Current opinion in critical care
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This article reviews the recent literature pertaining to assessment of the adequacy of oxygen delivery in critically ill patients with circulatory shock. ⋯ In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a 'tried and true' method - the physical examination. Also potentially important in the evaluation of oxygen delivery is the utilization of biomarkers (e.g., lactate, ScvO2, NIRS). In complementary fashion, bedside ultrasound for hemodynamic assessment may augment the physical examination and biomarkers, and represents a potentially important adjunct for assessing the adequacy of oxygen delivery.
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Curr Opin Crit Care · Oct 2016
ReviewRole of albumin, starches and gelatins versus crystalloids in volume resuscitation of critically ill patients.
The review focuses on fluid resuscitation of critically ill patients with either colloid or crystalloid solutions. ⋯ Fluid administration should be tailored to patient characteristics. Synthetic colloids should be avoided when possible, especially in patients at risk for kidney injury. In critically ill patients with suspected increased permeability, colloids may not be superior to crystalloids in expanding plasma volume. Albumin appears to be less harmful than synthetic colloids, although its beneficial effects need to be further investigated. The endothelial glycocalyx layer is the key structure finely regulating intravascular fluid distribution.
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Multidrug resistance of bacterial pathogens has confronted physicians around the world with the threat of inefficacy of the antibiotic regime, which is particularly important for patients with sepsis. Antibiotic resistance has revived search for alternative nonantibiotic strategies. Among them, prophylaxis by vaccination is an appealing concept. ⋯ The effects achieved by some conjugated vaccines (e.g. against Haemophilus influenzae B and Streptococcus pneumoniae) are encouraging. Their widespread use has resulted in a decrease or almost elimination of invasive diseases by the covered pneumococcal serotypes or Haemophilus influenzae B, respectively. These vaccines confer not only individual protection but also exploit herd protection effects. However, a multitude of failures reflects the obstacles on the way to effective and well tolerated bacterial vaccines. Regional differences in strain prevalence and variability of antigens that limit cross-protectivity remain major obstacles. However, promising candidates are in clinical development.
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Curr Opin Crit Care · Oct 2016
ReviewHow does prior health status (age, comorbidities and frailty) determine critical illness and outcome?
Critical illness has a significant impact on an individual's physical and mental health. However, it is less clear to what degree outcomes after critical illness are due to patients' preexisting characteristics, rather than the critical illness itself. In this review, we summarize recent findings regarding the role of age, comorbidity and frailty on long-term outcomes after critical illness. ⋯ Age, comorbidity and frailty play a critical role in determining the long-term outcomes of patients requiring intensive care.
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Curr Opin Crit Care · Oct 2016
Chronic pain disorders after critical illness and ICU-acquired opioid dependence: two clinical conundra.
Is to describe the potential for patients to undergo an acute-to-chronic pain transition after ICU discharge as a result of pain they experienced in ICU and to explore the phenomenon of ICU-acquired opioid dependence. Both topics are timely, in that they can negatively influence patient recovery after critical illness and contribute to post-ICU syndrome. ⋯ Providing sufficient analgesia to ICU patients while preventing opioid dependence and withdrawal is essential to promote comfort and rehabilitation. Obtaining this balance requires heightened ICU clinician attention and focused research.