Historic review of long-term outcomes research
Purpose of review This review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research. Recent findings The postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components. Summary Interest in patient-centred outcomes has been present since the beginning of modern intensive ...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

Deadoption of low-value practices in the ICU
Purpose of review Change of practice in the ICU, particularly the discontinuation of approaches, which are no longer felt to be beneficial, can be challenging. This review will examine this issue and outline current thinking regarding how to best approach it. Recent findings Practices in medicine that do not provide patients benefit and possibly cause harm exist throughout medicine and are called low-value practices. Some low-value practices have successfully been removed from the ICU whereas others remain. The process of removing these practices from established care is often called deadoption. Low-value practices th...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

Strategies to effect change in the ICU
Purpose of review To provide an update on implementation efforts in the care of critically ill patients, with a focus on work published in the last 2 years. Recent findings Only half of surveyed members of the multidisciplinary care team in the ICU were aware of the Choosing Wisely campaign, and of those that were, approximately one-third reported no implementation of the recommendations. Barriers to implementation of the ABCDE bundle extend to beyond patient-level domains, and include clinician-related, protocol-related, and other domains. Prospective audit and feedback approaches have demonstrated moderate success f...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

In the pursuit of partnership: patient and family engagement in critical care medicine
Purpose of review Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area. Recent findings Though the literature is relatively nascent, studies suggest that there is a desire to engage patients and families in cri...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

Defining standard of practice: pros and cons of the usual care arm
Purpose of review The aim of this review is to describe the use of usual care arms in randomized trials. Recent findings Randomization of patients to an experimental or a control arm remains paramount for the estimation of average causal effects. Selection of the control arm is as important as the definition of the intervention, and it might include a placebo control, specific standards of care, protocolized usual care, or unrestricted clinical practice. Usual care control arms may enhance generalizability, clinician acceptability of the protocol, patient recruitment, and ensure community equipoise, while at the same ...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

Population enrichment for critical care trials: phenotypes and differential outcomes
We present a narrative review on the recent developments in enriching patient populations for future sepsis and ARDS trials. Recent findings Many researchers are actively pursuing enrichment strategies to reduce heterogeneity to increase the sensitivity of future trials. Enrichment refers to the use of measurable patient characteristics, known before randomisation, to refine trial populations. Biomarkers could increase the diagnostic certainty of sepsis, whereas chest radiology training to enhance reliability of interpretation and stabilisation period of mechanical ventilation have been considered to increase the diagno...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

Challenges in conducting long-term outcomes studies in critical care
Purpose of review Evaluating longer term mortality, morbidity, and quality of life in survivors of critical illness is a research priority. This review details the challenges of long-term follow-up studies of critically ill patients and highlights recently proposed methodological solutions. Recent findings Barriers to long-term follow-up studies of critical care survivors include high rates of study attrition because of death or loss to follow-up, data missingness from experienced morbidity, and lack of standardized outcome as well as reporting of key covariates. A number of recent methods have been proposed to reduce...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by M. Elizabeth Wilcox Source Type: research

How should we treat acinetobacter pneumonia?
Purpose of review To describe recent data about Acinetobacter baumannii pneumonia epidemiology and the therapeutic options including adjunctive nebulized therapy. Recent findings A. baumannii is a major cause of nosocomial pneumonia in certain geographic areas affecting mainly debilitated patients, with prolonged hospitalization and broad-spectrum antimicrobials. Inappropriate empirical treatment has clearly been associated with increased mortality in A. baumannii pneumonia. Carbapenems may not be considered the treatment of choice in areas with high rates of carbapenem-resistant A. baumannii. Nowadays, polymyxins are...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Optimal and responsible use of antibiotics
Purpose of review In this review, we focus on the dual face of antibiotic therapy in the critically ill that must harmonize the need for early, appropriate and adequate antibiotic therapy in the individual-infected patient with the obligation to limit antibiotic selection pressure as much as possible to preserve its future potential. Recent findings Recent articles have highlighted and detailed the various aspects, which determine antibiotic efficacy, and have identified adjunctive treatments, such as source control, which impact outcome. In addition, settings and indications where antibiotics do not improve outcome a...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Severe influenza: overview in critically ill patients
Purpose of review Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity. Recent findings Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and m...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Optimizing therapy of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae
Purpose of review Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, because of the alarming emergence or carbapenem resistance, interest in effective alternatives has emerged. The present review summarizes the findings published on the antibiotics currently available for treatment of patients with an ESBL-E bloodstream infection (BSI). Recent findings Meropenem and imipenem are the drugs recommended for treatment of ESBL BSIs in critical...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Diagnosing invasive pulmonary aspergillosis in ICU patients: putting the puzzle together
Purpose of review The approach to diagnose invasive pulmonary aspergillosis in the absence of lung biopsy in ICU patients is reviewed. This approach should be based on four pillars: mycology, medical imaging, underlying conditions, and acute disease expression. Recent findings Diagnosing invasive pulmonary aspergillosis in the absence of histopathologic evidence is a matter of probability weighting. Initiating antifungal therapy in an early phase and with a lower likelihood of disease might outweigh further diagnostic workout with further delay in appropriate treatment. However, in ICU patients, a preemptive antifunga...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Meningitis and encephalitis management in the ICU
This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. Recent findings Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world. Advances in ICU care of central nervous system (CNS) infections include application of newer diagnostic methods, improved understanding and delivery of antibiotics to the CNS, infection prevention for nosocomial ...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Intravenous immunoglobulin for adjunctive treatment of severe infections in ICUs
Purpose of review This review focuses on the emerging literature regarding the use of intravenous immunoglobulins (IVIg) in critically ill patients with severe infections. The aim is to provide an accessible summary of the most recent evidence of IVIg use in sepsis and septic shock and to help clinicians to understand why there is still equipoise regarding the potential benefit of this adjunctive therapy in this setting. Recent findings Observational studies with propensity score matching analyses and investigating the effect of IVIg in severe infections including necrotizing soft tissue infection have been recently p...
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - August 31, 2019 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research

Assessment of microcirculation in cardiogenic shock
Purpose of review Adequate tissue perfusion is of utmost importance to avoid organ failure in patients with cardiogenic shock. Within the recent years, the microcirculation, defined as the perfusion of the smallest vessels, has been identified to play a crucial role. Microcirculatory changes may include capillary flow disturbances as well as changes in the density of perfused vessels. Due to the availability of new technologies to assess the microcirculation, interesting new data came up and it is the purpose of this review to summarize recent studies in the field. Recent findings Nowadays, an increasing number of stu...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Lactate and other biomarkers as treatment target in cardiogenic shock
Purpose of review Cardiogenic shock remains beside sudden cardiac death the most outcome relevant complication of acute myocardial infarction. Over the last two decades as confirmation of the benefit of early revascularization no further relevant improvement in outcome could be achieved. Biomarkers are important for diagnosis, monitoring, and management in cardiogenic shock patients. Recent findings A bunch of different biomarkers have been associated with prognosis in patients with cardiogenic shock. In routine use standard parameters such as serum lactate or serum creatinine are still most important in monitoring th...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence
This article provides an overview of VA-ECMO principles, indications, management, complications, and discusses the results of recent case series and trials. Recent findings VA-ECMO is utilized as a bridge to ‘decision’ that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support, and withdrawal in case of futility. VA-ECMO is considered the first-line TCS as it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella (Abiomed, Danvers, MA, USA) or intra-aortic balloon pump su...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Mechanical circulatory support devices in cardiogenic shock and acute heart failure: current evidence
Purpose of review The main purpose of this review is to highlight and summarize recently published studies on the usage of short-term mechanical circulatory support devices for treatment of cardiogenic shock. Importantly, this review will focus on percutaneously implanted devices. Recent findings In recent years, usage of active mechanical circulatory support devices, such as catheter-based left ventricular-assist devices and veno-arterial extracorporeal membrane oxygenation devices, has been widely adopted. Several device-specific strategies have been proposed to improve outcome of treated patients with cardiogenic s...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Inotropes and vasopressors use in cardiogenic shock: when, which and how much?
Purpose of review Data and interventional trials regarding vasopressor and inotrope use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In this article, we review the current use of vasopressor and inotrope agents during cardiogenic shock. Recent findings Two recent Cochrane analyses concluded that there was not sufficient evidence to prove that any one vasopressor or inotrope was superior to another in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine ...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Revascularization strategies in cardiogenic shock after acute myocardial infarction
Purpose of review Coronary revascularization compared with medical treatment alone leads to improved survival in patients with myocardial infarction (MI) and cardiogenic shock. Percutaneous coronary intervention (PCI) is the predominant mode of revascularization in clinical practice. This review discusses several aspects relevant to mechanical revascularization such as general indication, the roles of PCI and bypass surgery, percutaneous access site choice, strategy in multivessel disease and adjunctive antithrombotic therapy. Recent findings The recently published CULPRIT-SHOCK trial provided the first randomized evi...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Cardiogenic pulmonary edema: mechanisms and treatment - an intensivist's view
Purpose of review This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. Recent findings The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with e...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

An overview of international cardiogenic shock guidelines and application in clinical practice
Purpose of review In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. Recent findings The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies. There is litt...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Editorial: Cardiogenic shock: on the search for a breakthrough in outcome?
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Holger Thiele Source Type: research

Intermittent or continuous feeding: any difference during the first week?
Purpose of review To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. Recent findings Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release. RCTs investi...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Any news from the prokinetic front?
Purpose of review This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs. Recent findings Prokinetic drugs accelerate gastric emptying and, particularly in patients with gastric dysmotility and enteral feed intolerance, their use increases the delivery of enteral nutrition. However, prokinetic drugs have not been shown to improve patient-centered outcomes in trials but benefit is assumed on the basis of observational studies, which report close associations between gastric dysmotility, enteral feed intolerance and poor outcomes, and improvement in surr...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Enteral vs. parenteral nutrition in septic shock: are they equivalent?
Purpose of review The current review focuses on recent clinical evidence and updated guideline recommendations on the effects of enteral vs. parenteral nutrition in adult critically ill patients with (septic) shock. Recent findigs The largest multicenter randomized-controlled trial showed that the route of nutrient supply was unimportant for 28-day and 90-day mortality, infectious morbidity and length of stay in mechanically ventilated patients with shock. The enteral route, however, was associated with lower macronutrient intake and significantly higher frequency of hypoglycemia and moderate-to-severe gastrointestina...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Enteral nutrition better than proton pump inhibitors?
Purpose of review Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis. Recent findings The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last tw...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Safety of vitamin C in sepsis: a neglected topic
Purpose of review Although vitamin C is essentially a nontoxic vitamin; however, it is important to be aware regarding the safety of high doses before the wide clinical use. Recent findings Minor side effects of vitamin C have been reported, many being reported in earlier studies. High doses of vitamin C (up to 1.5 g/kg three times a week as intravenously) were safe in cancer patients with normal renal function and perfect glucose-6-phosphate dehydrogenase activity. As the dose and duration of administration of vitamin C in sepsis are lower and shorter than those used in cancer patients, it seems that it is relative...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

The glutamine debate in surgery and critical care
Purpose of review Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. However, recently signals of risk have come from two large-scale multicenter trials evaluating GLN (and other nutrients) at high dose and as primary pharmaconutrients, not as supplementation to complete nutrition. These trials indicate a risk of increased mortality when GLN is given to patients in shock, renal failure, and early in acute phase of critical care. Recent fi...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Translating the European Society for Clinical Nutrition and Metabolism 2019 guidelines into practice
Purpose of review To present a pragmatic approach to facilitate clinician's implementing the recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on clinical nutrition in the intensive care unit. Recent findings The ESPEN guidelines include 54 recommendations with a rationale for each recommendation. All data published since 1 January 2000 was reviewed and 31 meta-analyses were performed to inform these guidelines. An important aspect of the most recent ESPEN guidelines is an attempt to separate periods of critical illness into discrete – early acute, late acute and recovery – p...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Feeding should be individualized in the critically ill patients
Purpose of review Any critical care therapy requires individual adaptation, despite standardization of the concepts supporting them. Among these therapies, nutrition care has been repeatedly shown to influence clinical outcome. Individualized feeding is the next needed step towards optimal global critical care. Recent findings Both underfeeding and overfeeding generate complications and should be prevented. The long forgotten endogenous energy production, maximal during the first 3 to 4 days, should be integrated in the nutrition plan, through a slow progression of feeding, as full feeding may result in early overfeed...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Is it time to abandon glucose control in critically ill adult patients?
Purpose of review To summarize the advances in literature that support the best current practices regarding glucose control in the critically ill. Recent findings There are differences between patients with and without diabetes regarding the relationship of glucose metrics during acute illness to mortality. Among patients with diabetes, an assessment of preadmission glycemia, using measurement of Hemoglobin A1c (HgbA1c) informs the choice of glucose targets. For patients without diabetes and for patients with low HgbA1c levels, increasing mean glycemia during critical illness is independently associated with increasin...
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Mette M. Berger Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - June 27, 2019 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research

Physician factors in utilizing haemodynamic data in patient care
Purpose of review To focus on the missing link between accuracy and precision of monitoring devices and effective implementation of therapeutic strategies. Recent findings Haemodynamic monitoring is generally considered to be an essential part of intensive care medicine. However, randomized controlled trials fail to demonstrate improved outcome unequivocally as a result of hemodynamic monitoring. This absence of solid proof renders doctors to hesitance to apply haemodynamic monitoring in clinical practise. Profound understanding of the underlying mechanisms, adequate patient selection and timing, meaningful representa...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Hemodynamic monitoring in the extracorporeal membrane oxygenation patient
Purpose of review Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow. This review discusses the various monitoring modalities relevant to the management of patients on venovenous ECMO (VV ECMO) and venoarterial (VA ECMO). We emphasize tools to judge the adequacy of perfusion, predict the response to fluid boluses, measure right ventricular function, assess left ventricular distention (for VA ECMO), and monitor the process of weaning from ECMO. We emphasize how differences between VV ECMO and VA ECMO are reflected in distinct ap...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Is microcirculatory assessment ready for regular use in clinical practice?
Purpose of review The present review discusses the current role of microcirculatory assessment in the hemodynamic monitoring of critically ill patients. Recent findings Videomicroscopic techniques have demonstrated that microvascular perfusion is altered in critically ill patients, and especially in sepsis. These alterations are associated with organ dysfunction and poor outcome. Handheld microscopes can easily be applied on the sublingual area of critically ill patients. Among the specific limitations of these techniques, the most important is that these can mostly investigate the sublingual microcirculation. The rep...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Transpulmonary thermodilution techniques in the haemodynamically unstable patient
Purpose of review Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique. Recent findings Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery cat...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Measuring cardiac output at the bedside
Purpose of review Bedside cardiac output (CO) measurement is an important part of routine hemodynamic monitoring in the differential diagnosis of circulatory shock and fluid management. Different choices of CO measurement devices are available. The purpose of this review is to review the importance of CO [or stroke volume (SV)] measurement and to discuss the various methods (devices) used in determination of CO. Recent findings CO measurement devices can be classified into two types: those use simple physical principles with minimal assumptions, and those predicting CO via mathematical modelling with a number of assum...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

What should I use next if clinical evaluation and echocardiographic haemodynamic assessment is not enough?
Purpose of review To provide an integrated clinical approach to the critically ill patients in shock. Recent findings The complexity behind shock mechanism has improved in the last decades; as consequence, conventional generalized practices have been questioned, in favour of different approaches, titrated to patient's individual response. Bedside clinical examination has been demonstrated to be a reliable instrument to recognize the mismatch between cardiac function and peripheral oxygen demand. Mottling skin and capillary refill time have been recently proposed using a semi-quantitative approach as reliable tool to g...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Echocardiographic assessment of left ventricular diastolic pressure
Purpose of review Knowledge of the left ventricular pressures throughout the cardiac cycle is of considerable assistance in managing a haemodynamically unstable patient. Invasive pressure measurement is the only accurate way to analyze ventricular diastolic pressures but this is not feasible outside the catheterization laboratory, whereas the use of a pulmonary artery catheter or Doppler echocardiography, using surrogate measurements, is available at the bedside. The ever-increasing trend toward noninvasive monitoring puts echocardiography at the forefront and considerable effort has been made to define its role in this ...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Optimizing fluid therapy in shock
Purpose of review Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock. Recent findings Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality. Summary We believe that the approach to fluid therapy must be i...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Editorial: Haemodynamic monitoring: the why, when, which and what
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean Source Type: research

Out-of-hospital cardiac arrest survivors need both cardiological and neurological rehabilitation!
Purpose of review Most survivors of out-of-hospital cardiac arrest (OHCA) suffer from cardiologic symptoms and approximately half of them experience cognitive problems because of hypoxic brain damage. Symptoms of anxiety and depression are also common. This review aims to give an overview of recent literature on rehabilitation treatment aiming at improvement of quality of life after OHCA. Recent findings Existing cognitive screening tools are now validated for OHCA survivors. OHCA patients with cognitive deficits may have lower exercise capacity. Cardiac rehabilitation seems to be well tolerated for OHCA survivors, wi...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

Assessment of neurocognitive function after cardiac arrest
Purpose of review Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest. Recent findings Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments. A subjective report is a simple method to screen for cognitive problems, but divergent fin...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

An international, consensus-derived Core Outcome Set for Cardiac Arrest effectiveness trials: the COSCA initiative
Purpose of review Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials – the COSCA initiative. Recent findings The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described. Working collaboratively with inte...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

In the ICU – delirium post cardiac arrest
Purpose of review The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium. Recent findings Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Recognizing delirium in postcardiac arrest patients can be challenging; however,...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

Assessing brain injury after cardiac arrest, towards a quantitative approach
Purpose of review Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury. Recent findings Qualitative assessment of clinical findings, neurophysiological signals and radiological images a...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

Cardiac arrest: prediction models in the early phase of hospitalization
Purpose of review There is a need for an early assessment of outcome in patients with return of spontaneous circulation after cardiac arrest. During the last decade, several models were developed in order to identify predictive factors that may facilitate prognostication and stratification of outcome. Recent findings In addition to prognostication tools that are used in intensive care, at least five scores were recently developed using large datasets, based on simple and immediately available parameters, such as circumstances of arrest and early in-hospital indicators. Regarding neurological outcome, predictive perfor...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research

Prehospital termination of resuscitation rule
Purpose of review The purpose of the review is to briefly describe the derivation, validation and implementation of the Termination of Resuscitation Rules for out-of-hospital adult cardiac arrest and to describe the controversies surrounding implementation that have been recently published. Recent findings New guidelines, new interventions that alter baseline survival, the use of eCPR and issues related to duration of CPR have minimal impact on the sustainability and application of the TOR rule. Some published articles related to using only one criterion in the rule may be cavalier and miss potential survivors. Deci...
Source: Current Opinion in Critical Care - April 26, 2019 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Hans Friberg Source Type: research