Evaluation and management of the surgical abdomen
Purpose of review
The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill.
Recent findings
Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approache...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bryan A. Cotton Source Type: research
Prevention, diagnosis, and management of venous thromboembolism in the critically ill surgical and trauma patient
Purpose of review
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is common among trauma patients and critically ill surgical patients admitted to the ICU. Critical care surgical patients are at an extremely high risk for VTE and the related morbidity and mortality associated with it. The present review aims to provide an overview of the importance of identifying risk factors, prescribing effective prohylaxis, accurate diagnosis, and timely appropriate treatment for trauma and critically ill surgical patients with VTE in the ICU.
Recent findings
VTE is a healthcare burden a...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bryan A. Cotton Source Type: research
Assessment and management of agitation, sleep, and mental illness in the surgical ICU
Purpose of review
Increased focus on patient-centered outcomes, mental health, and delirium prevention makes this review timely and relevant for critical care.
Recent findings
This review focuses on patient-centered outcomes in the ICU, highlighting the latest research to promote brain health and psychological recovery during and after perioperative critical illness. Topics include sedation in the obese patient, delirium severity assessments, the role of the Psychiatry Consultation-Liaison in the ICU, Post-intensive care syndrome, and the importance of family engagement in the COVID era.
Summary
Highlighting new re...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bryan A. Cotton Source Type: research
Pain management in the surgical ICU patient
Purpose of review
Acute pain management in the surgical ICU is imperative. Effective acute pain management hastens a patient's return to normal function and avoid the negative sequelae of untreated acute pain. Traditionally, opioids have been the mainstay of acute pain management strategies in the surgical ICU, but alternative medications and management strategies are increasingly being utilized.
Recent findings
Extrapolating from lessons learned from enhanced recovery after surgery protocols, surgical intensivists are increasingly utilizing multimodal pain regimens (MMPRs) in critically ill surgical patients recoveri...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bryan A. Cotton Source Type: research
Nutrition in the critically ill surgical patient
Purpose of review
The aim of this study was to discuss recent findings related to providing adequate and well tolerated nutrition to the critically ill surgical patient.
Recent findings
The majority of nutritional studies in the critically ill have been performed on well nourished patients, but validated scoring systems can now identify high nutrition risk patients. Although it remains well accepted that early enteral nutrition with protein supplementation is key, mechanistic data suggest that hypocaloric feeding in septic patients may be beneficial. For critically ill patients unable to tolerate enteral nutrition, ra...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bryan A. Cotton Source Type: research
The limitations of evidence: increasing data and increasing doubt in the treatment of cardiac arrest
Purpose of review
Cardiac arrest is one of the most challenging disease processes to study with clinical trials due to the emergent and unpredictable nature of these events and complexity of the patient population. In recent years, there has been a major push to complete more large, multicentre trials. In many cases, however, there remains little certainty on what treatments are most efficacious, in spite of the recent increase in evidence. This review was undertaken to address some of the unique barriers to address answering research questions in cardiac arrest with clinical trials.
Recent findings
Multiple examples ...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION AND OTHER EMERGENCIES: Edited by Katherine M. Berg Source Type: research
Uses and pitfalls of measurement of end-tidal carbon dioxide during cardiac arrest
Purpose of review
To discuss recent studies relevant to the utility of measuring end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and its correlation with outcome in adults experiencing cardiac arrest.
Recent findings
Over the past couple of years, at least five studies have included measurement of ETCO2 in their methods. Two of these studies were prospective and two retrospective. All considered ETCO2 measurements after out-of-hospital cardiac arrest, either in the prehospital setting, or after arrival in the emergency department. All assessed for an association between ETCO2 measurement an...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION AND OTHER EMERGENCIES: Edited by Katherine M. Berg Source Type: research
Point-of-care cardiac ultrasound during cardiac arrest: a reliable tool for termination of resuscitation?
Purpose of review
Point-of-care ultrasound (POCUS) is commonly used during cardiac arrest to screen for potential causes and to inform termination of resuscitation. However, unique biases and limitations in diagnostic and prognostic test accuracy studies lead to potential for misinterpretation. The present review highlights recent evidence regarding POCUS in cardiac arrest, guides the incorporation of POCUS into clinical management, and outlines how to improve the certainty of evidence.
Recent findings
Multiple frameworks organize and direct POCUS during cardiac arrest. Although many are proofs of concept, several hav...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION AND OTHER EMERGENCIES: Edited by Katherine M. Berg Source Type: research
Refractory cardiac arrest: where extracorporeal cardiopulmonary resuscitation fits
Purpose of review
Extracorporeal cardiopulmonary resuscitation (ECPR) is a powerful technique increasingly used to care for patients with refractory cardiac arrest. This review will detail where ECPR fits in the current care of cardiac arrest patients, including the key aspects of ECPR deployment and patient selection shown to maximize its benefit.
Recent findings
ECPR has been shown to improve neurologically favourable survival in patients with refractory cardiac arrest in numerous nonrandomized cohort studies. The haemodynamic, oxygenation and ventilation support provided by ECPR eliminates the need for return of sp...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION AND OTHER EMERGENCIES: Edited by Katherine M. Berg Source Type: research
Epinephrine for cardiac arrest: knowns, unknowns and controversies
Purpose of review
The aim of this study was to describe our knowledge about the use of epinephrine in cardiac arrest and discuss the unknowns and current controversies.
Recent findings
A recent large, well conducted, double-blind, randomized placebo-controlled trial of over 8000 patients with out-of-hospital cardiac arrest (PARAMEDIC-2) showed that epinephrine increased return of spontaneous circulation and survival to hospital discharge. The trial's secondary outcomes have raised concerns that epinephrine increases the number of brain damaged survivors. Systematic review and meta-analysis suggest that epinephrine has...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION AND OTHER EMERGENCIES: Edited by Katherine M. Berg Source Type: research
Individualized acute kidney injury after care
Purpose of review
The aim of this study was to summarize the current evidence around the impact of individualizing patient care following an episode of acute kidney injury (AKI) in the ICU.
Recent findings
Over the last years, evidence has demonstrated that the follow-up care after episodes of AKI is lacking and standardization of this process is likely needed. Although this is informed largely by large retrospective cohort studies, a few prospective observational trials have been performed. Medication reconciliation and patient/caregiver education are important tenants of follow-up care, regardless of the severity of...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: RENAL SYSTEM: Edited by Marlies Ostermann Source Type: research
Precision renal replacement therapy
This article reviews the current evidence supporting the use of precision medicine in the delivery of acute renal replacement therapy (RRT) to critically ill patients, focusing on timing, solute control, anticoagulation and technologic innovation.
Recent findings
Precision medicine is most applicable to the timing of RRT in critically ill patients. As recent randomized controlled trials have failed to provide consensus on when to initiate acute RRT, the decision to start acute RRT should be based on individual patient clinical characteristics (e.g. severity of the disease, evolution of clinical parameters) and logistic ...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: RENAL SYSTEM: Edited by Marlies Ostermann Source Type: research
Artificial intelligence to guide management of acute kidney injury in the ICU: a narrative review
Purpose of review
Acute kidney injury (AKI) frequently complicates hospital admission, especially in the ICU or after major surgery, and is associated with high morbidity and mortality. The risk of developing AKI depends on the presence of preexisting comorbidities and the cause of the current disease. Besides, many other parameters affect the kidney function, such as the state of other vital organs, the host response, and the initiated treatment. Advancements in the field of informatics have led to the opportunity to store and utilize the patient-related data to train and validate models to detect specific patterns and,...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: RENAL SYSTEM: Edited by Marlies Ostermann Source Type: research
Biomarker-guided management of acute kidney injury
Purpose of review
The current narrative review discusses practical applications of stress and damage biomarkers for the management of acute kidney injury (AKI) based on clinical trials and real-world evaluations.
Recent findings
In 2013 with the discovery and validation study of biomarkers for AKI (Sapphire) advancement in care was provided allowing for the early identification of patients at high risk for developing AKI. It was the combination of new biomarkers and the Kidney Disease Improving Global Outcomes (KDIGO) guidelines for managing patients with AKI that provided an opportunity to improve patient care. In 20...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: RENAL SYSTEM: Edited by Marlies Ostermann Source Type: research
Real-time glomerular filtration rate: improving sensitivity, accuracy and prognostic value in acute kidney injury
Purpose of review
Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administrati...
Source: Current Opinion in Critical Care - October 28, 2020 Category: Nursing Tags: RENAL SYSTEM: Edited by Marlies Ostermann Source Type: research
