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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This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs. ⋯ It may not be feasible to establish superiority of a prokinetic drug within a randomized controlled trial with a patient-centered event as the primary outcome. The use of metoclopramide and erythromycin as prokinetic drugs is based on observations from trials measuring surrogate physiological outcomes. Randomized controlled trials of alternative drug regimens and novel prokinetic drugs have recently been completed and results outlined.
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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
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.
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Curr Opin Crit Care · Aug 2019
ReviewInotropes and vasopressors use in cardiogenic shock: when, which and how much?
Data and interventional trials regarding vasopressor and inotrope use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In this article, we review the current use of vasopressor and inotrope agents during cardiogenic shock. ⋯ When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Dobutamine is the first-line inotrope agent wheraes levosimendan can be used as a second-line agent or preferentially in patients previously treated with beta-blockers. Current information regarding comparative effective outcomes is nonetheless sparse and their use should be limited as a temporary bridge to recovery, mechanical circulatory support or heart transplantation.