Articles: function.
-
Minerva anestesiologica · Dec 2024
ReviewAssessment of the organ function as the primary intention of clinical reasoning applied to the critically ill patient.
This article examines how clinical reasoning about the critical patient is currently treated and draws attention to some critical issues already often highlighted in the literature. Traditional approaches to clinical reasoning, even when applied to critical patients, prioritize identifying structured diseases. In contrast, the critical care setting demands an alternative approach that aligns with the intensivist's goal of supporting or substituting vital organ functions. ⋯ This discourse emphasizes a deep understanding of physiology and pathophysiology as foundational for practical clinical reasoning in critical care. Finally, we propose a structured assessment method that prioritizes pinpointing the compromised organ function, elucidating the pathophysiological mechanism responsible, hypothesizing potential causes, and testing these hypotheses to guide therapeutic interventions. This approach aligns clinical reasoning with the intensivist's goal: supporting and restoring vital functions in the critically ill patient.
-
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously nonalcoholic fatty liver disease (NAFLD), is the number one chronic liver disorder worldwide. Progression to advanced fibrosis marks the emergence of a significant risk of liver-related negative outcomes. However, only a minority of patients will present at this stage. ⋯ As such, research is ongoing. A promising avenue is that of omics, a group of technologies that provide concomitant results on a large number of molecules (and other variables). With the advance of artificial intelligence, new NITs may arise from large demographic, biochemical, and radiological data sets.
-
Semin Respir Crit Care Med · Dec 2024
ReviewBacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology.
Aspiration pneumonia refers to the process of alveolar inflammation induced by the inhalation of oropharyngeal secretions into the lower respiratory tract. Predisposing factors comprise swallowing dysfunction, impaired cough reflex, and degenerative neurological diseases. Accumulating evidence projects a fading contribution of anaerobic bacteria in aspiration pneumonia at the expense of Gram-negative bacilli, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, becoming the predominant organisms recovered from respiratory specimens. ⋯ Understanding this complex temporal variability between microbiome-host associations was only made possible with the introduction of metagenomic sequencing. In this narrative review, we summarize existing knowledge and elaborate on the evolving microbiology of aspiration pneumonia including the link between oral microbiome and pulmonary aspiration. We also highlight the progress and challenges in instituting microbiome-targeted strategies for preventing and treating the sequelae of aspiration pneumonia.
-
To provide an overview of the current diagnostic criteria for acute kidney injury (AKI) including their limitations and to discuss prevention and treatment approaches in the perioperative setting. ⋯ Evidence suggests that the implementation of supportive measures in patients at high risk for AKI might reduce the occurrence of AKI. Novel biomarkers can help allocating resources by detecting patients at high risk for AKI.
-
Semin Respir Crit Care Med · Dec 2024
ReviewAspiration after critical illness: role of endotracheal tube, tracheostomy, swallowing disorders.
Swallowing is a complex process that involves over 50 muscles and nerves and has two critical roles: passing food from the oral cavity through the pharynx and into the esophagus and preventing contents from entering the airway. If a patient's swallowing physiology or airway protective mechanisms are disturbed, the airways and the lungs have innate defense systems to protect against injury and infection. However, critically ill patients are more likely to develop dysphagia, which is an impairment or malfunction in any aspect of the swallowing mechanism, due to the numerous interventions they undergo. ⋯ Further research is necessary to help determine the best ways to prevent and manage pulmonary aspiration in critically ill patients. Several interventions are essential in preventing and managing dysphagia and the sequelae of swallowing dysfunction. Further research is needed to help elucidate the best way to avoid and manage pulmonary aspiration in critically ill patients.