Acute liver failure
Purpose of review
Present an outline of acute liver failure, from its definition to its management in critical care, updated with findings of selected newer research.
Recent findings
Survival of patients with acute liver failure has progressively improved. Intracranial hypertension complicating hepatic encephalopathy is now much less frequent than in the past and invasive ICP monitoring is now rarely used. Early renal replacement therapy and possibly therapeutic plasma exchange have consolidated their role in the treatment. Further evidence confirms the low incidence of bleeding in these patients despite strikin...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Julia Wendon Source Type: research
Management of gastrointestinal failure in the adult critical care setting
Purpose of review
Gastrointestinal failure is a polymorphic syndrome with multiple causes. Managing the different situations from a practical, metabolic, and nutritional point of view is challenging, which the present review will try to address.
Recent findings
Acute gastrointestinal injury (AGI) has been defined and has evolved into a concept of gastrointestinal dysfunction score (GIDS) built on the model of Sequential Organ Failure Assessment (SOFA) score, and ranging from 0 (no risk) to 4 (life threatening). But there is yet no specific, reliable and reproducible, biomarker linked to it. Evaluating the risk w...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Julia Wendon Source Type: research
Liver trauma in the intensive care unit
Purpose of review
To review the surgical and critical care management of liver trauma; one of the most common abdominal injuries sustained due to its size and location.
Recent findings
Hepatic injuries range from negligible to life threatening: in the acute phase, the most common cause of morbidity and mortality is hemorrhage; however, severe traumatic hepatic injuries can also lead to biochemical abnormalities, altered coagulation, and ultimately liver failure. This brief review will review the classification of traumatic liver injuries by mechanism, grade, and severity. Most Grades I–III injuries can be mana...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Julia Wendon Source Type: research
Treating the body to prevent brain injury: lessons learned from the coronavirus disease 2019 pandemic
Purpose of review
We aim to provide the current evidence on utility and application of neuromonitoring tools including electroencephalography (EEG), transcranial Doppler (TCD), pupillometry, optic nerve sheath diameter (ONSD), cerebral near-infrared spectroscopy (cNIRS), somatosensory-evoked potentials (SSEPs), and invasive intracranial monitoring in COVID-19. We also provide recent evidence on management strategy of COVID-19-associated neurological complications.
Recent findings
Despite the common occurrence of neurological complications, we found limited use of standard neurologic monitoring in patients with C...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Acute traumatic brain injury in frail patients: the next pandemic
Purpose of review
To highlight recent findings on the evaluation and impact of frailty in the management of patients with traumatic brain injury (TBI).
Recent findings
Frailty is not a direct natural consequence of aging. Rather, it commonly results from the intersection of age-related decline with chronic diseases and conditions. It is associated with adverse outcomes such as institutionalization, falls, and worsening health status. Growing evidence suggests that frailty should be a key consideration both in care planning and in adverse outcome prevention. The prevalence of elderly patients with TBI is increasi...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
The intensive care management of acute ischaemic stroke
Purpose of review
To discuss recent advances in the critical care management of acute ischaemic stroke patients and highlight controversies and consensus.
Recent findings
Intravenous thrombolysis and endovascular thrombectomy are standard of care reperfusion therapies that have revolutionized the management of acute ischaemic stroke and transformed outcomes for patients. They can now be delivered in extended time windows and to those previously ineligible for intervention based on advanced neuroimaging criteria. Secondary systemic insults, such as hypo- and hypertension, hyperthermia or hyperglycaemia, which can...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Optimizing oxygen delivery to the injured brain
Purpose of review
The principle of optimizing oxygen delivery to the injured brain rests on the premise that both hypoxia and hyperoxia are important mediators of secondary brain injury and should be avoided. This rationale has prompted a move towards incorporating oxygenation endpoints into the management of neurocritical care patients, particularly those with traumatic brain injury. The present review will seek to describe clinical strategies to optimize oxygenation in the acutely brain-injured patient, drawing upon relevant physiologic principles and clinical data, where it exists.
Recent findings
A phase II ...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Challenges in the hemodynamic management of acute nontraumatic neurological injuries
Purpose of review
To appraise the evidence from the literature and suggest an integrated hemodynamic approach of early and delayed phases of acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH).
Recent findings
In AIS, the research aims to evaluate the optimal pressure control before, during and after the revascularization, to optimize the perfusion in the ischemic areas, minimizing the risk of hemorrhage or secondary damage to already infarcted areas. In the early phase of SAH, systemic pressure should be controlled to balance the risk of stroke, hypertension-related reb...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Fever management in acute brain injury
Purpose of review
Fever is common after acute brain injury and is associated with poor prognosis in this setting.
Recent findings
Achieving normothermia is feasible in patients with ischemic or hemorrhagic stroke, subarachnoid hemorrhage and traumatic brain injury. Pharmacological strategies (i.e. paracetamol or nonsteroidal anti-inflammatory drugs) are frequently ineffective and physical (i.e. cooling devices) therapies are often required. There are no good quality data supporting any benefit from therapeutic strategies aiming at normothermia in all brain injured patients when compared with standard of care, wh...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Individualized cerebral perfusion pressure in acute neurological injury: are we ready for clinical use?
Purpose of review
Individualizing cerebral perfusion pressure based on cerebrovascular autoregulation assessment is a promising concept for neurological injuries where autoregulation is typically impaired. The purpose of this review is to describe the status quo of autoregulation-guided protocols and discuss steps towards clinical use.
Recent findings
Retrospective studies have indicated an association of impaired autoregulation and poor clinical outcome in traumatic brain injury (TBI), hypoxic–ischemic brain injury (HIBI) and aneurysmal subarachnoid hemorrhage (aSAH). The feasibility and safety to target a ce...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
How to manage traumatic brain injury without invasive monitoring?
Purpose of review
Severe traumatic brain injury (TBI) is an extremely serious health problem, especially in low–middle income countries (LMICs). The prevalence of severe TBI continues to increase in LMICs. Major limitations in the chain of care for TBI patients are common in LMICs including suboptimal or nonexistent prehospital care, overburdened emergency services, lack of trained human resources and limited availability of ICUs. Basic neuromonitoring, such as intracranial pressure, are unavailable or underutilized and advanced techniques are not available.
Recent findings
Attention to fundamental principles ...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Intracranial pressure management: moving beyond guidelines
Purpose of review
The aim of this study was to provide an overview on advances in intracranial pressure (ICP) protocols for care, moving from traditional to more recent concepts.
Recent findings
Deep understanding of mechanics and dynamics of fluids and solids have been introduced for intracranial physiology. The amplitude or the harmonics of the cerebral-spinal fluid and the cerebral blood waves shows more information about ICP than just a numeric threshold. When the ICP overcome the compensatory mechanisms that maintain the compliance within the skull, an intracranial compartment syndrome (ICCS) is defined. Au...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Editorial: Effective treatments for acute neurological injury: are we moving forward?
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Extracorporeal membrane oxygenation for coronavirus disease 2019-related acute respiratory distress syndrome
Purpose of review
To understand the potential role of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), highlighting evolving practices and outcomes.
Recent findings
The role for ECMO in COVID-19-related ARDS has evolved throughout the pandemic. Early reports of high mortality led to some to advocate for withholding ECMO in this setting. Subsequent data suggested mortality rates were on par with those from studies conducted prior to the pandemic. However, outcomes are evolving and mortality in these patients may be worsening with...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
