Endocarditis in the intensive care unit: an update
Purpose of review
The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature.
Recent findings
IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory st...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Update on Staphylococcus aureus bacteraemia
Purpose of review
To review recently published evidence relevant to Staphylococcus aureus bacteremia (SAB).
Recent findings
Staphylococcus aureus is the most common pathogen causing co-infections and superinfections in patients with COVID-19. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia ratios have sharply risen during the pandemic. SAB mortality is 18% at 1 month and 27% at 3 months but has gradually decreased over the last 30 years. Recurrences and reinfections are common (9%). Standardised items to define complicated SAB, and a new cut-off defining persisting bacteremia after 2 days w...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Critical care management of meningitis and encephalitis: an update
Purpose of review
Meningitis and encephalitis represent severe neurological syndromes associated with encephalopathy, seizures, focal deficits, and neurological sequelae in survivors. We update on the critical care management of adult patients with severe meningitis and encephalitis.
Recent findings
Large multicenter studies conducted in the adult population improved current knowledge on the epidemiology and outcomes of patients with severe meningitis and encephalitis. An early multimodal diagnostic workup (including CSF analysis, brain MRI, EEG, and serum studies) is mandatory for diagnosis and prognostication ...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Nosocomial infections during extracorporeal membrane oxygenation
Purpose of the review
The aim of this review is to present the latest evidence regarding the prevention, diagnosis and treatment of nosocomial infections during extracorporeal membrane oxygenation (ECMO) support.
Recent findings
New descriptive data from the Extracorporeal Life Support Organisation (ELSO) registry and single centre studies have been published. In parallel, there is an increase in the availability of evidence about the diagnostic accuracy of infection markers, yield of routine cultures, effectivity of antibiotic prophylaxis and other preventive measures.
Summary
ECMO is a rescue therapy fo...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?
Purpose of review
Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) may concern up to one third of intensive care unit (ICU) patients. The purpose of this review is to discuss the diagnostic criteria, the pathogenesis, the risk factors, the incidence, the impact on outcome, and the diagnostic and therapeutic management of CAPA in critically ill patients.
Recent findings
The incidence of CAPA ranges 3--28% of critically ill patients, depending on the definition used, study design, and systematic or triggered screening. COVID-19 is associated with direct damage of the respiratory epithelium,...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Bacterial infection in coronavirus disease 2019 patients: co-infection, super-infection and how it impacts on antimicrobial use
Purpose of review
Since the beginning of the severe acute respiratory syndrome coronavirus 2 pandemic, there has been a large increase in the consumption of antimicrobials, both as a form of treatment for viral pneumonia, which has been shown to be ineffective, and in the treatment of secondary infections that arise over the course of the severe presentation of coronavirus disease 2019 (COVID-19). This increase in consumption, often empirical, ends up causing an increase in the incidence of colonization and secondary infections by multi and pan-resistant germs.
Recent findings
The presence of a hyperinflammatory...
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Editorial: Severe infections in the ICU: new perspectives and challenges
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: SEVERE INFECTIONS: Edited by Jan J. De Waele Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - September 11, 2022 Category: Nursing Tags: Editorial Introductions Source Type: research
Staffing models in the cardiac intensive care unit
We describe the most recent evidence which will inform future CICU staffing models.
Recent findings
In the United States, the majority of CICUs are open as opposed to closed units, yet recent data suggests that transition to a closed staffing model is associated with a decrease in mortality. These reductions in mortality in closed CICUs are most pronounced in the most critically ill populations, such as patients with mechanical circulatory support, cardiac arrest, and respiratory failure. In addition, one study has shown that transition to a cardiac intensivist staffed CICU was associated with a reduction in mortali...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Outcomes in cardiogenic shock: the role of surrogate endpoints
Purpose of review
Early revascularization, invasive hemodynamic profiling, and initiation of temporary mechanical circulatory support (MCS) have all become routine components of cardiogenic shock (CS) management. Despite this evolution in clinical practice, patient selection and timing of treatment initiation remain a significant barrier to achieving sustained improvement in CS outcomes. Recent efforts to standardize CS management, through the development of treatment algorithms, have relied heavily on surrogate endpoints to drive therapeutic decisions. The present review aims to provide an overview of the basis of evi...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Mechanical circulatory support in the treatment of cardiogenic shock
Purpose of review
Cardiogenic shock is a condition that is characterized by end-organ hypoperfusion secondary to reduced cardiac output, and is associated with substantial mortality. The mainstay of therapy for cardiogenic shock is reversal of the underlying cause, and concomitant supportive care with vasoactive medications (vasopressors and inotropes). Patients who continue to deteriorate despite these measures may require mechanical circulatory support (MCS). Here, we review the devices available for MCS, and their associated benefits and risks.
Recent findings
Despite growing use worldwide, there is little ra...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Transcatheter edge-to-edge repair in patients with mitral regurgitation and cardiogenic shock: a new therapeutic target
Purpose of review
Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation.
Recent findings
Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation. Surgical interventions for mitral r...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Inotrope and vasopressor use in cardiogenic shock: what, when and why?
Purpose of review
Despite increasing interest in the management of cardiogenic shock (CS), mortality rates remain unacceptably high. The mainstay of supportive treatment includes vasopressors and inotropes. These medications are recommended in international guidelines and are widely used despite limited evidence supporting safety and efficacy in CS.
Recent findings
The OptimaCC trial further supports that norepinephrine should continue to be the first-line vasopressor of choice in CS. The CAPITAL DOREMI trial found that milrinone is not superior to dobutamine in reducing morbidity and mortality in CS. Two studie...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Editorial: Idolatry in cardiogenic shock: are we coming to a state of emergence
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: CARDIOGENIC SHOCK: Edited by Benjamin Hibbert Source Type: research
Poor physical recovery after critical illness: incidence, features, risk factors, pathophysiology, and evidence-based therapies
Purpose of review
To summarize the incidence, features, pathogenesis, risk factors, and evidence-based therapies of prolonged intensive care unit (ICU) acquired weakness (ICU-AW). We aim to provide an updated overview on aspects of poor physical recovery following critical illness.
Recent findings
New physical problems after ICU survival, such as muscle weakness, weakened condition, and reduced exercise capacity, are the most frequently encountered limitations of patients with postintensive care syndrome. Disabilities may persist for months to years and frequently do not fully recover. Hormonal and mitochondrial...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
