| 1. |
- Blaser, Annika Reintam, et al.
(author)
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Acute mesenteric ischaemia
- 2022
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In: Current Opinion in Critical Care. - : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 28:6, s. 702-708
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Research review (peer-reviewed)abstract
- Purpose of review To summarize the recent evidence on acute mesenteric ischaemia (AMI). Recent findings The overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce. Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI. Improved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.
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| 2. |
- Chew, Michelle, et al.
(author)
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Echocardiography in shock
- 2023
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In: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 29:3, s. 252-258
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Research review (peer-reviewed)abstract
- Purpose of reviewThe aim of this study was to illustrate the varying roles of echocardiography in all phases of shock ranging from a rapid, diagnostic tool at the bedside, to a tool for monitoring the adequacy and effects of shock treatment and finally for identification of patients suitable for de-escalation of therapy.Recent findingsEchocardiography has become an indispensable tool for establishing diagnosis in patients with shock. It is also important for assessing the adequacy of treatment such as fluid resuscitation, vasopressors and inotropes by providing integrated information on cardiac contractility and systemic flow conditions, particularly when used in conjunction with other methods of advanced haemodynamic monitoring. Apart from a traditional, diagnostic role, it may be used as an advanced, albeit intermittent, monitoring tool. Examples include the assessment of heart-lung interactions in mechanically ventilated patients, fluid responsiveness, vasopressor adequacy, preload dependence in ventilator-induced pulmonary oedema and indications for and monitoring during extracorporeal life support. Emerging studies also illustrate the role of echocardiography in de-escalation of shock treatment.This study provides the reader with a structured review on the uses of echocardiography in all phases of shock treatment.
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| 3. |
- Chew, Michelle, et al.
(author)
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Myocardial injury after noncardiac surgery: facts, fallacies and how to approach clinically
- 2021
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In: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 27:6, s. 670-675
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Research review (peer-reviewed)abstract
- Purpose of review Acute myocardial injury occurs commonly during perioperative care. There is still considerable confusion regarding its diagnosis and definition, and a lack of consensus on who and how to screen, exacerbated by a lack of studies addressing how to manage patients with detected myocardial injury. Recent findings Far from a benign biochemical anomaly, myocardial injury occurring perioperatively is largely a silent disease and is not necessarily because of ischaemia. Preoperative, postoperative, and perioperative changes in cardiac troponins (cTns) are independently associated with increased mortality and adverse cardiovascular outcomes. Routine screening with cTns is required for reliable detection of myocardial injury. Measurement of changes (from preoperative to postoperative) will detect acute events as well as identify patients with chronic troponin increases. This review aims to bring together current literature regarding myocardial injury that is detected perioperatively, identifies knowledge gaps for future research and provides suggestions for management.
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| 4. |
- Hedenstierna, Göran, et al.
(author)
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Influence of abdominal pressure on respiratory and abdominal organ function
- 2012
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In: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 18:1, s. 80-85
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Research review (peer-reviewed)abstract
- Purpose of review:Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been realized as severe complications in the intensive care patient. Laparoscopic surgery in older and more obese patients increases the risk of IAH and ACS.Recent findings:The incidence of IAH may be larger than thought of being approximately one-third of mechanically ventilated intensive care patients. In shock/trauma, three-fourths of all patients may suffer from IAH. Kidney and liver may dysfunction and the gut barrier may be impeded, permitting spread of inflammation to other organs. IAH and ACS have an impact on respiratory mechanics and may impede ventilation and require higher ventilation pressures than under normal conditions. Prone position and alternating (asynchronous) ventilation may moderate the IAH. In addition, surgical decompression should be considered.Summary: In view of the frequent occurrence of IAH in intensive care, the need of better understanding of the mechanisms behind IAH is a prerequisite for better treatment. Respiratory mechanics are affected but may also indicate routes of ventilatory treatment to lower IAH.
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| 5. |
- Hedenstierna, Göran, et al.
(author)
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Lymphatics and lymph in acute lung injury
- 2008
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In: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 14:1, s. 31-36
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Research review (peer-reviewed)abstract
- Purpose of review Lymph flow will be discussed as part of the drainage and fluid balance of lung tissue and abdomen as well as a qualitative analysis of inflammatory processes. Recent findings Measurement of lung lymph is still a technical challenge. Mechanical ventilation and positive end-expiratory pressure impede lung lymph flow by increased intrathoracic pressure and increased central venous pressure. Positive end-expiratory pressure may thus enhance edema formation of the lung. Inflammatory spread from abdomen to the lung via the lymphatic system has been shown in a number of experimental studies. Ligation or diversion of the thoracic duct has been proposed to blunt the effects of noxious stimuli mediated by lymphatics to the lungs. Lymphatics have a major role on abdominal fluid balance while draining extravascular fluid accumulation and edema, especially during sepsis. Mechanical ventilation with high airway pressure increases abdominal edema (ascites) and spontaneous breathing protects from edema formation. Summary Lymph flow measurements are still a difficult task to perform; however, new results show an important function in the fluid balance of the lung and abdomen. Inflammatory spread may occur from the lung to the periphery by the blood stream and from the abdomen to the lung by lymph flow.
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| 6. |
- Hossain, Iftakher, et al.
(author)
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The management of severe traumatic brain injury in the initial postinjury hours : current evidence and controversies
- 2023
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In: Current Opinion in Critical Care. - : Wolters Kluwer. - 1070-5295 .- 1531-7072. ; 29:6, s. 650-658
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Research review (peer-reviewed)abstract
- Purpose of review To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours.Recent findings Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials.Summary Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.
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| 7. |
- Ljungqvist, Olle, 1954-, et al.
(author)
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Metabolic perioperative management : novel concepts
- 2005
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In: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 11:4, s. 295-9
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Research review (peer-reviewed)abstract
- Purpose of review: This review summarizes novel information regarding the role of metabolic control in the perioperative period.Recent findings: Managing perioperative metabolism has recently been shown to be an important way to improve outcomes in surgical care. In particular, postoperative insulin resistance and hyperglycemia have been linked to many common complications. Recent studies have explored the toxicity of hyperglycemia and suggest a causal relation between insulin resistance and complications in the postoperative state. Controlling glucose concentrations with insulin has been shown to also improve protein balance and fat metabolism. In addition, insulin may affect other hormones including insulinlike growth factor-I during surgical stress. Lastly, recent data suggest that hyperglycemia plays an important role in aggravating the inflammatory response, in that overflow of substrates in the mitochondria causes the formation of excess free oxygen radicals and may also alter gene expression to enhance cytokine production. Although overcoming insulin resistance by insulin infusion is one way of combating hyperglycemia, prevention of its development can also be achieved by using epidural blockade to reduce the release of adrenal stress hormones and to control pain, by preoperative carbohydrates instead of overnight fasting, and by minimal invasive surgical techniques.Summary: Minimizing the effects of insulin resistance has been shown to substantially improve outcome after surgical stress.
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| 8. |
- Rubertsson, Sten
(author)
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Update on mechanical cardiopulmonary resuscitation devices
- 2016
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In: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 22:3, s. 225-229
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Research review (peer-reviewed)abstract
- Purpose of review The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. Recent findings Three recently published large multicenter randomized trials have not been able to show any improved outcome in adult out-of-hospital cardiac arrest patients when compared with manual chest compressions. Summary Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.
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| 9. |
- Soop, Mattias, et al.
(author)
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Optimizing perioperative management of patients undergoing colorectal surgery : what is new?
- 2006
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In: Current Opinion in Critical Care. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 12:2, s. 166-70
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Research review (peer-reviewed)abstract
- Purpose or review: This review highlights recent developments in individual perioperative interventions in colorectal surgery, and progress in so-called fast-track or enhanced-recovery programmes.Recent findings: A new survey from five northern European countries has revealed that best clinical practice in perioperative care, based on previously published high-grade evidence, is only partially in use in daily clinical practice. Recently, a number of trials contrasting clinical results in enhanced-recovery protocols versus traditional care clearly show that such protocols indeed enhance recovery, although effects on morbidity are less obvious. Further evidence supporting preoperative oral carbohydrate treatment, avoidance of oral bowel preparation and wound drainage in elective colonic surgery and avoidance of intraoperative fluid excess has emerged. The oral opioid antagonist alvimopan has recently been shown to limit postoperative gastrointestinal paralysis. The role of laparoscopic surgery in the era of enhanced-recovery programmes is unclear.Summary: There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not utilized in daily practice. Further evidence has emerged supporting several perioperative treatments, and successful experiences of enhanced-recovery programmes have now been reported from several centres.
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| 10. |
- Suarez-Sipmann, Fernando, et al.
(author)
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Volumetric capnography : the time has come
- 2014
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In: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 20:3, s. 333-339
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Research review (peer-reviewed)abstract
- Purpose of review This review article summarizes the recent advances in electrical impedance tomography (EIT) related to cardiopulmonary imaging and monitoring on the background of the 30-year development of this technology. Recent findings EIT is expected to become a bedside tool for monitoring and guiding ventilator therapy. In this context, several studies applied EIT to determine spatial ventilation distribution during different ventilation modes and settings. EIT was increasingly combined with other signals, such as airway pressure, enabling the assessment of regional respiratory system mechanics. EIT was for the first time used prospectively to define ventilator settings in an experimental and a clinical study. Increased neonatal and paediatric use of EIT was noted. Only few studies focused on cardiac function and lung perfusion. Advanced radiological imaging techniques were applied to assess EIT performance in detecting regional lung ventilation. New approaches to improve the quality of thoracic EIT images were proposed. EIT is not routinely used in a clinical setting, but the interest in EIT is evident. The major task for EIT research is to provide the clinicians with guidelines how to conduct, analyse and interpret EIT examinations and combine them with other medical techniques so as to meaningfully impact the clinical decision-making.
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