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
ReviewRevascularization strategies in cardiogenic shock after acute myocardial infarction.
Coronary revascularization compared with medical treatment alone leads to improved survival in patients with myocardial infarction (MI) and cardiogenic shock. Percutaneous coronary intervention (PCI) is the predominant mode of revascularization in clinical practice. This review discusses several aspects relevant to mechanical revascularization such as general indication, the roles of PCI and bypass surgery, percutaneous access site choice, strategy in multivessel disease and adjunctive antithrombotic therapy. ⋯ Coronary revascularization remains the cornerstone in the early management of patients with acute MI and cardiogenic shock. In patients with multivessel disease, a strategy of culprit lesion only PCI is the default approach.
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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.