The place of extracorporeal life support in cardiogenic shock
This article provides an overview on new cardiogenic shock classification, currently available devices, place of TCS in the management of cardiogenic shock patients, and discusses the results of recent case series and trials in this setting. Recent finding A new classification system for cardiogenic shock has recently been proposed to homogenize definitions of cardiogenic shock and appropriately differentiate patient subsets in clinical trials and registries. Although the routine use of intraaortic balloon pump is no more recommended, other TCS are increasingly used and investigated but many advantages favor the use of ...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

Kidney and liver dysfunction in cardiogenic shock
Purpose of review Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock. Recent findings Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction. Kidney and liver injury and dysfunction will markedly increase m...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

Vasopressor use in cardiogenic shock
Purpose of review Data and interventional trials on vasopressor 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 the present article, we review the current use of vasopressor therapy during cardiogenic shock. Recent findings Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in pat...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

Inotropic agents in cardiogenic shock
Purpose of review Cardiogenic shock is a multifactorial and diverse entity in which inotropes are the cornerstone therapy. Although published clinical trials have focused on pharmacologic treatment of cardiogenic shock, there is lack of an established and widely accepted decision-making algorithm on the use of inotropic agents in cardiogenic shock. Recent findings The current review incorporates cardiogenic shock pathophysiology, inotropes and vasopressors pharmacodynamics. It emphasizes on each agent's indications, potential adverse effects, highlights special considerations and fsummarizes the recent guidelines. Su...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

Cardiogenic shock: role of invasive cardiology
Purpose of review Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related cardiogenic shock. Recent findings On the basis of the SHOCK trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related cardiogen...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

An outlook on biomarkers in cardiogenic shock
Purpose of review Cardiogenic shock is a severe complication with mortality rates of ∼50% that requires a rapid and complex management to aid and identify the highest and lowest risk patients. To that end, novel cardiogenic shock biomarkers are needed to improve risk stratification and to personalize therapy. Recent findings Established biomarkers such as BNP, NT-proBNP, ST2, and troponins provide insufficient predictive value in cardiogenic shock. More recent biomarkers, including DPP3, adrenomedullin, angiopoietin 2, and the CS4P score are gaining momentum. DPP3 showed early prediction of refractory status and s...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

How to assess the severity of heart failure?
Purpose of review Mortality rates for acute decompensated heart failure and cardiogenic shock remain unacceptably high despite advances in medical therapy and mechanical circulatory support. Systems designed to quickly and accurately identify and risk stratify these patients are needed in order to improve survival. Recent findings The Society for Cardiovascular Angiography and Interventions developed an expert consensus statement aimed at early identification and assessment of patients with advanced heart failure and cardiogenic shock. Recent studies have validated this novel classification system within several large...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Alexandre Mebazaa Source Type: research

Bone metabolism and fracture risk during and after critical illness
Purpose of review There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies. Recent findings Critical illness is associated with an increase in bone turnover and with an uncoupling between bone resorption and bone formation. This results in loss of bone mass, as highlighted by changes in bone marker serum levels and in bone mineral density. Data suggest that ICU survivors are at an increased risk of bone f...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Novel approaches to metabolic assessment and structured exercise to promote recovery in ICU survivors
In conclusion, we must continue to look to other areas of medicine and to athletes if we hope to ultimately improve ‘ICU Survivorship’. (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Metabolic support in sepsis: corticosteroids and vitamins: the why, the when, the how
Purpose of review Sepsis is a global health issue, and there is a need for effective, low-cost adjunct metabolic treatments. Corticosteroids have been investigated in many trials for decades, and recently the administration of vitamin C, thiamine (vitamin B1), and vitamin D have been proposed as novel therapies in patients with sepsis. Recent findings APROCCHSS (N = 1241) and ADRENAL (N = 3800) trial reported inconsistent results in mortality outcome; however, both demonstrated a decreased duration of shock with low-dose corticosteroids. The CITRIS-ALI trial (N = 170) examined the effects of intravenous vi...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Trace element and vitamin deficiency: quantum medicine or essential prescription?
Purpose of review In critical care, micronutrients remain perceived as ‘quantum’ part, that is, a little pertinent component of therapy. Some micronutrients have attracted more attention because of their antioxidant properties. During the last decade, some large size trials have tested their therapeutic potential, generally as ‘single high-dose micronutrient intervention’, with variable success. This review aims at taking stock of most recent. Recent findings Micronutrient blood levels are generally low in ICU patients, which has prompted the concept of replenishing or compensating deficits, or...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Mitochondrial dysfunction in critical illness during acute metabolic stress and convalescence: consequences for nutrition therapy
Purpose of review Mitochondrial dysfunction is associated with increased morbidity and mortality during and after critical illness. The concept of adaptive mitochondrial metabolic-bio-energetic downregulation rather than bio-energetic failure during the acute phase of critical illness has gained traction. As mitochondria are not able to utilize substrate during adaptive hibernation and aggressive feeding induces further harm, this condition has consequences for nutrition therapy. Recent findings Meeting resting energy expenditure in early critical illness is associated with enhanced oxidative stress and attenuation of...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Continuous versus intermittent feeding of the critically ill: have we made progress?
Purpose of review Despite the lack of high-quality data for many years, the discussion on the best modality for enteral nutrition has been going on with little changes pertaining in recent guidelines. The present work aims to provide an overview on the different arguments in favour of either continuous or noncontinuous modes of enteral feed administration, emphasizing both clinical and pathophysiological aspects and comparing their relevance. Recent findings Different physiological effects deriving from enteral nutrition modes and that could impact on outcomes of care under critical illness settings are examined, such...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

The best recipe: fat-based, protein-based, single amino acids?
Purpose of review Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients. Recent findings Larger proportion of carbohydrates than lipids is usual in most of the commercial products. However, patients suffering from sepsis and from acute kidney injury preferentially utilize lipids. Parenteral omega-3-fatty acids, in particular, may be beneficial. Protein source and amount are important factors to achieve the best absorption and an i...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Practical applications of nutritional scores
Purpose of review Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care. The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. Recent findings Critical...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Editorial: A potpourri of nutrition and metabolism in the ICU
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research

Parameters of fluid responsiveness
Purpose of review On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness. Recent findings Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart–...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

How to assess ventriculoarterial coupling in sepsis
Purpose of review We will highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it. Recent findings Most septic patients show a ventriculoarterial uncoupling at the time of diagnosis with arterial elastance (Ea) greater than left ventricle (LV) end-systolic elastance (Ees), often despite arterial hypotension. Ventriculoarterial coupling levels predict the cardiovascular response to resuscitation in this heterogeneously responding population. Summary Ventriculoarterial coupling is quantified as the ratio of Ea to Ees. The efficiency of the cardiovascular function is opt...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

This is your toolkit in hemodynamic monitoring
Purpose of review To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables. Recent findings The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be suf...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Focused ultrasonography for septic shock resuscitation
Purpose of review Severe sepsis with septic shock is the most common cause of death among critically ill patients. Mortality has decreased substantially over the last decade but recent data has shown that opportunities remain for the improvement of early and targeted therapy. This review discusses published data regarding the role of focused ultrasonography in septic shock resuscitation. Recent findings Early categorization of the cardiovascular phenotypes with echocardiography can be crucial for timely diagnosis and targeted therapy of patients with septic shock. In the last few years, markers of volume status and vo...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Monitoring mitochondrial PO2: the next step
Purpose of review To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level. Recent findings Mitochondrial oxygen tension can be measured by means of the protoporphyrin IX-Trip...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Regional perfusion monitoring in shock
Purpose of review Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included. Recent findings We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Automated quantification of tissue red blood cell perfusion as a new resuscitation target
Purpose of review Identification of insufficient tissue perfusion is fundamental to recognizing circulatory shock in critically ill patients, and the primary target to restore adequate oxygen delivery. However, the concept of tissue perfusion remains ill-defined and out-of-reach for clinicians as point-of-care resuscitation target. Even though handheld vital microscopy (HVM) provides the technical prerequisites to collect information on tissue perfusion in the sublingual microcirculation, challenges in image analysis prevent quantification of tissue perfusion and manual analysis steps prohibit point-of-care application. ...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Monitoring coherence between the macro and microcirculation in septic shock
Purpose of review Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. Recent findings Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the de...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research

Individualized blood pressure targets during postcardiac arrest intensive care
Purpose of review To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics. Recent findings Observational data suggest that mean arterial pressure (MAP) below 65–75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care a...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

Optimal ventilator settings after return of spontaneous circulation
Purpose of review To describe current practice, recent advances in knowledge and future directions for research related to the post return of spontaneous circulation (ROSC) ventilatory management of cardiac arrest patients. Recent findings Out-of-hospital cardiac arrest (OHCA) is a major public health problem with an estimated incidence of approximately one per 1000 persons per year. A priority of intensive care management of resuscitated OHCA patients is to reduce secondary reperfusion injury. Most OHCA patients are mechanically ventilated. Most of these require mechanical ventilation as they are unconscious and for ...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

Drugs during cardiopulmonary resuscitation
Purpose of review The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. Recent findings Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, cal...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

The impact of intra-arrest hypothermia
Purpose of review To address the impact of therapeutic hypothermia induced already during cardiopulmonary resuscitation (i.e. intra-arrest cooling) and its association with neurologic functional outcome. Recent findings Intra-arrest cooling is superior than post-ROSC cooling to mitigate brain injuries in experimental models of cardiac arrest. The delayed initiation of hypothermia in human studies may not have adequately addressed the underlying pathophysiology of ischemia and reperfusion. The assessment of early initiation of cooling has been complicated by increased rate of hemodynamic adverse events caused by infusi...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

Extracorporeal cardiopulmonary resuscitation for cardiac arrest
Purpose of review Extracorporeal cardiopulmonary resuscitation (ECPR) is a contemporary resuscitation approach that employs veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This approach is increasingly used worldwide to mitigate the widespread hemodynamic and multiorgan dysfunction that accompanies cardiac arrest. Recent findings In this review, the physiology of VA-ECMO and ECPR, the role of ECPR in contemporary resuscitation care, the complications associated with ECPR and VA-ECMO usage, and intensive care considerations for this population are discussed. Summary ECPR offers a promising mechanism to ...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

Monitor the quality of cardiopulmonary resuscitation in 2020
Purpose of review The current review will give an overview of different possibilities to monitor quality of cardiopulmonary resuscitation (CPR) from a physiologic and a process point of view and how these two approaches can/should overlap. Recent findings Technology is evolving fast with a lot of opportunities to improve the CPR quality. The role of smartphones and wearables are step-by-step identified as also the possibilities to perform patient tailored CPR based on physiologic parameters. The first steps have been taken, but more are to be expected. In this context, the limits of what is possible with human provide...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research

Management of severe upper gastrointestinal bleeding in the ICU
Purpose of review Upper gastrointestinal bleeding (UGIB) is a common condition that can lead to significant morbidity and mortality. Critical care physicians usually get involved in the care of patients with severe UGIB that is associated with hemodynamic compromise. We aim to provide the readers with evidence-based review of the management of patients with severe UGIB. Recent findings Proton pump inhibitors are the main pharmacologic intervention for UGIB, along with adequate resuscitation and timely endoscopic intervention. Endoscopic therapy should be performed as soon as haemodynamics stabilization is achieved, wh...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Evaluation and management of abdominal sepsis
Purpose of review The review focuses on the evaluation and management of abdominal sepsis. Recent findings A multitude of surgical approaches towards abdominal sepsis are practized in the world and may be associated with significant morbidity and mortality rates. Despite decades of sepsis research, no specific therapies for sepsis have emerged. Without specific therapies, the management of abdominal sepsis is based on the control of the infection and organ support. Summary Early clinical diagnosis, adequate source control to stop ongoing contamination, appropriate antibiotic therapy dictated by patient and infectio...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Update on nutritional assessment and therapy in critical care
Purpose of review To summarize recent data regarding nutritional assessment and interventions in the ICU. Recent findings Current methods to assess nutritional risk do not allow identification of ICU patients who may benefit from specific nutritional intervention. Early full energy delivery does not appear to improve outcomes at the population level. Specific nutrient composition of formula has been shown to improve glycemic outcomes in patients with hyperglycemia but patient-centered outcomes are unaffected. Summary Based on recent studies, full energy feeding early during critical illness has no measurable benefi...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Evaluation and management of intraabdominal hypertension
Purpose of review The purpose of this review is to provide an overview of the pathophysiology of intraabdominal hypertension/compartment syndrome and to review the recent advances in the areas of evaluation and management of this disorder. Recent findings The incidence of intraabdominal hypertension (IAH) in intensive care units is as high as 45%, an incidence much higher than initially suspected. Despite decompressive laparotomy as a treatment, mortality in patients who developed abdominal compartment syndrome (ACS) requiring this procedure is as high as 50%. Some patients may be treated by fewer invasive methods, su...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

The gastrointestinal system in the critically ill cirrhotic patient
Purpose of review ICU admissions due to complications of advanced liver disease continue to rise. Among indications for admission to the ICU in patients with cirrhosis, gastrointestinal issues such as bleeding are common. In patients in whom gastrointestinal issues are not the principal indication for ICU, gastrointestinal issues such as nutrition and ileus remain important concerns for generalized intensive care support. This review highlights current trends in management of gastrointestinal issues in patients with cirrhosis admitted to the ICU. Recent findings General management of upper gastrointestinal bleeding re...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Update on extracorporeal liver support
Purpose of review Extracorporeal liver support (ELS) is a large unmet need in day-to-day hepatology practice. In an era of ever-improving outcomes with liver transplantation for very sick patients with either acute liver failure (ALF) or acute-on-chronic liver failure, the outcomes for similar patients who are ineligible for transplantation remains poor. Providing a bridge to recovery from these catastrophic conditions is the aim of ELS, and we aim to review the evidence to date of different ELS devices as well as look to the future of ELS device development. Recent findings Studies on different ELS devices shave been...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Critical care considerations in the management of acute-on-chronic liver failure
Purpose of review Patients with cirrhosis are frequently hospitalized with acute decompensation and organ system failure – a syndrome referred to as acute on chronic liver failure (ACLF). These patients often require critical care intervention and experience significant mortality; however, established diagnostic and prognostic criteria are lacking. Given this, it remains imperative for intensivists to develop an expertise in common ACLF complications and management. Recent findings Liver transplantation serves as the definitive management strategy in ACLF. Traditional organ allocation procedures are based on the...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Update on the management of acute liver failure
Purpose of review The aim of this article is to provide the reader with an overview of established standards of care and to summarize important newer research findings in acute liver failure (ALF). Recent findings New international guidelines are now in place with recommendations for medical care and nutritional support. Large-scale retrospective studies have confirmed the low level of bleeding complications observed, despite apparently severe coagulopathy on standard laboratory testing, and the improved survival seen with continuous rather than intermittent forms of renal replacement therapy. Advances in neurologic s...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Gastrointestinal and hepatic critical care: a domain of intensive care in evolution
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research

Brain death: optimizing support of the traumatic brain injury patient awaiting organ procurement
Purpose of review Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply–demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs. Recent findings Recipient outcomes are not worsened when transplanting organs from donors who were declared dead after traumatic brain injury. Protocolized donor management improves overall organ procurement rates and subsequent organ function. Longer periods of active managem...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Early mobilization in neurocritical care patients
Purpose of review To examine the potential benefits of early mobilization in neurocritically ill patients and to summarize the recent evidence for and against early mobilization. Recent findings Early ICU mobilization in medically critically ill patients may decrease ICU and hospital length of stay, increase discharge-to-home, and reduce medical costs. Whether these benefits apply to neurologically critically ill patients remains unclear, as neuro ICU patients are often excluded from trials of early mobility. Neurocritically ill patients may present with hemodynamic instability, acute hemiplegia, altered consciousness...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Extracranial complications after traumatic brain injury: targeting the brain and the body
Purpose of review The aim of this review is to provide an update on the pathophysiology and treatment of severe traumatic brain injury (TBI)-related complications on extracranial organs. Recent findings Extracranial complications are common and influence the outcome from TBI. Significant improvements in outcome in a sizeable proportion of patients could potentially be accomplished by improving the ability to prevent or reverse nonneurological complications such as pneumonia, cardiac and kidney failure. Prompt recognition and treatment of systemic complications is therefore fundamental to care of this patient cohort. H...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Minimally invasive surgery for intracerebral hemorrhage
Purpose of review Spontaneous intracerebral hemorrhage (ICH) is common, associated with a high degree of mortality and long-term functional impairment, and remains without effective proven treatments. Surgical hematoma evacuation can reduce mass effect and decrease cytotoxic effects from blood product breakdown. However, results from large clinical trials that have examined the role of open craniotomy have not demonstrated a significant outcome benefit over medical management. We review the data on minimally invasive surgery (MIS) that is emerging as a treatment modality for spontaneous ICH. Recent findings The use of...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Anticoagulation reversal for intracranial hemorrhage in the era of the direct oral anticoagulants
Purpose of review This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility. Recent findings Increases in prescribing of DOACs has led to the introduction of drug-specific reversal agents. The clinical trials that evaluated these agents did not include a comparator arm making it difficult to determine if they are clinically superior to nonspecific reversal agents. Summary Numerous options for re...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Eyeing up the injured brain: automated pupillometry and optic nerve sheath diameter
Purpose of review Multimodal monitoring has emerged as a novel paradigm of care in acute brain injury, and in this context the value of noninvasive devices is increasingly under scrutiny. This narrative review summarizes recent clinical investigation focused on the role of automated infrared pupillometry (AIP) and optic nerve sheath diameter (ONSD) ultrasound as novel techniques to monitor and manage neurocritical care patients. Recent findings AIP provides a quantitative measurement of the pupillary light reflex that is more precise and reliable than the traditional examination of the pupillary light reflex using man...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Treatment targets based on autoregulation parameters in neurocritical care patients
Purpose of review This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow. Recent findings The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice. It is hypothesized that if both pressures are used as individual targets and followed, the incidence and severity of dysautoregulation will dim...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Molecular biomarkers in the neurological ICU: is there a role?
Purpose of review The aim of the article is to summarize recent advances in the field of molecular biomarkers in neurocritical care. Recent findings Advances in ultrasensitive immunoassay technology have made it possible to measure brain-derived proteins that are present at subfemtomolar concentrations in blood. These assays have made it possible to measure neurofilament light chain (NfL) in serum or plasma, and early studies indicate that NfL is a promising prognostic and pharmacodynamic biomarker across a broad range of neurologic disorders, including cardiac arrest and traumatic brain injury. However, as acquired b...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

Quality improvement in neurocritical care: current state and looking to the future
Purpose of review Neurocritical care has matured as a field and there is now a growing body of literature on the subject of quality improvement in neurocritically ill patients. This review will highlight major recent contributions in this field and discuss future directions. Recent findings Articles published in the past 18 months have evaluated neurocritical care unit staffing, structure, and disease-specific protocols including subarachnoid hemorrhage and severe traumatic brain injury management. An assessment of current quality improvement practices in neurocritical care was also conducted. A neurocritical care-spe...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research