Current opinion in critical care
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Curr Opin Crit Care · Apr 2021
ReviewIntra-abdominal hypertension and abdominal compartment syndrome: a current review.
Intra-abdominal hypertension (IAH) and its deleterious effects are present in at least one-third of ICU patients. Increased recognition of IAH has led to significant reduction in the incidence of abdominal compartment syndrome (ACS). Many questions remain regarding what therapeutic interventions truly reduce morbidity and mortality associated with IAH/ACS. Recent research sheds new light on the effects of IAH in individual organ systems and unique disease states. This paper will review recent research in IAH/ACS recognition, treatment, and management. ⋯ There is significant research on the broad impact of IAH/ACS in the ICU setting. Focus on IAH/ACS has gone beyond the purview of intensivists and surgeons to include outstanding work by specialists in multiple sub-specialties. These advances have generated improvements in current treatment algorithms. We review recent IAH/ACS literature and have categorized the most pertinent results into organ system-specific contributions.
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Curr Opin Crit Care · Apr 2021
ReviewLung-protective ventilation and adjunctive strategies to manage respiratory failure: are they safe in the neurological patient?
The coexistence of neurological injury and respiratory failure is common in intensive care. This article provides a contemporary overview of the safety and efficacy of different strategies for mechanical ventilation and adjunctive respiratory approaches in patients with acute brain injury. ⋯ Research is needed to determine the safety, feasibility, and efficacy of LPV and adjunctive approaches for managing patients with concurrent brain injury and respiratory failure.
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Curr Opin Crit Care · Apr 2021
ReviewRehabilitating the neurological patient in the ICU: what is important?
To describe recent literature evaluating the effectiveness of early rehabilitation in neurocritical care patients. ⋯ Further research is warranted to determine the benefits and harm of early rehabilitation in neurological patients. As current evidence is limited, and given recent findings in stroke studies, careful consideration should be taken when prescribing exercises in neurocritically ill patients.
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Although the gut microbiome plays a crucial role in the maintenance of health, it is hypothesized to drive morbidity and mortality in critically ill patients. This review describes the relationship between the gut microbiome and the immune system in critical illness. ⋯ The gut microbiome is dramatically altered in the ICU. In light of constant crosstalk between the microbiome and the host immune system, the pathobiome may play a key mechanistic role in driving a maladaptive response in critically ill patients. The pathobiome represents a potential therapeutic target in the management of critical illness whereby restoration of a healthier microbiome may directly alter the host inflammatory response, which could lead to improved patient outcomes.
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To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. ⋯ Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.