Pathophysiology of cardiogenic shock
We describe the pathophysiology of cardiogenic shock (CS), from the main pathways to the inflammatory mechanisms and the proteomic features.
Recent findings
Although the classical pathophysiological pathways underlying CS, namely reduced organ perfusion due to inadequate cardiac output and peripheral vasoconstriction, have been well-established for a long time, the role of macro-and micro-hemodynamics in the magnitude of the disease and its prognosis has been investigated extensively only over the last few years. Moreover, to complete the complex picture of CS pathophysiology, the study of cytokine cascade, inflamma...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Epidemiology and causes of cardiogenic shock
Purpose of review
Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. The purpose of this review is to describe the contemporary epidemiology of cardiogenic shock, including trends in clinical outcomes and recent efforts to refine risk assessment.
Recent fi...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Editorial: Managing the cardiogenic shock patient in the ICU
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Fabio Guarracino Source Type: research
Objective assessment of metabolism and guidance of ICU rehabilitation with cardiopulmonary exercise testing
Purpose of review
Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET).
Recent findings
Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function. This manifests in reduced aerobic exercise capacity and metabolic inflexibility. CPET-guided targeted metabolic conditioning...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Role of ketones, ketogenic diets and intermittent fasting in ICU
Purpose of review
To summarize the clinical evidence for beneficial effects of ketones, ketogenic diets and intermittent fasting in critical illness, and to review potential mechanisms behind such effects.
Recent findings
Recent evidence demonstrates that activation of a metabolic fasting response may be beneficial to recover from critical insults. Potential protective mechanisms are, among others, activation of ketogenesis and of damage removal by autophagy. Novel feeding strategies, including ketone supplements, ketogenic diets and intermittent fasting regimens, can activate these pathways – at least partial...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Vitamin D in critical care: where are we now and what is next?
Purpose of review
To summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19.
Recent findings
Vitamin D is a strong predictor for worse outcomes in critically ill patients, and as well in COVID-19. The vitamin D content in typical nutrition regimes is lower than what is recommended for the general population. Although its supplementation has been shown to reduce respiratory tract infections, asthma exacerbations and mortality risk in noncritically ill patients, its role in the acute setting is not yet clear. Several s...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Nutrients and micronutrients at risk during renal replacement therapy: a scoping review
Purpose of review
Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been described, there is no clear guidance regarding the role of micronutrient supplementation.
Recent findings
A scoping review was conducted with the aim to review the existing literature on micronutrients status during RRT: 35 publications including data on effluent losses and blood concentrations were considered relevant and analysed. For completeness, we also inc...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Novel methods to identify and measure catabolism
Purpose of review
Assess current potential catabolism-biomarkers to characterize patients developing prolonged critical illness.
Recent findings
A raised urea-to-creatinine ratio (UCR) during critical illness is negatively associated with muscle mass with greater increases in UCR seen patients developing persistent critical illness. Similarly, sarcopenia index (a ratio of creatinine to cystatin-c concentrations) correlates well to muscle mass in intensive care populations. Elevated growth/differentiation factor-15 (GDF-15) has been inconsistently associated with muscle loss. Although GDF-15 was a poor marker of ...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Monitoring muscle mass using ultrasound: a key role in critical care
Purpose of review
The loss of muscle mass in critically ill patients contributes to morbidity and mortality, and results in impaired recovery of physical functioning. The number of publications on the topic is increasing. However, there is a lack of consistent methodology and the most optimal methodology remains unclear, hampering its broad use in clinical practice.
Recent findings
There is a large variety of studies recently published on the use of ultrasound for assessment of muscle mass. A selection of studies has been made, focusing on monitoring of muscle mass (repeated measurements), practical aspects, fea...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness
Purpose of review
Insight into body composition is of great value in the ICU. Bioelectric impedance analysis (BIA) is the most applicable bedside technique. However, bioimpedance has not been validated in the critically ill, and the interpretation of the measurements poses challenges. This review discusses the potential clinical applications of BIA and explores caveats and solutions to its use in the intensive care setting.
Recent findings
A correlation is repeatedly found between raw impedance parameters, fluid ratios, overhydration, and adverse outcome of critical illness. However, cut-off and reference values...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Indirect calorimetry in critical illness: a new standard of care?
Purpose of review
Review recent literature on the role of indirect calorimetry in critical care nutrition management.
Recent findings
Critical illness demands objective, targeted nutritional therapy to prevent adverse effects of underfeeding/over feeding. Thus, all recent societal guidelines recommend indirect calorimetry use to determine energy needs. Very recently, indirect calorimetry technology has finally evolved to allow for accurate, simple, and routine utilization in a wider range of ICU patients. Recent data continues to confirm poor correlation between measured and equation-predicted energy expenditure...
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Editorial: Objective measurement of nutrition and metabolism in the ICU: the future of personalized metabolic therapy
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Paul E. Wischmeyer Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 12, 2021 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
How do we identify the crashing traumatic brain injury patient – the intensivist's view
Purpose of review
Over 40% of patients with severe traumatic brain injury (TBI) show clinically significant neurological worsening within the acute admission period. This review addresses the importance of identifying the crashing TBI patient, the difficulties appreciating clinical neurological deterioration in the comatose patient and how neuromonitoring may provide continuous real-time ancillary information to detect physiologic worsening.
Recent findings
The latest editions of the Brain Trauma Foundation's Guidelines omitted management algorithms for adult patients with severe TBI. Subsequently, three consens...
Source: Current Opinion in Critical Care - May 10, 2021 Category: Nursing Tags: SPECIAL COMMENTARY Source Type: research
Weaning patients with obesity from ventilatory support
Purpose of review
Obesity prevalence is increasing in most countries in the world. In the United States, 42% of the population is obese (body mass index (BMI) > 30) and 9.2% is obese class III (BMI > 40). One of the greatest challenges in critically ill patients with obesity is the optimization of mechanical ventilation. The goal of this review is to describe respiratory physiologic changes in patients with obesity and discuss possible mechanical ventilation strategies to improve respiratory function.
Recent findings
Individualized mechanical ventilation based on respiratory physiology after a decrementa...
Source: Current Opinion in Critical Care - May 10, 2021 Category: Nursing Tags: CARDIOPULMONARY MONITORING Source Type: research
