Abstract:
PURPOSE OF REVIEW:Mortality/morbidity-based end points have been useful in evaluating treatments that modulate 'mediator variables' with a large effect size. Ventilation is usually a supportive measure, and hence is best seen as a 'moderator variable'. It can, therefore, have only a modest impact on disease-specific mortality. In this context, over reliance on final outcome-based end points (mortality, length of stay, etc.) risks the abandonment of several potentially useful developments. These concepts are important in considering how future developments should be evaluated. MAIN FINDINGS:A modest effect size implies that large sample sizes will be necessary to demonstrate mortality/morbidity benefits. Recruiting large numbers over geographically/culturally/economically heterogeneous areas over long periods (during which clinical practice is unlikely to remain constant) has several limitations. Furthermore, manifestations of critical illness are based on nonlinear interactions between insult, host responses and other moderator variables. In such nonlinear systems the final outcome is unpredictable and does not follow simple linear assumptions. Such 'unexpected' events occurring in clinical trials involving moderator variables, may potentially lead to erroneous conclusions. SUMMARY:It is crucial that a more dynamic approach, not based on final outcome alone, is considered in designing new clinical trials involving new ventilation strategies.
journal_name
Curr Opin Crit Carejournal_title
Current opinion in critical careauthors
Edwards D,Nirmalan Mdoi
10.1097/mcc.0b013e32833548cfsubject
Has Abstractpub_date
2010-02-01 00:00:00pages
34-8issue
1eissn
1070-5295issn
1531-7072journal_volume
16pub_type
杂志文章,评审abstract:PURPOSE OF REVIEW:To describe current antimicrobial resistance in ESKAPE Gram-negative microorganisms and their situation in the ICUs, the implication of the so-called high-risk clones (HiRCs) involved in the spread of antimicrobial resistance as well as relevance of the COVID-19 pandemic in the potential increase of r...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000755
更新日期:2020-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Tissue hypoperfusion is a common pathophysiologic process leading to multiple-organ dysfunction and death. An important goal of hemodynamic monitoring is the early detection of inadequate tissue perfusion and oxygenation. The use of simple, noninvasive monitoring techniques has the advantage of facili...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3282fad4e1
更新日期:2008-06-01 00:00:00
abstract:PURPOSE OF REVIEW:To discuss the perioperative monitoring tools and targets for haemodynamic optimization and to assess the influence of goal-directed therapy (GDT) on organ function, complications and outcome in different categories of surgical patients. RECENT FINDINGS:The choice of perioperative haemodynamic monito...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32833ab81e
更新日期:2010-08-01 00:00:00
abstract:PURPOSE OF REVIEW:This article reviews the current literature dealing with pathophysiology, diagnostics, bleeding management, and thromboprophylaxis in patients with acute and chronic liver dysfunction. RECENT FINDINGS:Routine coagulation tests such as prothrombin time and International Normalized Ratio (INR) are not ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32835ebb52
更新日期:2013-04-01 00:00:00
abstract:PURPOSE OF REVIEW:Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings. RECENT FINDINGS:The role of ou...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000160
更新日期:2014-12-01 00:00:00
abstract:PURPOSE OF REVIEW:This article reviews and critiques new developments in the critical care of burn patients. RECENT FINDINGS:The practice of restrictive transfusion is slowly gaining traction. Abdominal compartment syndrome is associated with resuscitation volumes of 300 ml/kg per 24 h, and percutaneous decompression ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328263888f
更新日期:2007-08-01 00:00:00
abstract:PURPOSE OF REVIEW:This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. RECENT FINDINGS:The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar flui...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000626
更新日期:2019-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. However, recently signals of risk have come from two large-scale m...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000633
更新日期:2019-08-01 00:00:00
abstract::The introduction of mechanical ventilation in the intensive care unit environment had the merit of putting a potent life-saving tool in the physicians' hands in a number of situations; however, like most sophisticated technologies, it can cause severe side effects and eventually increase mortality if improperly applie...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200102000-00007
更新日期:2001-02-01 00:00:00
abstract:PURPOSE OF REVIEW:The following review intends to outline the unique aspects of providing cardiopulmonary resuscitation for the poisoned patient and highlights both current practice and new therapies that apply to toxicologic cases. RECENT FINDINGS:Although there are few prospective randomized studies to further evide...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32814b040c
更新日期:2007-06-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of this review is to provide an update of recent developments pertaining to the use of percutaneous tracheostomy. Percutaneous tracheostomy has been established as an alternative to open surgical tracheostomy, but many key questions about the optimal use of this procedure remain unanswered...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000170680.09759.f2
更新日期:2005-08-01 00:00:00
abstract:PURPOSE OF REVIEW:This review will discuss the rationale and clinical utility of percutaneous left ventricular assist devices in the management of patients with cardiogenic shock. RECENT FINDINGS:Left ventricular assist devices maintain partial or total circulatory support in case of severe left ventricular failure. C...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3282efd5bc
更新日期:2007-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Selenium is a trace element essential to human health. Critical illness is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing critically ill patients with antioxidant nutrients may improve survival. Selenium levels can be low due to redis...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000216581.80051.d6
更新日期:2006-04-01 00:00:00
abstract::The use of therapeutic moderate hypothermia for treating severe traumatic brain injury has been reported for more than 50 years. However, the most intense investigation of this treatment has occurred during the last 10 to 15 years. Virtually all preclinical studies have documented a robust treatment effect, not only i...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200204000-00004
更新日期:2002-04-01 00:00:00
abstract:PURPOSE OF REVIEW:Despite decades of advances in prehospital and in-hospital medical care, patients with out-of-hospital cardiac arrest continue to have poor neurologic and cardiac function following otherwise successful resuscitation. This review examines the mechanisms and therapeutic strategies currently under devel...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000087
更新日期:2014-06-01 00:00:00
abstract:PURPOSE OF REVIEW:Efforts to improve outcomes from acute kidney injury (AKI) have focussed on timely diagnosis and effective delivery of basic patient care. Electronic alerts (e-alerts) for AKI have attracted interest as a tool to facilitate this. Initial feasibility has already been demonstrated; this review will disc...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000245
更新日期:2015-12-01 00:00:00
abstract:PURPOSE OF REVIEW:The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI). RECENT FINDINGS:AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, comp...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000560
更新日期:2018-12-01 00:00:00
abstract::Clinicians are increasingly aware that fungal pathogens are a significant cause of morbidity and mortality in hospitalized patients. Historically, these infections occurred in severely immunocompromised patients who were undergoing treatment for hematological malignancy or solid organ transplantation. Currently, howev...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200108000-00005
更新日期:2001-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Status epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of co...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000661
更新日期:2019-12-01 00:00:00
abstract::Critical illness polyneuropathy (CIP) is a syndrome that was first extensively described in the early 1980s, mainly in patients with failure to wean from mechanical ventilation. The syndrome is further characterized by limb muscle weakness, usually more pronounced distally than proximally, and is often accompanied by ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200208000-00006
更新日期:2002-08-01 00:00:00
abstract:PURPOSE OF REVIEW:To outline evidence that suggests increased intestinal epithelial apoptosis (programmed cell death) plays an important role in critical illness of infectious and noninfectious origin. RECENT FINDINGS:Both human and animal studies demonstrate that the gut epithelium has increased levels of cellular de...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200304000-00013
更新日期:2003-04-01 00:00:00
abstract:PURPOSE OF REVIEW:This review describes the current intensive care management of acute liver failure (ALF) and the latest evidence for emerging therapies. RECENT FINDINGS:Mortality from ALF continues to improve and in some cases, medical therapy can negate the need for liver transplantation because of protocolized man...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000583
更新日期:2019-04-01 00:00:00
abstract:PURPOSE OF REVIEW:To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP). RECENT FINDINGS:NV-HAP is emerging as a new challenge for clinicians, particularly because VAP incidence has been decreasing. The clinical diagnosis of NV-HAP uses the...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000525
更新日期:2018-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Ventilator weaning forms an integral part in critical care medicine and strategies to shorten duration are rapidly evolving alongside our knowledge of the relevant physiological processes. The purpose of the current review is to discuss new physiological and clinical insights in ventilator weaning tha...
journal_title:Current opinion in critical care
pub_type: 杂志文章
doi:10.1097/MCC.0000000000000790
更新日期:2021-02-01 00:00:00
abstract:PURPOSE OF REVIEW:We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. RECENT FINDINGS:The most important results regarding the use of extracorporeal gas exchange are expect...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283220e1f
更新日期:2009-02-01 00:00:00
abstract:PURPOSE OF REVIEW:As incidence of acute lung injury (ALI) increases and case fatality decreases, long-term care of survivors is of public health importance. Previous studies demonstrate that these survivors are at risk for impairment in physical, cognitive and mental health. In this review, we will discuss recent studi...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32834f186d
更新日期:2012-02-01 00:00:00
abstract:PURPOSE OF REVIEW:There is significant controversy for perioperative fluid management. This review discusses the evidence from clinical studies, basic research, and systematic reviews to provide a summary of the current best practice in this area. RECENT FINDINGS:Recent evidence has challenged the long-held contention...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283632f1f
更新日期:2013-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Antimicrobials are very commonly used drugs in the intensive care setting. Extensive research has been conducted in recent years to describe their pharmacokinetics/pharmacodynamics in order to maximize the pharmacological benefit and patient outcome. Translating these new findings into clinical practi...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000229
更新日期:2015-10-01 00:00:00
abstract::During the past decade, enormous advances have been made in cell biology. Major advances included the publication of the human genome sequence, the development of proteomics, and DNA microarray technologies and techniques to selectively "silence" genes using short strands of double-stranded RNA. Some areas of great pr...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000130150.33814.71
更新日期:2004-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Traumatic injury continues to be a significant cause of morbidity and mortality in the year 2011. In addition, the healthcare expenditures and lost years of productivity represent significant economic cost to the affected individuals and their communities. Helicopters have been used to transport traum...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32834c5655
更新日期:2011-12-01 00:00:00