| 1. |
- Acosta, Stefan
(författare)
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Mesenteric ischemia.
- 2015
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 21:2, s. 171-178
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Forskningsöversikt (refereegranskat)abstract
- Diagnosis of acute mesenteric ischemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischemia may be treated with urgent intestinal revascularization.
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| 2. |
- Blaser, Annika Reintam, et al.
(författare)
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Acute mesenteric ischaemia
- 2022
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Ingår i: Current Opinion in Critical Care. - : Lippincott Williams & Wilkins. - 1070-5295 .- 1531-7072. ; 28:6, s. 702-708
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Forskningsöversikt (refereegranskat)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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| 3. |
- Blennow Nordström, Erik, et al.
(författare)
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Assessment of neurocognitive function after cardiac arrest
- 2019
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 25:3, s. 234-239
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest. RECENT FINDINGS: Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments. A subjective report is a simple method to screen for cognitive problems, but divergent findings were reported when comparing with objective measures. A standardized observer report may be useful for cognitive screening postcardiac arrest. The Montreal Cognitive Assessment (MoCA) was recommended for cognitive screening after cardiac arrest. Detailed neurocognitive assessments were reported as valuable for in-depth evaluation of patients in interventional studies. The best time-point for neurocognitive assessments remains unknown. Recent findings report that most neurocognitive recovery is seen within the first months after cardiac arrest, with some improvement also noted between 3 and 12 months postcardiac arrest. SUMMARY: Neurocognitive assessments after cardiac arrest are important and the approach should differ depending on the clinical situation. Large, prospective, well designed studies, to guide the selection of neurocognitive assessments after cardiac arrest, are urgently needed.
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| 4. |
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| 5. |
- Chew, Michelle, et al.
(författare)
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Echocardiography in shock
- 2023
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Ingår i: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 29:3, s. 252-258
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Forskningsöversikt (refereegranskat)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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| 6. |
- Chew, Michelle, et al.
(författare)
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Haemodynamic monitoring using arterial waveform analysis.
- 2013
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 19:3, s. 234-241
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE OF REVIEW: To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. RECENT FINDINGS: The precision of cardiac output (CO) measurements varies considerably and deteriorates during haemodynamic instability. Significant device-to-device differences exist. Nevertheless, most are sufficiently accurate for tracking changes in CO. Targeted intervention guided by haemodynamic monitoring reduces mortality and morbidity in high-risk surgical patients. Dynamic changes in variables such as systolic pulse variation, pulse pressure variation (PPV) and stroke volume variation (SVV) may be useful for evaluating fluid responsiveness, although important caveats exist. Newer indices such as PPV : SVV ratio may be useful in identifying preload and vasopressor-dependent patients. Peripheral arterial dP/dt has not been validated in critically ill patients and requires further investigation. SUMMARY: Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
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| 7. |
- Chew, Michelle, et al.
(författare)
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Myocardial injury after noncardiac surgery: facts, fallacies and how to approach clinically
- 2021
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Ingår i: Current Opinion in Critical Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1070-5295 .- 1531-7072. ; 27:6, s. 670-675
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Forskningsöversikt (refereegranskat)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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| 8. |
- Cronberg, Tobias
(författare)
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Assessing brain injury after cardiac arrest, towards a quantitative approach
- 2019
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Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 25:3, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury. RECENT FINDINGS: Qualitative assessment of clinical findings, neurophysiological signals and radiological images are prone to error due to the individual assessors' experience and competence. Currently, the only quantitative method for assessment of postarrest brain injury in regular clinical use is the measurement of neuron-specific enolase in serum. Since 2015 several promising methods to standardize assessment have been introduced including pupillometry, standardized electroencephalography interpretation and the quantification of somatosensory evoked potentials, computed tomography and MRI-signals. In addition, novel and superior blood biomarkers are on the verge of clinical introduction. SUMMARY: The current guidelines for neuroprognostication include a step-by-step multimodal algorithm but many patients will still be left with an uncertain prognosis 4-5 days after cardiac arrest. Novel quantitative methods are a necessary step to a more nuanced prediction of outcome for this group of patients.
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| 9. |
- Hedenstierna, Göran, et al.
(författare)
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Influence of abdominal pressure on respiratory and abdominal organ function
- 2012
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 18:1, s. 80-85
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Forskningsöversikt (refereegranskat)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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| 10. |
- Hedenstierna, Göran, et al.
(författare)
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Lymphatics and lymph in acute lung injury
- 2008
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Ingår i: Current Opinion in Critical Care. - 1070-5295 .- 1531-7072. ; 14:1, s. 31-36
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Forskningsöversikt (refereegranskat)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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