Current opinion in critical care
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This review describes the current intensive care management of acute liver failure (ALF) and the latest evidence for emerging therapies. ⋯ ICU management of ALF has improved such that liver transplantation is not required in some cases. HVP has emerged as a potential therapy for patients who may not be good liver transplantation candidates. Nevertheless in suitable patients with poor prognosis liver transplantation remains the optimal therapy.
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Curr Opin Crit Care · Apr 2019
ReviewImpact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome.
Facilitating spontaneous breathing has been traditionally recommended during mechanical ventilation in acute respiratory distress syndrome (ARDS). However, early, short-term use of neuromuscular blockade appears to improve survival, and spontaneous effort has been shown to potentiate lung injury in animal and clinical studies. The purpose of this review is to describe the beneficial and deleterious effects of spontaneous breathing in ARDS, explain potential mechanisms for harm, and provide contemporary suggestions for clinical management. ⋯ We update and summarize the role of spontaneous breathing during mechanical ventilation in ARDS, which can be beneficial or deleterious, depending on the strength of spontaneous activity and severity of lung injury. Future studies are needed to determine ventilator strategies that minimize injury but maintaining some diaphragm activity.
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Curr Opin Crit Care · Apr 2019
ReviewFluids and hyperosmolar agents in neurocritical care: an update.
To discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care. ⋯ Fluid resuscitation with crystalloids seems to be reasonable in this setting although no recommendations can be made regarding type of crystalloids. Based on current evidence, elevated ICP can be effectively reduced by either hypertonic saline or mannitol.
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Curr Opin Crit Care · Apr 2019
ReviewNutritional and metabolic supplementation for the injured brain: an update.
Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition. ⋯ Nutritional support is a key parameter in brain injured patient and must be initiated quickly to counteract hypermetabolic state by caring to improve caloric and nitrogen input. Recent clinical data support the use of immunonutrition, glutamine and zinc in this particular setting.
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Curr Opin Crit Care · Apr 2019
ReviewHow to deal with severe acute pancreatitis in the critically ill.
To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU. ⋯ Management of SAP is multimodal with emphasis on monitoring, adequate fluid resuscitation, avoiding prophylactic use of antibiotics, cause-directed procedures or treatment, and organ support. There is a role for early enteral nutrition including probiotics.