Current opinion in critical care
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Curr Opin Crit Care · Feb 2024
ReviewSetting positive end-expiratory pressure: the use of esophageal pressure measurements.
To summarize the key concepts, physiological rationale and clinical evidence for titrating positive end-expiratory pressure (PEEP) using transpulmonary pressure ( PL ) derived from esophageal manometry, and describe considerations to facilitate bedside implementation. ⋯ Esophageal pressure monitoring has the potential to individualize the PEEP settings. Future studies are needed to evaluate the clinical benefit of such approach.
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Current demographic change leads to higher number of elderly patients admitted to an ICU. Among other organs also the kidneys show age-related changes, which are associated with a decline in various aspects of renal function. The purpose of this review is to provide an overview of structural and functional changes in elderly and also to specifically address the increased risk of acute kidney injury (AKI) in this population. ⋯ Age-related alterations of the kidneys were found at microscopic and macroscopic levels of the cell. These changes lead to a reduced renal reserve and subsequently to an increased vulnerability of aged kidneys when an additional stressor is added. Age is an independent risk factor for developing AKI. Physicians should take into account the altered renal function in elderly patients and take renal protective measures at an early stage.
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Curr Opin Crit Care · Dec 2023
ReviewExtracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest - current status.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging treatment for refractory cardiac arrest. In recent years, several randomized controlled trials have been published that aimed to address the efficacy and effectiveness of ECPR for out-of-hospital cardiac arrest (OHCA). Despite the lack of high-quality evidence concerning clinical effectiveness and cost-effectiveness, ECPR is increasingly implemented throughout the world. In this review, we aim to provide an overview of the current status of ECPR for OHCA. ⋯ The potential of ECPR to increase survival in selected patients in highly dedicated systems seems to be proven, the question remains whether ECPR for OHCA can be widely implemented successfully and can develop into a sustainable, commonplace resource-effective treatment.
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Curr Opin Crit Care · Dec 2023
ReviewCurrent knowledge and availability of machine learning across the spectrum of trauma science.
Recent technological advances have accelerated the use of Machine Learning in trauma science. This review provides an overview on the available evidence for research and patient care. The review aims to familiarize clinicians with this rapidly evolving field, offer perspectives, and identify existing and future challenges. ⋯ Machine Learning holds promise for actionable decision support in trauma science, but rigorous proof-of-concept studies are urgently needed. Future research should assess workflow integration, human-machine interaction, and, most importantly, the impact on patient outcome. Machine Learning enhanced causal inference for observational data carries an enormous potential to change trauma research as complement to randomized studies. The scientific trauma community needs to engage with the existing challenges to drive progress in the field.
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Acute kidney injury (AKI) is a highly prevalent clinical syndrome that substantially impacts patient outcomes. It is accepted by the clinical communities that the management of AKI is time-sensitive. Unfortunately, despite growing proof of its preventability, AKI management remains suboptimal in community, acute care, and postacute care settings. Digital health solutions comprise various tools and models to improve care processes and patient outcomes in multiple medical fields. AKI development, progression, recovery, or lack thereof, offers tremendous opportunities for developing, validating, and implementing digital health solutions in multiple settings. This article will review the definitions and components of digital health, the characteristics of AKI that allow digital health solutions to be considered, and the opportunities and threats in implementing these solutions. ⋯ Careful needs assessment, selection of the correct digital health solution, and appropriate clinical validation of the benefits while avoiding additional health disparities are moral, professional, and ethical obligations for all individuals using these healthcare tools, including clinicians, data scientists, and administrators.