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Determinants and Management of the Post –Pulmonary Embolism Syndrome
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722964Acute pulmonary embolism (PE) is not only a serious and potentially life-threatening disease in the acute phase, in recent years it has become evident that it may also have a major impact on a patient's daily life in the long run. Persistent dyspnea and impaired functional status are common, occurring in up to 50% of PE survivors, and have been termed the post-PE syndrome (PPES). Chronic thromboembolic pulmonary hypertension is the most feared cause of post-PE dyspnea. When pulmonary hypertension is ruled out, cardiopulmonary exercise testing can play a central role in ...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Boon, Gudula J.A.M. Huisman, Menno V. Klok, Frederikus A. Tags: Review Article Source Type: research

COVID-19 and Its Implications for Thrombosis and Anticoagulation
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722992Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Berkman, Samuel A. Tapson, Victor F. Tags: Review Article Source Type: research

Pulmonary Embolism in Pregnancy
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722867Even though venous thromboembolism is a leading cause of maternal mortality in high-income countries, there are limited high-quality data to assist clinicians with the management of pulmonary embolism in this patient population. Diagnosis, prevention, and treatment of pregnancy-associated pulmonary embolism are complicated by the need to consider fetal, as well as maternal, well-being. Recent studies suggest that clinical prediction rules and D-dimer testing can reduce the need for diagnostic imaging in a subset of patients. Low-molecular-weight heparin is the preferred...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Bates, Shannon M. Tags: Review Article Source Type: research

Artificial Intelligence in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1719037The diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, encompassing computer vision, natural language processing, and machine learning, with the latter being more commonly employed in the ICUs. Machine learning may be divided in supervised learning models (i.e., support vector machine [SVM] and random forest), unsupervised models (i.e., neural networks [NN]), and reinforcem...
Source: Seminars in Respiratory and Critical Care Medicine - November 5, 2020 Category: Respiratory Medicine Authors: Greco, Massimiliano Caruso, Pier F. Cecconi, Maurizio Tags: Review Article Source Type: research

Challenges in Critical Care
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1719038 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Vincent, Jean-Louis Artigas, Antonio Tags: Preface Source Type: research

Noninvasive Monitoring in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1718387There has been considerable development in the field of noninvasive hemodynamic monitoring in recent years. Multiple devices have been proposed to assess blood pressure, cardiac output, and tissue perfusion. All have their own advantages and disadvantages and selection should be based on individual patient requirements and disease severity and adjusted according to ongoing patient evolution. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Re...
Source: Seminars in Respiratory and Critical Care Medicine - October 16, 2020 Category: Respiratory Medicine Authors: De Backer, Daniel Vincent, Jean-Louis Tags: Review Article Source Type: research

Optimal Sedation and Pain Management: A Patient- and Symptom-Oriented Paradigm
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1716736In the critically ill patient, optimal pain and sedation management remains the cornerstone of achieving comfort, safety, and to facilitate complex life support interventions. Pain relief, using multimodal analgesia, is an integral component of any orchestrated approach to achieve clinically appropriate goals in critically ill patients. Sedative management, however, remains a significant challenge. Subsequent studies including most recent randomized trials have failed to provide strong evidence in favor of a sedative agent, a mode of sedation or ancillary protocols such...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2020 Category: Respiratory Medicine Authors: Shehabi, Yahya Al-Bassam, Wisam Pakavakis, Adrian Murfin, Brendan Howe, Belinda Tags: Review Article Source Type: research

Management and Challenges of Severe Traumatic Brain Injury
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1716493Traumatic brain injury (TBI) is the leading cause of death and disability in trauma patients, and can be classified into mild, moderate, and severe by the Glasgow coma scale (GCS). Prehospital, initial emergency department, and subsequent intensive care unit (ICU) management of severe TBI should focus on avoiding secondary brain injury from hypotension and hypoxia, with appropriate reversal of anticoagulation and surgical evacuation of mass lesions as indicated. Utilizing principles based on the Monro–Kellie doctrine and cerebral perfusion pressure (CPP), a surrogate ...
Source: Seminars in Respiratory and Critical Care Medicine - September 10, 2020 Category: Respiratory Medicine Authors: Rakhit, Shayan Nordness, Mina F. Lombardo, Sarah R. Cook, Madison Smith, Laney Patel, Mayur B. Tags: Review Article Source Type: research

Metabolic and Endocrine Challenges
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1713084This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated ...
Source: Seminars in Respiratory and Critical Care Medicine - September 2, 2020 Category: Respiratory Medicine Authors: Martucci, Gennaro Bonicolini, Eleonora Parekh, Dhruv Thein, Onn Shaun Scherkl, Mario Amrein, Karin Tags: Review Article Source Type: research

Life-Threatening Hemoptysis
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714386Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxyg...
Source: Seminars in Respiratory and Critical Care Medicine - August 29, 2020 Category: Respiratory Medicine Authors: Deshwal, Himanshu Sinha, Ankur Mehta, Atul C. Tags: Review Article Source Type: research

Vasopressor Therapy in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710320After fluid administration for vasodilatory shock, vasopressors are commonly infused. Causes of vasodilatory shock include septic shock, post-cardiovascular surgery, post-acute myocardial infarction, postsurgery, other causes of an intense systemic inflammatory response, and drug -associated anaphylaxis. Therapeutic vasopressors are hormones that activate receptors—adrenergic: α1, α2, β1, β2; angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine: DA1, DA2. Vasopressor choice and dose vary widely because of patient and physician practice heterogene...
Source: Seminars in Respiratory and Critical Care Medicine - August 19, 2020 Category: Respiratory Medicine Authors: Russell, James A. Gordon, Anthony C. Williams, Mark D. Boyd, John H. Walley, Keith R. Kissoon, Niranjan Tags: Review Article Source Type: research

Chronic Obstructive Pulmonary Disease in the Intensive Care Unit: Antibiotic Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1708837Patients who suffer from chronic obstructive pulmonary disease (COPD) often experience deterioration of baseline respiratory symptoms, acute exacerbations of COPD (AECOPD), that become more frequent with disease progression. Based on symptom severity, approximately 20% of these patients will require hospitalization. The most common indicators for intensive care unit (ICU) admission have been found to be worsening or impending respiratory failure and hemodynamic instability. Bacterial and viral bronchial infections are the causative triggers in the majority of COPD exace...
Source: Seminars in Respiratory and Critical Care Medicine - August 10, 2020 Category: Respiratory Medicine Authors: Gupta, Nita Haley, Ryan Gupta, Ashish Sethi, Sanjay Tags: Review Article Source Type: research

Radiographic and Histopathologic Features in Sarcoidosis: A Pictorial Display
Semin Respir Crit Care Med 2020; 41: 758-784 DOI: 10.1055/s-0040-1712534Sarcoidosis is a multisystemic granulomatous disorder that can affect virtually any organ. However, pulmonary and thoracic lymph node involvement predominates; abnormalities on chest radiographs are present in 80 to 90% of patients with sarcoidosis. High-resolution computed tomographic (HRCT) scans are superior to chest X-rays in assessing extent of disease, and some CT features may discriminate an active inflammatory component (which may be amenable to therapy) from fibrosis (for which therapy is not indicated). Typical findings on HRCT include micron...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Shaikh, Faisal Abtin, Fereidoun G. Lau, Ryan Saggar, Rajan Belperio, John A. Lynch, Joseph P. Tags: Review Article Source Type: research

Screening Sarcoidosis Patients for Occult Disease
Semin Respir Crit Care Med 2020; 41: 741-757 DOI: 10.1055/s-0040-1709496As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to scree...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Judson, Marc A. Tags: Review Article Source Type: research

Nonlife-Threatening Sarcoidosis
Semin Respir Crit Care Med 2020; 41: 733-740 DOI: 10.1055/s-0040-1710371Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is quite variable and is mainly related to persistent inflammatory processes and the development of fibrosis. Many prognostic factors have been described, but the disease evolution is not yet entirely known. The nonthreatening course is characterized by spontaneous involution or stability after treatment withdrawal. Löfgren's syndrome is a subset within the spectrum of sarcoidosis phenotypes, composed of acute onset of fever, bilateral hilar lymphadenopathy, erythema nodo...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Castro, Marina Dornfeld Cunha Pereira, Carlos Alberto de Castro Tags: Review Article Source Type: research