Current opinion in critical care
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We have highlighted the recent advances in infection in neurocritical care. ⋯ Acute brain injury triggers an inflammatory response that involves a complex interaction between innate and adaptive immunity, and there are several factors that can be implicated, such as age, genetic predisposition, the degree and mechanism of the injury, systemic and secondary injury and therapeutic interventions. Neuroinflammation is a major contributor to secondary injury. The frequent and challenging presence of fever is a common denominator amongst all neurocritical care patients.
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Curr Opin Crit Care · Oct 2021
ReviewSepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?
To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates. ⋯ The high mortality rates of critically ill patients with severe COVID-19 disease are not only related to the severity of patient disease but also to modifiable factors, such as the ICU strain, HAI incidence, and organizational aspects. Therefore, HAI prevention and the delivery of best evidence-based care for these patients to avoid additional damage is important. Quality improvement interventions might help in improving outcomes mainly in resource-limited settings.
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Curr Opin Crit Care · Apr 2021
ReviewHow much oxygen for the injured brain - can invasive parenchymal catheters help?
Each year in the United States there are over 2.5 million visits to emergency departments for traumatic brain injury (TBI), 300,000 hospitalizations, and 50,000 deaths. TBI initiates a complex cascade of events which can lead to significant secondary brain damage. Great interest exists in directly measuring cerebral oxygen delivery and demand after TBI to prevent this secondary injury. Several invasive, catheter-based devices are now available which directly monitor the partial pressure of oxygen in brain tissue (PbtO2), yet significant equipoise exists regarding their clinical use in severe TBI. ⋯ While current evidence regarding the use of PbtO2 remains mixed, three ongoing clinical trials are expected to definitively answer the question of what role PbtO2 monitoring plays in severe TBI.
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Curr Opin Crit Care · Feb 2021
ReviewMechanical ventilation of the healthy lungs: lessons learned from recent trials.
Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs. ⋯ In patients with healthy lungs, data indicate that low tidal volume but not higher PEEP is beneficial. Thereby, ventilation strategies differ from those in ARDS patients.
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Curr Opin Crit Care · Dec 2021
ReviewAdvanced cardiac life support: lessons from recent trials on how to move forward.
This review discusses potential reasons why many recent large trials in advanced cardiac life support have failed to demonstrate a difference in outcomes and suggests some points for consideration in planning future trials. ⋯ Refining our ability to select patients with potential to benefit from an intervention, providing those interventions earlier, and tailoring the specifics of an intervention to the individual patient all may be important in design of cardiac arrest trials, as illustrated by the large effect seen in the ARREST trial.