Current opinion in critical care
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Curr Opin Crit Care · Feb 2021
ReviewBedside noninvasive monitoring of mechanically ventilated patients.
Among noninvasive lung imaging techniques that can be employed at the bedside electrical impedance tomography (EIT) and lung ultrasound (LUS) can provide dynamic, repeatable data on the distribution regional lung ventilation and response to therapeutic manoeuvres.In this review, we will provide an overview on the rationale, basic functioning and most common applications of EIT and Point of Care Ultrasound (PoCUS, mainly but not limited to LUS) in the management of mechanically ventilated patients. ⋯ Bedside techniques - such as EIT and PoCUS - are becoming standards of the care for mechanically ventilated patients to monitor the changes in lung aeration, ventilation and perfusion in response to treatment and to assess weaning from mechanical ventilation.
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If developed using rigorous methods and produced in a timely manner, clinical practice guidelines have the potential to improve patient outcomes. Although the COVID-19 pandemic has highlighted the challenges involved in generating reliable clinical guidance, it has also provided an opportunity to address these challenges. ⋯ We provide an example of how rapid and rigorous guidelines can be accomplished, even in the setting of a pandemic, capitalizing on expertise, large and dedicated teams, and focused scope. We highlight the benefits of multifaceted knowledge dissemination through multiple formats to ensure global dissemination and in order to maximize impact.
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We describe the pathophysiology of cardiogenic shock (CS), from the main pathways to the inflammatory mechanisms and the proteomic features. ⋯ Understanding the pathophysiology of CS is important to treat it optimally.
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Curr Opin Crit Care · Dec 2021
ReviewChanging resuscitation strategies during a pandemic: lessons from the consecutive surges in New York and global challenges.
To provide a framework for resuscitation of COVID-19 critical illness for emergency and intensive care clinicians with the most up to date evidence and recommendations in the care of COVID-19 patients in cardiac arrest or in extremis. ⋯ The resuscitation of critically ill COVID-19 patients poses new challenges, but the principles remain largely unchanged.
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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.