How do we identify the crashing traumatic brain injury patient – the neurosurgeon's view
Purpose of review
To provide an overview on recent advances in the field of assessment and monitoring of patients with severe traumatic brain injury (sTBI) in neurocritical care from a neurosurgical point of view.
Recent findings
In high-income countries, monitoring of patients with sTBI heavily relies on multimodal neurocritical parameters, nonetheless clinical assessment still has a solid role in decision-making. There are guidelines and consensus-based treatment algorithms that can be employed in both absence and presence of multimodal monitoring in the management of patients with sTBI. Additionally, novel dy...
Source: Current Opinion in Critical Care - March 10, 2021 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Markus B. Skrifvars Source Type: research
The features of the typical traumatic brain injury patient in the ICU are changing: what will this mean for the intensivist?
Purpose of review
To describe the key features and epidemiology of traumatic brain injury (TBI) and how they may be changing, with an emphasis on how this may affect care in the intensive care unit.
Recent findings
TBI has been traditionally perceived as occurring mainly in a younger, predominantly male population injured in high velocity motor vehicle crashes or assaults. However, there are an increasing number of patients over 65 years who have sustained a TBI secondary to low velocity falls. Considering the effects of frailty, comorbidities and extracranial injuries is important when making management decis...
Source: Current Opinion in Critical Care - March 10, 2021 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Markus B. Skrifvars Source Type: research
Editorial: Recent advances in the management of acute neurological problems in the ICU
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - March 10, 2021 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Markus B. Skrifvars Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - March 10, 2021 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Bedside noninvasive monitoring of mechanically ventilated patients
Purpose of review
Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.
In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients.
Recent findings
The use of EIT in clinical practice is supported by several studies demonstrat...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Noninvasive ventilation and high-flow nasal oxygen for acute respiratory failure: is less more?
Purpose of review
High-flow nasal oxygen and noninvasive ventilation (NIV) are two strategies representing an alternative to standard oxygen in the management of respiratory failure.
Recent findings
Although high-flow nasal oxygen has shown promising results in patients with de-novo acute respiratory failure, further large clinical trials are needed to determine the best oxygenation strategy. As NIV may have deleterious effects, especially in patients generating strong inspiratory efforts, protective NIV using higher levels of positive-end expiratory pressure, more prolonged sessions and additional interfaces su...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Mechanical ventilation of the healthy lungs: lessons learned from recent trials
Purpose of review
Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs.
Recent findings
Use of low tidal volume during operative ventilation decreases postoperative pulmonary complications (PPC). In the critically ill patients with healthy lungs, use of low tidal volume is as effective as intermediate tidal volume. Use of higher PEEP during operat...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Biomarkers in acute respiratory distress syndrome
This article provides an overview of protein biomarkers for acute respiratory distress syndrome (ARDS) and their potential use in future clinical trials.
Recent findings
The protein biomarkers studied as indices of biological processes involved in the pathogenesis of ARDS may have diagnostic and/or prognostic value. Recently, they also proved useful for identifying ARDS phenotypes and assessing heterogeneity of treatment effect in retrospective analyses of completed clinical trials.
Summary
This article summarizes the current research on ARDS biomarkers and provides insights into how they should be integrated...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Airway management in the critically ill
Purpose of review
To provide an evidence-based approach to improve first pass success in tracheal intubation while maintaining patient safety in the critically ill.
Recent findings
Despite advances in the management of critically ill patients, tracheal intubation in these patients remains a high-risk procedure associated with increased morbidity and mortality. Recent interventions to enhance patient safety and improve first pass success in tracheal intubation emphasize reducing repeated attempts at tracheal intubation, oxygen desaturation and cardiovascular collapse during airway management by optimizing patient...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Weaning the patient: between protocols and physiology
Purpose of review
Ventilator weaning forms an integral part in critical care medicine and strategies to shorten duration are rapidly evolving alongside our knowledge of the relevant physiological processes. The purpose of the current review is to discuss new physiological and clinical insights in ventilator weaning that help us to fasten liberation from mechanical ventilation.
Recent findings
Several new concepts have been introduced in the field of ventilator weaning in the past 2 years. Approaches to shorten the time until ventilator liberation include frequent spontaneous breathing trials, early noninvasive m...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Emerging cellular and pharmacologic therapies for acute respiratory distress syndrome
Purpose of review
Advances in our understanding of the pathophysiology and biology of ARDS has identified a number of promising cellular and pharmacological therapies. These emerging therapeutics can modulate the immune response, reduce epithelial injury, target endothelial and vascular dysfunction, have anticoagulant effects, and enhance ARDS resolution.
Recent findings
Mesenchymal stromal cell therapy shows promise in earlier phase clinical testing, whereas a number of issues regarding clinical translation, such as donor and effect variability, are currently being optimized to enable larger scale clinical tria...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Preparedness of ICU networks for pandemics
Purpose of review
The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries’ healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons.
Recent findings
Appropriate separate paths for infected and noninfected patients and prompt isolation of infected critical patients in dedicated ICUs play a pivotal role in limiting the contagions and optimizing resources during pandemics. The key to handle these challenging...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Ventilation of coronavirus disease 2019 patients
Purpose of review
To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19.
Recent findings
Early reports suggested that COVID-19 is an ‘atypical ARDS’ with profound hypoxemia with normal respiratory system compliance (Crs). Contrarily, several more populated analyses showed that COVID-19 ARDS has pathophysiological features similar to non-COVID-19 ARDS, with reduced Crs, and high heterogeneity of respiratory mechanics, hypoxemia severity, and lung recruitability. There is no evidence supporting COVID-19-specific ventilatory settings, and the v...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Monitoring the patient for a safe-assisted ventilation
Purpose of review
A growing evidence shows that injurious spontaneous breathing, either too weak or too strong, may injure lung and diaphragm. The purpose of review is to understand why we need monitoring for safe spontaneous breathing, and to know the target value of each monitoring to preserve safe spontaneous breathing during assisted ventilation.
Recent findings
Lung protection sometimes goes counter to diaphragm protection. For instance, silence of respiratory muscle activity is necessary to minimize lung injury from vigorous spontaneous effort in acute respiratory distress syndrome, but it may also have a ...
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Bellani Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - December 29, 2020 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
