Current opinion in critical care
-
Curr Opin Crit Care · Oct 2019
ReviewIn the pursuit of partnership: patient and family engagement in critical care medicine.
Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area. ⋯ Patient and family engagement in critical care medicine is an emerging field that requires further study to support definitive conclusions. Until then, it is important to match interested patients and family members with appropriate opportunities and provide training and support to ensure meaningful engagement.
-
Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. ⋯ Advances in diagnostics and therapeutic approach to CNS infections are continually made. For intensivists, focus on neuromonitoring and brain resuscitation in critically ill patients with CNS infections may present a path to enhance preservation of brain function and improve outcomes. VIDEO ABSTRACT: http://links.lww.com/COCC/A22.
-
Curr Opin Crit Care · Oct 2019
ReviewOptimizing therapy of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae.
Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, because of the alarming emergence or carbapenem resistance, interest in effective alternatives has emerged. The present review summarizes the findings published on the antibiotics currently available for treatment of patients with an ESBL-E bloodstream infection (BSI). ⋯ Carbapenems should be used in patients with serious infections; alternatives could be used individually, particularly for definitive treatment of patients with milder presentations.
-
Curr Opin Crit Care · Aug 2019
ReviewIntermittent or continuous feeding: any difference during the first week?
To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness. ⋯ Benefits of intermittent feeding in the ICU are today speculative, yet its potential impact may reach far beyond the gastrointestinal tract. Only adequately powered RCTs, evaluating both gastrointestinal tolerance, metabolic impact and patient-centered effects of intermittent feeding will allow to adopt or abort this nutritional strategy.
-
Curr Opin Crit Care · Aug 2019
ReviewMechanical circulatory support devices in cardiogenic shock and acute heart failure: current evidence.
The main purpose of this review is to highlight and summarize recently published studies on the usage of short-term mechanical circulatory support devices for treatment of cardiogenic shock. Importantly, this review will focus on percutaneously implanted devices. ⋯ Randomized, controlled trials are utterly needed to guide treatment with mechanical circulatory support for patients with cardiogenic shock. Importantly, such trials should focus patient selection criteria.