authors":"Mattia Docci, Antenor Rodrigues, Sebastian Dubo, Matthew Ko, Laurent Brochard","doi":"10.1097/MCC.0000000000001225","DOIUrl":"10.1097/MCC.0000000000001225","url":null,"abstract":"Purpose of review: Past observational studies have reported the association between patient-ventilator asynchronies and poor clinical outcomes, namely longer duration of mechanical ventilation and higher mortality. But causality has remained undetermined. During the era of lung and diaphragm protective ventilation, should we revolutionize our clinical practice to detect and treat dyssynchrony?Recent findings: Clinicians' ability to recognize asynchronies is typically low. Automatized softwares based on artificial intelligence have been trained to largely outperform human eyesight and are close to be implemented at the bedside. There is growing evidence that in susceptible patients, dyssynchrony may lead to ventilation-induced lung injury (or patient self-inflicted lung injury) and that clusters of such dyssynchronous events have the highest association with poor outcomes. Dyssynchrony may also be associated with harm indirectly when it reflects over-assistance or over-sedation. However, the occurrence of reverse triggering by means of low inspiratory efforts during passive ventilation may prevent diaphragm dysfunction and atrophy and be beneficial.Summary: Most recent evidence on the topic suggests that synchrony between the patient and the mechanical ventilator is a critical element for protecting lung and diaphragm during the time of invasive mechanical ventilation or may reflect inadequate settings or sedation. Therefore, it is a complex situation, and clinical trials are still needed to test the effectiveness of keeping patient-ventilator interaction synchronous on clinical outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"21-29"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496656","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

Tracheostomy: update on why, when and how. 气管造口术：为何、何时以及如何进行的最新进展。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-25 DOI: 10.1097/MCC.0000000000001224

Giulia Lais, Lise Piquilloud

{"title":"Tracheostomy: update on why, when and how.","authors":"Giulia Lais, Lise Piquilloud","doi":"10.1097/MCC.0000000000001224","DOIUrl":"10.1097/MCC.0000000000001224","url":null,"abstract":"Purpose of review: The aim of this review is to summarize available data, including the most recent ones, to help develop the best possible strategy regarding the use of tracheostomy in ICU patients requiring prolonged mechanical ventilation or who experience loss of airway-protecting mechanisms.Recent findings: Tracheostomy facilitates the weaning process by reducing the patient's work of breathing and increasing comfort. It thus allows for a reduction in sedation levels. It also helps with secretions clearance, facilitates disconnection from the ventilator, and enables earlier phonation, oral intake, and mobilization. Despite these advantages, tracheostomy does not reduce mortality and is associated with both early and late complications, particularly tracheal stenosis. The timing of tracheostomy remains a subject of debate, and only a personalized approach that considers each patient's specific characteristics can help find the best possible compromise between avoiding unnecessary delays and minimizing the risks of performing a needless invasive procedure. In the absence of contraindications, the percutaneous single dilator technique under fibroscopic guidance should be the first choice, but only if the team is properly trained.Summary: A step-by-step individualized approach based on the available evidence allows identifying the best strategy regarding the use of tracheostomy in ICU patients.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"101-107"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715468","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 achieving lung and diaphragm-protective ventilation. 实现肺和横膈膜保护性通气的进展。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-11-14 DOI: 10.1097/MCC.0000000000001228

Maarten J W van den Berg, Leo Heunks, Jonne Doorduin

{"title":"Advances in achieving lung and diaphragm-protective ventilation.","authors":"Maarten J W van den Berg, Leo Heunks, Jonne Doorduin","doi":"10.1097/MCC.0000000000001228","DOIUrl":"10.1097/MCC.0000000000001228","url":null,"abstract":"Purpose of review: Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation.Recent findings: Noninvasive ventilator maneuvers (P0.1, airway occlusion pressure, pressure-muscle index) can accurately detect low and excessive respiratory efforts and high lung stress. Additional monitoring techniques include esophageal manometry, ultrasound, electrical activity of the diaphragm, and electrical impedance tomography. Recent trials demonstrate that a systematic approach to titrating inspiratory support and sedation facilitates lung- and diaphragm protective ventilation. Titration of positive-end expiratory pressure and, if available, veno-venous extracorporeal membrane oxygenation sweep gas flow may further modulate neural respiratory drive and effort to facilitate lung- and diaphragm protective ventilation.Summary: Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"38-46"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667279","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

Monitoring and modulating respiratory drive in mechanically ventilated patients. 监测和调节机械通气患者的呼吸驱动力。

IF 3.5 3区医学

Current Opinion in Critical Care Pub Date : 2025-02-01 Epub Date: 2024-10-21 DOI: 10.1097/MCC.0000000000001223

Sebastián Consalvo, Matías Accoce, Irene Telias

{"title":"Monitoring and modulating respiratory drive in mechanically ventilated patients.","authors":"Sebastián Consalvo, Matías Accoce, Irene Telias","doi":"10.1097/MCC.0000000000001223","DOIUrl":"10.1097/MCC.0000000000001223","url":null,"abstract":"Purpose of review: Respiratory drive is frequently deranged in the ICU, being associated with adverse clinical outcomes. Monitoring and modulating respiratory drive to prevent potentially injurious consequences merits attention. This review gives a general overview of the available monitoring tools and interventions to modulate drive.Recent findings: Airway occlusion pressure (P0.1) is an excellent measure of drive and is displayed on ventilators. Respiratory drive can also be estimated based on the electrical activity of respiratory muscles and measures of respiratory effort; however, high respiratory drive might be present in the context of low effort with neuromuscular weakness. Modulating a deranged drive requires a multifaceted intervention, prioritizing treatment of the underlying cause and adjusting ventilator settings for comfort. Additional tools include changes in PEEP, peak inspiratory flow, fraction of inspired oxygen, and sweep gas flow (in patients receiving extracorporeal life-support). Sedatives and opioids have differential effects on drive according to drug category. Monitoring response to any intervention is warranted and modulating drive should not preclude readiness to wean assessment or delay ventilation liberation.Summary: Monitoring and modulating respiratory drive are feasible based on physiological principles presented in this review. However, evidence arising from clinical trials will help determine precise thresholds and optimal interventions.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"30-37"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496658","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 uncertainty principle: a novel approach to optimizing trials in critical care. 不确定性原则：优化重症监护试验的新方法。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI: 10.1097/MCC.0000000000001220

Jacob Vine, Ari Moskowitz, Michael W Donnino

引用次数: 0

Acute kidney injury subphenotyping and personalized medicine. 急性肾损伤亚表型和个性化医疗。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-13 DOI: 10.1097/MCC.0000000000001212

Melanie Meersch, Timo Mayerhöfer, Michael Joannidis

{"title":"Acute kidney injury subphenotyping and personalized medicine.","authors":"Melanie Meersch, Timo Mayerhöfer, Michael Joannidis","doi":"10.1097/MCC.0000000000001212","DOIUrl":"10.1097/MCC.0000000000001212","url":null,"abstract":"Purpose of review: This review discusses novel concepts of acute kidney injury (AKI), including subphenotyping, which may facilitate the development of target treatment strategies for specific subgroups of patients to achieve precision medicine.Recent findings: AKI is a multifaceted syndrome with a major impact on morbidity and mortality. As efforts to identify treatment strategies have largely failed, it is becoming increasingly apparent that there are different subphenotypes that require different treatment strategies. Various ways of subphenotyping AKI have been investigated, including the use of novel renal biomarkers, machine learning and artificial intelligence, some of which have already been implemented in the clinical setting. Thus, novel renal biomarkers have been recommended for inclusion in new definition criteria for AKI and for the use of biomarker bundled strategies for the prevention of AKI. Computational models have been explored and require future research.Summary: Subphenotyping of AKI may provide a new understanding of this syndrome and guide targeted treatment strategies in order to improve patient outcomes.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"555-562"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582256","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

Fluid management of acute kidney injury. 急性肾损伤的输液治疗。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1097/MCC.0000000000001211

Alison Fahey, Patrick J Neligan, Bairbre McNicholas

{"title":"Fluid management of acute kidney injury.","authors":"Alison Fahey, Patrick J Neligan, Bairbre McNicholas","doi":"10.1097/MCC.0000000000001211","DOIUrl":"10.1097/MCC.0000000000001211","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) is commonly encountered in critical care medicine as is intravenous fluid therapy. It is accepted that there is interplay between fluid use and AKI, both potentially positive and negative. An understanding of the physiological rationale for fluid is important to help clinicians when considering fluid therapy in patients with, or at risk for AKI; this includes understanding choice of fluid, method of monitoring, administration and clinical sequelae.Recent findings: There is increasing interest in combining both static and dynamic measures to assess fluid balance, fluid responsiveness effects of fluid therapy, which are areas requiring ongoing study to translate this theory into clinically useful practice at the bedside. Whilst the debate of choice of crystalloid in ICU practice continues, further evidence for benefits for balanced solutions emerges in the form of international guidelines and patient data meta-analysis of previously performed trials.Summary: This review assesses the physiological rationale for fluid use in ICU cohorts with AKI of various types, as well as a systematic approach for choice of fluid therapy using a number of different variables, which aims to help guide clinicians in managing fluid use and fluid balance in critically ill patients with AKI.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 6","pages":"548-554"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582280","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

Identifying the high-risk surgical patient. 识别高风险手术病人。

IF 3.4 3区医学

Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI: 10.1097/MCC.0000000000001209

Javier Ripollés-Melchor, César Aldecoa

引用次数: 0