Current opinion in critical care
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Curr Opin Crit Care · Aug 2019
ReviewIntermittent or continuous feeding: any difference during the first week?
To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. ⋯ Benefits of intermittent feeding in the ICU are today speculative, yet its potential impact may reach far beyond the gastrointestinal tract. Only adequately powered RCTs, evaluating both gastrointestinal tolerance, metabolic impact and patient-centered effects of intermittent feeding will allow to adopt or abort this nutritional strategy.
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Curr Opin Crit Care · Aug 2019
ReviewMechanical circulatory support devices in cardiogenic shock and acute heart failure: current evidence.
The main purpose of this review is to highlight and summarize recently published studies on the usage of short-term mechanical circulatory support devices for treatment of cardiogenic shock. Importantly, this review will focus on percutaneously implanted devices. ⋯ Randomized, controlled trials are utterly needed to guide treatment with mechanical circulatory support for patients with cardiogenic shock. Importantly, such trials should focus patient selection criteria.
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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
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
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.