Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients
Purpose of review
Immunocompromised patients are notably vulnerable to severe coronavirus disease 2019. This review summarizes COVID-19 features and outcomes in autologous and allogeneic hematopoietic stem cell transplantation (HSCT) recipients.
Recent findings
Recent findings suggest that HSCT recipients exhibit a high burden of comorbidities and COVID-19 clinical features almost similar to the general COVID population. Furthermore, HSCT recipients exhibit a protracted SARS-CoV-2 shedding, prolonging duration of symptoms and promoting the generation of highly mutated viruses. Last, most of studies report a high...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients
Purpose of review
We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS).
Recent findings
Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome
Purpose of review
To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19).
Recent findings
Due to the heterogeneity between patients, management of COVID-19 requires daily monitoring of and/or aeration and inspiratory effort. Electrical impedance tomography can be used to optimize positive end-expiratory pressure, monitor the response to changes in treatment or body position and assess pulmonary perfusion and ventilation/perfusion matching. Lung ultrasound is more readily available and can be used to measure and monitor recruitment, provid...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Prone position in COVID 19-associated acute respiratory failure
Purpose of review
Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing (’awake prone’). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS.
Recent findings
A literature search retrieved 70 studies separating whether patient was intubated (24 studies) or nonintubated (46 studies). The outcomes analyzed were intubation rate, mortality and respiratory response to prone. In nonintubated patient receiving pro...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Protective ventilation in patients with acute respiratory distress syndrome related to COVID-19: always, sometimes or never?
Purpose of review
To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation.
Recent findings
Although multiple observations and physiological studies seem to show a different pathophysiological behaviour in COVID-19-ARDS compared with ‘classical’ ARDS, numerous studies on thousands of patients do not confirm these findings and COVID-19-ARDS indeed shares similar characteristics and interindividual heterogeneity with ARDS from other causes. Although still scarce, present evidence on the application ...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Noninvasive respiratory support for acute respiratory failure due to COVID-19
Purpose of review
Noninvasive respiratory support has been widely applied during the COVID-19 pandemic. We provide a narrative review on the benefits and possible harms of noninvasive respiratory support for COVID-19 respiratory failure.
Recent findings
Maintenance of spontaneous breathing by means of noninvasive respiratory support in hypoxemic patients with vigorous spontaneous effort carries the risk of patient self-induced lung injury: the benefit of averting intubation in successful patients should be balanced with the harms of a worse outcome in patients who are intubated after failing a trial of noninvasi...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Chest imaging in patients with acute respiratory failure because of coronavirus disease 2019
This article includes a systematic literature search, evidencing the different chest imaging modalities used in patients with ARDS from COVID-19. Literature evidences different possible approaches going from the conventional CXR and CT to the LUS, MRI, and PET/CT.
Summary
CT is the technique with higher sensitivity and definition for studying chest in COVID-19 patients. LUS or bedside CXR are critical in patients requiring close and repeated monitoring. Moreover, LUS and CXR reduce the radiation burden and the risk of infection compared with CT. PET/CT and MRI, especially in ARDS patients, are not usually used for d...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Pathophysiology of coronavirus-19 disease acute lung injury
Purpose of review
More than 230 million people have tested positive for severe acute respiratory syndrome-coronavirus-2 infection globally by September 2021. The infection affects primarily the function of the respiratory system, where ∼20% of infected individuals develop coronavirus-19 disease (COVID-19) pneumonia. This review provides an update on the pathophysiology of the COVID-19 acute lung injury.
Recent findings
In patients with COVID-19 pneumonia admitted to the intensive care unit, the PaO2/FiO2 ratio is typically (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Phenotyping in acute respiratory distress syndrome: state of the art and clinical implications
Purpose of review
Decades of research in acute respiratory distress syndrome (ARDS) have led to few interventions that impact clinical outcomes. The pandemic of patients with ARDS due to the novel SARS-CoV-2 infection has stressed the need for more effective therapies in ARDS. Phenotyping may enable successful trials and precision therapeutics in this patient population.
Recent findings
Clinical phenotypes that group patients by shared cause, time-course or radiographic presentation are of prognostic value, but their use is limited by misclassification. Physiological phenotypes, including the P/F ratio, ventilat...
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: RESPIRATORY SYSTEM: Edited by Giacomo Grasselli Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - December 31, 2021 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
New peripheral nerve blocks and local anesthetics
Purpose of review
To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline.
Recent findings
There are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of t...
Source: Current Opinion in Critical Care - November 19, 2021 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bernd Saugel Source Type: research
Management of the patient with the open abdomen
Purpose of review
The aim of this study was to outline the management of the patient with the open abdomen.
Recent findings
An open abdomen approach is used after damage control laparotomy, to decrease risk for postsurgery intra-abdominal hypertension, if reoperation is likely and after primary abdominal decompression.
Temporary abdominal wall closure without negative pressure is associated with higher rates of intra-abdominal infection and evisceration. Negative pressure systems improve fascial closure rates but increase fistula formation. Definitive abdominal wall closure should be considered once oedema ha...
Source: Current Opinion in Critical Care - November 19, 2021 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bernd Saugel Source Type: research
Measuring the human immune response to surgery: multiomics for the prediction of postoperative outcomes
Purpose of review
Postoperative complications including infections, cognitive impairment, and protracted recovery occur in one-third of the 300 million surgeries performed annually worldwide. Complications cause personal suffering along with a significant economic burden on our healthcare system. However, the accurate prediction of postoperative complications and patient-targeted interventions for their prevention remain as major clinical challenges.
Recent findings
Although multifactorial in origin, the dysregulation of immunological mechanisms that occur in response to surgical trauma is a key determinant of p...
Source: Current Opinion in Critical Care - November 19, 2021 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bernd Saugel Source Type: research
Patient Blood Management in intensive care patients
Purpose of review
Patients admitted to ICUs are a heterogeneous group, displaying multiple anaemia risk factors and comorbidities. Clinicians should therefore take all possible measures to identify modifiable risks. Patient Blood Management (PBM) is an approach promoting the timely application of evidence-based interventions designed to maintain patients own blood mass.
Recent findings
Within ICU-patients, anaemia is highly prevalent. Generally, anaemia is associated with impaired outcome and need of blood transfusion. Currently, with ICUs working at full capacity and the global blood reserves exhausted, the SAR...
Source: Current Opinion in Critical Care - November 19, 2021 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bernd Saugel Source Type: research
Cerebral monitoring in surgical ICU patients
Purpose of review
To give an overview of cerebral monitoring techniques for surgical ICU patients.
Recent findings
As the burden of postsurgical neurological and neurocognitive complications becomes increasingly recognized, cerebral monitoring in the surgical ICU might gain a relevant role in detecting and possibly preventing adverse outcomes. However, identifying neurological alterations in surgical ICU patients, who are often sedated and mechanically ventilated, can be challenging. Various noninvasive and invasive techniques are available for cerebral monitoring, providing an assessment of cortical electrical ...
Source: Current Opinion in Critical Care - November 19, 2021 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Bernd Saugel Source Type: research
