Current opinion in critical care
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Curr Opin Crit Care · Aug 2019
ReviewFeeding should be individualized in the critically ill patients.
Any critical care therapy requires individual adaptation, despite standardization of the concepts supporting them. Among these therapies, nutrition care has been repeatedly shown to influence clinical outcome. Individualized feeding is the next needed step towards optimal global critical care. ⋯ Although energy expenditure can now be measured, we miss indicators of early endogenous energy production and of protein needs. A pragmatic ramping up of extrinsic energy provision by nutrition support reduces the risk of overfeeding-related adverse effects.
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Curr Opin Crit Care · Aug 2019
ReviewAn overview of international cardiogenic shock guidelines and application in clinical practice.
In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. ⋯ There are some inconsistencies between individual guideline recommendations, but there are no consistent associations between the strength of underlying evidence, weight of guideline recommendations, and adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a strong evidence base, together with research efforts to address priority cardiogenic shock research needs, could serve-to-harmonize recommendations and improve patient outcomes.
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Curr Opin Crit Care · Aug 2019
ReviewCardiogenic pulmonary edema: mechanisms and treatment: an intensivist's view.
This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. ⋯ Treatments must be initiated early, whereas evaluation still is occurring and requires multimodality intervention. The general treatment of cardiogenic pulmonary edema includes diuretics, possibly morphine and often nitrates. The appropriate use of newer approaches - such as, nesiritide, high-dose vasodilators, milrinone, and vasopressin receptor antagonists - needs larger clinical trials.
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Curr Opin Crit Care · Aug 2019
Review Meta AnalysisTranslating the European Society for Clinical Nutrition and Metabolism 2019 guidelines into practice.
To present a pragmatic approach to facilitate clinician's implementing the recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on clinical nutrition in the intensive care unit. ⋯ A pragmatic approach to incorporate the recent ESPEN guidelines into everyday clinical practice is provided.