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Should Vasopressors Be Started Early in Septic Shock?
Semin Respir Crit Care Med 2021; 42: 683-688 DOI: 10.1055/s-0041-1733897Sepsis can influence blood volume, its distribution, vascular tone, and cardiac function. Persistent hypotension or the need for vasopressors after volume resuscitation is part of the definition of septic shock. Since increased positive fluid balance has been associated with increased morbidity and mortality in sepsis, timing of vasopressors in the treatment of septic shock seems crucial. However, conclusive evidence on timing and sequence of interventions with the goal to restore tissue perfusion is lacking. The aim of this narrative review is to depi...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: Cioccari, Luca Jakob, Stephan M. Takala, Jukka Tags: Review Article Source Type: research

Any Role of High-Dose Vitamin C for Septic Shock in 2021?
Semin Respir Crit Care Med 2021; 42: 672-682 DOI: 10.1055/s-0041-1733986While the use of vitamin C as a therapeutic agent has been investigated since the 1950s, there has been substantial recent interest in the role of vitamin C supplementation in critical illness and particularly, sepsis and septic shock. Humans cannot synthesize vitamin C and rely on exogenous intake to maintain a plasma concentration of approximately 70 to 80 μmol/L. Vitamin C, in healthy humans, is involved with antioxidant function, wound healing, endothelial function, and catecholamine synthesis. Its function in the human body informs the theoreti...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: Agarwal, Ankita Hager, David N. Sevransky, Jonathan E. Tags: Review Article Source Type: research

Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis?
Semin Respir Crit Care Med 2021; 42: 662-671 DOI: 10.1055/s-0041-1735148The diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community a...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: P óvoa, Pedro Coelho, Luis Tags: Review Article Source Type: research

What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock?
Semin Respir Crit Care Med 2021; 42: 650-661 DOI: 10.1055/s-0041-1733915Elevations in blood lactate concentrations have been studied in sepsis and other disease states for decades and are well known to be associated with increased mortality. Many studies have also demonstrated the prognostic accuracy of serial lactate levels, and some have suggested that lactate clearance may be a useful therapeutic target for resuscitation. Lactate measurements have therefore gained an increasingly prominent role in sepsis definitions, screening protocols, management guidelines, and quality measures over the past two decades. The heavy em...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: Weinberger, Jeremy Klompas, Michael Rhee, Chanu Tags: Review Article Source Type: research

Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock
Semin Respir Crit Care Med 2021; 42: 641-649 DOI: 10.1055/s-0041-1733896Despite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly tar...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: Sweeney, Daniel A. Wiley, Brandon M. Tags: Review Article Source Type: research

Sepsis and Septic Shock
Semin Respir Crit Care Med 2021; 42: 639-640 DOI: 10.1055/s-0041-1735218 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2021 Category: Respiratory Medicine Authors: Kalil, Andre C Tags: Preface Source Type: research

The Deteriorating Patient: Therapies Including Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 623-638 DOI: 10.1055/s-0041-1730946In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that c...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Detailleur, Stephanie Vos, Robin Goeminne, Pieter Tags: Review Article Source Type: research

Airway Clearance and Mucoactive Therapies
Semin Respir Crit Care Med 2021; 42: 616-622 DOI: 10.1055/s-0041-1730922The respiratory system is constantly exposed to external pathogens but has different and effective defense systems. The pathophysiology of bronchiectasis affects the defense system considerably in that alterations occur in the airway that reduce its effectiveness in mucociliary clearance and the greater presence of mucins leads to the accumulation of more adherent and viscous mucus. One of the pillars of treatment of this disease should be improvement of mucociliary clearance and a decrease in the adherence and viscosity of the mucus. To this end, the ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Mu ñoz Castro, Gerard Bala ñá Corberó, Ana Tags: Review Article Source Type: research

Long-Term Antibiotics in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 606-615 DOI: 10.1055/s-0041-1730945A significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Suarez-Cuartin, Guillermo Hernandez-Argudo, Marta Perea, Lidia Sibila, Oriol Tags: Review Article Source Type: research

Bronchiectasis Exacerbations: Definitions, Causes, and Acute Management
Semin Respir Crit Care Med 2021; 42: 595-605 DOI: 10.1055/s-0041-1730944Pulmonary exacerbations (PExs) are events in the course of bronchiectasis which are defined as an increase in disease symptoms lasting a period of a few days. It is established that the tendency toward having PEx is stable throughout the course of the disease. Certain conditions were found to be associated with an increased risk of developing a PEx. Among these are chronic airway infection with Pseudomonas aeruginosa or Aspergillus species, concomitant airway diseases (asthma, chronic obstructive pulmonary disease, and chronic rhinosinusitis), genetic ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Perl, Sivan Shteinberg, Michal Tags: Review Article Source Type: research

Pseudomonas aeruginosa in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 587-594 DOI: 10.1055/s-0041-1730921 Pseudomonas aeruginosa (PA) in patients with bronchiectasis (BE) is associated with a poor outcome and quality of life, and its presence is considered a marker of disease severity. This opportunistic pathogen is known for its ability to produce biofilms on biotic or abiotic surfaces and to survive environmental stress exerted by antimicrobials, inflammation, and nutrient or oxygen depletion. The presence of PA biofilms has been linked to chronic respiratory infection in cystic fibrosis but not in BE. There is considerable inconsistency in the rep...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Fern ández-Barat, Laia Alcaraz-Serrano, Victoria Amaro, Rosanel Torres, Antoni Tags: Review Article Source Type: research

Nontuberculous Mycobacteria
This article will provide a useful introduction and framework for clinicians involved in the management of bronchiectasis and NTM. It includes an overview of the epidemiology, pathogenesis, diagnosis, and management of NTM PD. We will address the challenges faced in the diagnosis of NTM PD and the importance of subspeciation in guiding treatment and follow-up, especially in Mycobacterium abscessus infections. The treatment of both Mycobacterium avium complex and M. abscessus, the two most common NTM species known to cause disease, will be discussed in detail. Elements of the recent ATS/ERS/ESCMID/IDSA NTM guidelines publis...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Tan, Shera Kasperbauer, Shannon Tags: Review Article Source Type: research

Aspergillus-Associated Endophenotypes in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 556-566 DOI: 10.1055/s-0041-1730947Bronchiectasis is a chronic condition of global relevance resulting in permanent and irreversible structural airway damage. Bacterial infection in bronchiectasis is well studied; however, recent molecular studies identify fungi as important pathogens, either independently or in association with bacteria. Aspergillus species are established fungal pathogens in cystic fibrosis and their role is now increasingly being recognized in noncystic fibrosis bronchiectasis. While the healthy airway is constantly exposed to ubiquitously present Aspergillus conidia...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Jaggi, Tavleen Kaur Ter, Soo Kai Mac Aog áin, Micheál Chotirmall, Sanjay H. Tags: Review Article Source Type: research

Clinical and Radiological Phenotypes and Endotypes
Semin Respir Crit Care Med 2021; 42: 549-555 DOI: 10.1055/s-0041-1730894Bronchiectasis is a heterogenous disease with multiple etiologies and associated comorbidities. As bronchiectasis is a complex disease, it is unsound to think of it as a single disease particularly when the differing etiologies are likely to be driving bronchiectasis through initial divergent molecular pathways, known as endotypes, that phenotypically present as the same disease due to protracted airway inflammation, but revealing potential differing underlying mechanisms that may have disparity of drug responses. Improved understanding of the cellular...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Jos é, Ricardo J. Loebinger, Michael R. Tags: Review Article Source Type: research

Primary Ciliary Dyskinesia
This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Shoemark, Amelia Harman, Katharine Tags: Review Article Source Type: research