Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic
Purpose of review
To describe current antimicrobial resistance in ESKAPE Gram-negative microorganisms and their situation in the ICUs, the implication of the so-called high-risk clones (HiRCs) involved in the spread of antimicrobial resistance as well as relevance of the COVID-19 pandemic in the potential increase of resistance.
Recent findings
Extended-spectrum and carbapenemase producing Enterobacterales and multidrug and extensive drug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii have increased worldwide. Sequence type (ST)131 Escherichia coli, ST258, ST11, ST10, ST147 and ST307 Klebsiella pneumonia...
Source: Current Opinion in Critical Care - September 3, 2020 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jean-François Timsit Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 3, 2020 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
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 sur...
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 even realizing ...
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
