The best recipe: fat-based, protein-based, single amino acids?
Purpose of review
Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients.
Recent findings
Larger proportion of carbohydrates than lipids is usual in most of the commercial products. However, patients suffering from sepsis and from acute kidney injury preferentially utilize lipids. Parenteral omega-3-fatty acids, in particular, may be beneficial. Protein source and amount are important factors to achieve the best absorption and an i...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research
Practical applications of nutritional scores
Purpose of review
Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.
The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU.
Recent findings
Critical...
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Karin Amrein and Gennaro Martucci Source Type: research
Editorial: A potpourri of nutrition and metabolism in the ICU
No abstract available (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
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 30, 2020 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Parameters of fluid responsiveness
Purpose of review
On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness.
Recent findings
Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart–lung...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
How to assess ventriculoarterial coupling in sepsis
Purpose of review
We will highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it.
Recent findings
Most septic patients show a ventriculoarterial uncoupling at the time of diagnosis with arterial elastance (Ea) greater than left ventricle (LV) end-systolic elastance (Ees), often despite arterial hypotension. Ventriculoarterial coupling levels predict the cardiovascular response to resuscitation in this heterogeneously responding population.
Summary
Ventriculoarterial coupling is quantified as the ratio of Ea to Ees. The efficiency of the cardiovascular function is opt...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
This is your toolkit in hemodynamic monitoring
Purpose of review
To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables.
Recent findings
The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be suf...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Focused ultrasonography for septic shock resuscitation
Purpose of review
Severe sepsis with septic shock is the most common cause of death among critically ill patients. Mortality has decreased substantially over the last decade but recent data has shown that opportunities remain for the improvement of early and targeted therapy. This review discusses published data regarding the role of focused ultrasonography in septic shock resuscitation.
Recent findings
Early categorization of the cardiovascular phenotypes with echocardiography can be crucial for timely diagnosis and targeted therapy of patients with septic shock. In the last few years, markers of volume status and vo...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Monitoring mitochondrial PO2: the next step
Purpose of review
To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level.
Recent findings
Mitochondrial oxygen tension can be measured by means of the protoporphyrin IX-Trip...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Regional perfusion monitoring in shock
Purpose of review
Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included.
Recent findings
We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Automated quantification of tissue red blood cell perfusion as a new resuscitation target
Purpose of review
Identification of insufficient tissue perfusion is fundamental to recognizing circulatory shock in critically ill patients, and the primary target to restore adequate oxygen delivery. However, the concept of tissue perfusion remains ill-defined and out-of-reach for clinicians as point-of-care resuscitation target. Even though handheld vital microscopy (HVM) provides the technical prerequisites to collect information on tissue perfusion in the sublingual microcirculation, challenges in image analysis prevent quantification of tissue perfusion and manual analysis steps prohibit point-of-care application. ...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Monitoring coherence between the macro and microcirculation in septic shock
Purpose of review
Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation.
Recent findings
Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the de...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jan Bakke Source Type: research
Individualized blood pressure targets during postcardiac arrest intensive care
Purpose of review
To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics.
Recent findings
Observational data suggest that mean arterial pressure (MAP) below 65–75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and f...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research
Optimal ventilator settings after return of spontaneous circulation
Purpose of review
To describe current practice, recent advances in knowledge and future directions for research related to the post return of spontaneous circulation (ROSC) ventilatory management of cardiac arrest patients.
Recent findings
Out-of-hospital cardiac arrest (OHCA) is a major public health problem with an estimated incidence of approximately one per 1000 persons per year. A priority of intensive care management of resuscitated OHCA patients is to reduce secondary reperfusion injury. Most OHCA patients are mechanically ventilated. Most of these require mechanical ventilation as they are unconscious and for ...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research
Drugs during cardiopulmonary resuscitation
Purpose of review
The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation.
Recent findings
Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, cal...
Source: Current Opinion in Critical Care - April 29, 2020 Category: Nursing Tags: CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. Taccone Source Type: research
