Current opinion in critical care
-
Curr Opin Crit Care · Dec 2020
ReviewPrevention, diagnosis, and management of venous thromboembolism in the critically ill surgical and trauma patient.
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is common among trauma patients and critically ill surgical patients admitted to the ICU. Critical care surgical patients are at an extremely high risk for VTE and the related morbidity and mortality associated with it. The present review aims to provide an overview of the importance of identifying risk factors, prescribing effective prohylaxis, accurate diagnosis, and timely appropriate treatment for trauma and critically ill surgical patients with VTE in the ICU. ⋯ Critical care surgical and trauma patients represent a population that are at a heightened risk for VTE and associated complications. Appropriate screening, prevention strategies, accurate diagnosis, and timely administration of appropriate treatment must be utilized to reduce morbidity and mortality.
-
The aim of this study was to discuss recent findings related to providing adequate and well tolerated nutrition to the critically ill surgical patient. ⋯ Current evidence suggests early enteral nutrition with protein supplementation in critically ill surgical patients with consideration of early parenteral nutrition in high nutrition risk patients unable to achieve nutrition goals enterally. Despite established guidelines for nutritional therapy, the paucity of data to support these recommendations illustrates the critical need for additional studies.
-
Curr Opin Crit Care · Dec 2020
ReviewArtificial intelligence to guide management of acute kidney injury in the ICU: a narrative review.
Acute kidney injury (AKI) frequently complicates hospital admission, especially in the ICU or after major surgery, and is associated with high morbidity and mortality. The risk of developing AKI depends on the presence of preexisting comorbidities and the cause of the current disease. Besides, many other parameters affect the kidney function, such as the state of other vital organs, the host response, and the initiated treatment. Advancements in the field of informatics have led to the opportunity to store and utilize the patient-related data to train and validate models to detect specific patterns and, as such, predict disease states or outcomes. ⋯ In this article, we provide an overview of the machine-learning prediction models for AKI and its outcomes in critically ill patients and individuals undergoing major surgery. We also discuss the pitfalls and the opportunities related to the implementation of these models in clinical practices.
-
The current narrative review discusses practical applications of stress and damage biomarkers for the management of acute kidney injury (AKI) based on clinical trials and real-world evaluations. ⋯ Stress and damage biomarker-based approaches to patient care seem to be promising for identifying patients at high risk for developing AKI and thus offers an opportunity for early management to prevent and ameliorate AKI and drug-associated AKI.
-
Curr Opin Crit Care · Dec 2020
ReviewUses and pitfalls of measurement of end-tidal carbon dioxide during cardiac arrest.
To discuss recent studies relevant to the utility of measuring end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and its correlation with outcome in adults experiencing cardiac arrest. ⋯ Higher values of ETCO2 during resuscitation from cardiac arrest are generally associated with a greater likelihood of ROSC. However, timing of measurements and cut-off values used show significant variability across different studies, making it hard to draw any conclusions about the utility of any particular reading for prognostication. Future studies might aim to develop an accepted standard for the timing and cut-off value of ETCO2 used, to enable comparison of the parameter across different studies.