Current opinion in critical care
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Curr Opin Crit Care · Dec 2024
ReviewNew perspectives of drug related kidney diseases and disorders.
The aim of this review is to provide a discussion of new perspectives for up-to-date definitions, a contemporary classification system, and the potential role of stress and damage biomarkers in the context of drug related kidney diseases and disorders. ⋯ Consistent definitions should be adopted with consideration to drug related diseases and disorders. Drug management can be guided using novel biomarkers to isolate a possible drug cause in the presence of more than one nephrotoxin or a nondrug cause, assisting with the diagnosis of pseudo-AKI, and deciding the likelihood AKI recovery. Furthermore, stress and damage kidney biomarkers provide the opportunity to detect subclinical AKI for early intervention in patients at high-risk for severe AKI.
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Curr Opin Crit Care · Dec 2024
ReviewRe-evaluating intra-cardiac arrest adjunctive medications and routes of drug administration.
This narrative review summarizes the evidence for the most commonly used intra-cardiac arrest adjunctive medications and routes of administration and discusses promising new therapies from preclinical animal models. ⋯ Large trials on intra-cardiac arrest administration of calcium and vasopressin with glucocorticoids have been performed. Several trials are ongoing that will provide valuable insights into the potential benefit of other intra-cardiac arrest medications such as bicarbonate as well as the potential benefit of intravenous or intraosseous vascular access.
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Curr Opin Crit Care · Dec 2024
ReviewManual mastery vs. mechanized magic: current opinions on manual vs. mechanical chest compressions.
Mechanical chest compression devices are increasingly deployed during cardiopulmonary resuscitation. We discuss the data supporting the use of mechanical chest compression devices during cardiac arrest and provide an opinion about the future of the technology. ⋯ Mechanical chest compression devices offer a solution to some of the human limiting factors of resuscitation, but have failed to demonstrate meaningful improvement in outcomes from cardiac arrest. Routine use of mechanical chest compression devices during cardiac arrest is not supported by evidence.
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Curr Opin Crit Care · Dec 2024
ReviewIs tranexamic acid appropriate for all patients undergoing high-risk surgery?
Tranexamic acid (TXA), an antifibrinolytic agent, reduces surgical bleeding in a variety of procedures, such as cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery. However, there are surgical interventions for which its use is not yet widespread, and some caution persists because of concerns regarding thrombotic risk. The purpose of this review is to analyze the most recent evidence in various subgroups of surgical specialties and the association of TXA with thrombotic events and other side effects (e.g. seizures). ⋯ Wider use of TXA has the potential to improve surgical safety, avoid unnecessary blood use, and save healthcare funds.
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Curr Opin Crit Care · Dec 2024
ReviewDevelopments in the epidemiology of calcium channel blocker poisoning and implications for management.
The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents. ⋯ Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.