Editorial: Critical care outcomes in the context of a pandemic
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: CRITICAL CARE OUTCOMES: Edited by Hayley B. Gershengorn Source Type: research
Janus Kinase inhibitors for the treatment of hospitalized patients with COVID-19
Purpose of review
Janus Kinase (JAK) inhibitors have been successfully utilized in the clinical treatment of several rheumatologic (e.g. rheumatoid arthritis) and inflammatory diseases (e.g. hemophagocytic lymphohistiocytosis). Based on the growing evidence that moderate and severe COVID-19 infections are associated with a dysregulated inflammatory state, this class of medications has been repurposed as a potential therapy for COVID-19, an infection caused by Severe Acute Respiratory Syndrome Coronavirus 2.
Recent findings
Three JAK inhibitors have been evaluated in human studies of COVID-19: Baricitinib, Tofaci...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
What is the role of remdesivir in patients with COVID-19?
Purpose of review
COVID-19 represents an unprecedented public health crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The antiviral remdesivir is one component of treating COVID-19. Unfortunately, the trials evaluating remdesivir have reported mixed results, leading to uncertainty on when to use remdesivir. This review discusses the trials evaluating the efficacy of remdesivir for COVID-19 and other supporting data to help inform the role of remdesivir in patients with COVID-19.
Recent findings
Since the start of the pandemic, there have been four randomized trials of remdesivir...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Is there a role for immune-enhancing therapies for acutely ill patients with coronavirus disease 2019?
Purpose of review
Although the so-called cytokine storm has been early described and related to a dramatic evolution in severe COVID-19 patients, it soon became clear that those patients display clinical and biological evidence of an immunosuppressive state characterized, among other, by a profound lymphopenia. The negative role of this immune suppression on the outcome raises the question on immune therapies that might improve patient's condition.
Recent findings
Important positive effects of active immune therapies, such as IL-7 or thymosin-α are already described and warrant confirmation in larger prospectiv...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?
Purpose of review
To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates.
Recent findings
In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings. Patients with severe COVID-19 present a phenotype of multiorgan dysfunction that leads to death in an unacceptable high percentage of the patients, with...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Secondary pneumonias in critically ill patients with COVID-19: risk factors and outcomes
Purpose of review
The aim of this review is to provide an overview of the current evidence of secondary pneumonias in COVID-19 patients, its incidence, risk factors and impact outcomes.
Recent findings
Early studies reported low incidence of hospital-acquired infections in COVID-19 patients. More recent large studies clearly showed that the incidence of secondary pneumonias was markedly high in patients under mechanical ventilation. Duration of mechanical ventilation, acute respiratory distress syndrome, prone position and male sex were identified as risk factors. The adjunctive therapy with steroids and immunom...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Coronavirus disease 2019 respiratory failure: what is the best supportive care for patients who require ICU admission?
Purpose of review
Currently, there is no cure for SARS-CoV-2 infection, yet hospital mortality rates for COVID-19 have improved over the course of the pandemic and may be due in part to improved supportive care in the ICU. This review highlights the evidence for and against various ICU supportive therapies for the treatment of critically ill patients with COVID-19.
Recent findings
Early in the pandemic, there was great interest in novel ICU supportive care, both for the benefit of the patient, and the safety of clinicians. With a few exceptions (e.g. prone ventilation of nonintubated patients), clinicians abando...
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Editorial: COVID-19: A New Severe Infection
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Andre C. Kalil Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 3, 2021 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Hemodynamic monitoring in cardiogenic shock
Purpose of review
Cardiogenic shock remains a major cause of mortality today. With recent advancements in invasive mechanical support strategies, reperfusion practice, and a new classification scheme is proposed for cardiogenic shock, an updated review of the latest hemodynamic monitoring techniques is important.
Recent findings
Multiple recent studies have emerged supporting the use of pulmonary artery catheters in the cardiogenic shock population. Data likewise continues to emerge on the use of echocardiography and biomarker measurement in the care of these patients.
Summary
The integration of multiple ...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Mechanical ventilation in cardiogenic shock
Purpose of review
Mechanical ventilation is frequently needed in patients with cardiogenic shock. The aim of this review is to summarize and discuss the current evidence and the pathophysiological mechanism that a clinician should consider while setting the ventilator.
Recent findings
Little attention has been placed specifically to ventilatory strategies in patients with cardiogenic shock undertaking mechanical ventilation. Lung failure in patients with cardiogenic shock is associated with worsening outcome as well as a delay in mechanical ventilation institution. The hemodynamic profile and cardiogenic shock c...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
The mechanical support of cardiogenic shock
Purpose of review
Cardiogenic shock (CS) therapy involving catecholamines, inotropes, fluids and revascularization is often insufficient, and short-term mortality remains 50%. Different treatment algorithms and mechanical circulatory support devices (MCS) have been increasingly used in the treatment of CS. Coronavirus disease 2019 (COVID-19) pandemic is a major challenge faced by intensive care medicine providers inevitably influencing also CS management.
Recent findings
There is a lack of prospective data as well as international consensus regarding CS classification, patient risk stratification, and MCS use. V...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Interventional treatment of acute myocardial infarction-related cardiogenic shock
Purpose of review
Acute revascularization is with some evidence the only intervention proven to improve the prognosis in myocardial infarction-related cardiogenic shock but several interventions are continuously being investigated in order to increase survival among these patients. In this review, several aspects related to the interventional treatment of cardiogenic shock are discussed chronologically from symptom debut to leaving the cardiac catheterization laboratory.
Recent findings
In the randomized CULPRIT-SHOCK trial, a culprit-only revascularization strategy was reported superior to immediate complete re...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
The medical treatment of cardiogenic shock: cardiovascular drugs
Purpose of review
To discuss the use of vasopressors and inotropes in cardiogenic shock.
Recent findings
The classic form or cardiogenic shock requires administration of inotropic and/or vasopressor agents to try to improve the impaired tissue perfusion. Among vasopressors various alpha-adrenergic agents, vasopressin derivatives and angiotensin can be used. The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses. On the contrary, epinephrine is associated with an increased incidence of refractory shoc...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Managing the first 120 min of cardiogenic shock: from resuscitation to diagnosis
We describe a structured ABCDE approach involving stabilization of the airway, breathing and circulation, followed by damage control and etiologic assessment. Respiratory failure is common and many cardiogenic shock patients require invasive mechanical ventilation. Norepinephrine is titrated to restore mean arterial pressure and dobutamine is titrated to restore cardiac output and organ perfusion. Echocardiography is essential to identify potential causes and characterize the phenotype of cardiogenic shock. Coronary angiography is usually indicated, particularly when acute myocardial ischemia is suspected, followed by culp...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
