Abstract:
PURPOSE OF REVIEW:Ventilator-induced lung injury (VILI) can occur despite use of tidal volume (VT) limited to 6 ml/kg of predicted body weight, especially in patients with a smaller aerated compartment (i.e. the baby lung) in which, indeed, tidal ventilation takes place. Because respiratory system static compliance (CRS) is mostly affected by the volume of the baby lung, the ratio VT/CRS (i.e. the driving pressure, ΔP) may potentially help tailoring interventions on VT setting. RECENT FINDINGS:Driving pressure is the ventilatory variable most strongly associated with changes in survival and has been shown to be the key mediator of the effects of mechanical ventilation on outcome in the acute respiratory distress syndrome. Observational data suggest an increased risk of death for patients with ΔP more than 14 cmH2O, but a well tolerated threshold for this parameter has yet to be identified. Prone position along with simple ventilatory adjustments to facilitate CO2 clearance may help reduce ΔP in isocapnic conditions. The safety and feasibility of low-flow extracorporeal CO2 removal in enhancing further reduction in VT and ΔP are currently being investigated. SUMMARY:Driving pressure is a bedside available parameter that may help identify patients prone to develop VILI and at increased risk of death. No study had prospectively evaluated whether interventions on ΔP may provide a relevant clinical benefit, but it appears physiologically sound to try titrating VT to minimize ΔP, especially when it is higher than 14 cmH2O and when it has minimal costs in terms of CO2 clearance.
journal_name
Curr Opin Crit Carejournal_title
Current opinion in critical careauthors
Grieco DL,Chen L,Dres M,Brochard Ldoi
10.1097/MCC.0000000000000377subject
Has Abstractpub_date
2017-02-01 00:00:00pages
38-44issue
1eissn
1070-5295issn
1531-7072journal_volume
23pub_type
杂志文章,评审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:PURPOSE OF REVIEW:To provide an update on the progress of the multicenter, randomized, controlled trial of corticosteroids after significant head injury (CRASH). RECENT FINDINGS:After a successful pilot phase, the main phase of the CRASH Trial began in March 2001. By June 2002, 107 hospitals from 31 countries were par...
journal_title:Current opinion in critical care
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00075198-200304000-00003
更新日期:2003-04-01 00:00:00
abstract:PURPOSE OF REVIEW:Care of the injured patient is a dynamic process. Hemorrhage remains the primary cause of preventable death after trauma. Rapid and effective early care can improve survival and outcomes. Emerging therapies to address traumatic hemorrhage will be discussed. RECENT FINDINGS:Current concepts in trauma ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328331f57c
更新日期:2009-12-01 00:00:00
abstract:PURPOSE OF REVIEW:To investigate the impact of critical illness polyneuropathy and critical illness myopathy on short-term and long-term patient outcome. RECENT FINDINGS:In the acute-care setting, critical illness polyneuropathy and critical illness myopathy are important causes of acute paralysis in critically ill co...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000168530.30702.3e
更新日期:2005-08-01 00:00:00
abstract:PURPOSE OF REVIEW:End-of-life care and communication deficits are important sources of conflicts within ICU teams and with patients or families. This narrative review describes recent studies on how to improve palliative care and surrogate decision-making in ICUs and compares the results with previously published liter...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328358d417
更新日期:2012-12-01 00:00:00
abstract:PURPOSE OF REVIEW:To describe and put into context recent conceptual advances regarding the relationship of energy load and power to ventilator-induced lung injury (VILI). RECENT FINDINGS:Investigative emphasis regarding VILI has almost exclusively centered on the static characteristics of the individual tidal cycle -...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000470
更新日期:2018-02-01 00:00:00
abstract:PURPOSE OF REVIEW:Point-of-care ultrasound (POCUS) is commonly used during cardiac arrest to screen for potential causes and to inform termination of resuscitation. However, unique biases and limitations in diagnostic and prognostic test accuracy studies lead to potential for misinterpretation. The present review highl...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000766
更新日期:2020-12-01 00:00:00
abstract:PURPOSE OF REVIEW:This article reviews the results of case series and trials which evaluated venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. Potential indications of the technique in this setting are discussed. RECENT FINDINGS:Major technological improvements in extracorporeal ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328357f090
更新日期:2012-10-01 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:In the past 12 years, atherosclerosis and the acute coronary syndromes have turned out to be thromboinflammatory diseases. Recent data suggest that inflammation also plays an important role in the pathogenesis and outcome of cardiogenic shock. This review will summarize recent advances in the understa...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000139364.53198.fd
更新日期:2004-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Research and studies related to the long-term consequences of intensive care are increasing. This review focuses on some of the most recent knowledge in this field. RECENT FINDINGS:Still studies regarding the health-related quality of life (HRQOL) in survivors after intensive care are frequently publ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32833cc90b
更新日期:2010-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of re...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000520
更新日期:2018-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Shock occurs because of a failure to deliver adequate oxygen to meet the metabolic demands of the body resulting in metabolic acidosis, inflammation, and coagulopathy. Resuscitation is the process of treating shock in an attempt to restore normal physiology. Various hemodynamic, metabolic, and regiona...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000248
更新日期:2015-12-01 00:00:00
abstract:PURPOSE OF REVIEW:This review intends to summarize the recent findings regarding the presence of increased oxidative stress in critically ill patients and its potential pathophysiologic role, as well as the results of recent clinical trials of antioxidant therapies. RECENT FINDINGS:Several lines of evidence confirm th...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200308000-00003
更新日期:2003-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Implantable cardioverter-defibrillator (ICD) implantation is the standard of care for secondary prevention in patients with previous cardiac arrest and for primary prevention in appropriately selected patients with cardiomyopathy. However, ICD therapies and the arrhythmias that trigger these therapies...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328357ae68
更新日期:2012-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Postoperative sepsis is a major cause of surgical associated morbidity and mortality. Our goal is to describe its incidence, pathophysiology, and contributing factors. In addition, we will review preventive measures and treatment options that may possibly reduce its healthcare burden. RECENT FINDINGS...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328348bee2
更新日期:2011-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses several different conditions that vary considerably. The lack of a widely accepted definition for prerenal failure makes it impossible to determine the epidemiology, natural history...
journal_title:Current opinion in critical care
pub_type: 杂志文章
doi:10.1097/MCC.0b013e328332f6e3
更新日期:2009-12-01 00:00:00
abstract:PURPOSE OF REVIEW:This article reviews current concepts in perioperative pulmonary management. RECENT FINDINGS:Preoperative risk assessment tools for perioperative pulmonary complications (POPCs) are evolving for both children and adults. Intraoperative management strategies have a demonstrable effect on outcomes. Lat...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328348bfc8
更新日期:2011-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Acute kidney injury (AKI) is commonplace in most ICUs. In many cases the cause is believed to be multifactorial with sepsis being a major component. However, occasionally intrinsic renal disease will present to the ICU and as such critical care practitioners should be aware of this possibility and the...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000155
更新日期:2014-12-01 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:PURPOSE OF REVIEW:The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to critically ill patients has resulted in a recent shift in ARDS research. Increasin...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000174
更新日期:2015-02-01 00:00:00
abstract:PURPOSE OF REVIEW:Health-related quality of life (HRQoL) is an important patient-reported outcome measure following critical illness. 'Validated' and professionally endorsed generic measures are widely used to evaluate critical care intervention and guide practice, policy and research. Although recognizing that they ar...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32834a4bd4
更新日期:2011-10-01 00:00:00
abstract::Successes in machine-based extracorporeal support for different organ functions stimulated research in the field of liver support approximately 50 years ago. Initial failure to improve outcome using detoxification methods like dialysis, blood and plasma exchange, or plasmapheresis over sorbents fueled interest in biol...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200204000-00014
更新日期:2002-04-01 00:00:00
abstract::Widespread provision of early defibrillation following cardiac arrest holds major promise for improved survival from ventricular fibrillation. The critical element in predicting a successful outcome is the rapidity with which defibrillation is achieved. A worldwide awareness of this potential and its advocacy by such ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200106000-00002
更新日期:2001-06-01 00:00:00
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200502000-00003
更新日期:2005-02-01 00:00:00
abstract:PURPOSE OF REVIEW:The aim of this review is to summarize important publications in enhanced recovery during 2010-2011 and to highlight key themes. Specifically, we focus on updated systematic reviews of high-quality clinical trials of enhanced recovery in colorectal surgery, exemplar studies of enhanced recovery in oth...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283558968
更新日期:2012-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Uncertainty surrounding medical decision-making is particularly important during end-of-life decision-making. Doubts about the patient's best interests and prognostic accuracy may lead to conflict. RECENT FINDINGS:Many authors have suggested recently that medical attitudes to uncertainty need review....
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000030
更新日期:2013-12-01 00:00:00
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 mo...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/mcc.0b013e32833548cf
更新日期:2010-02-01 00:00:00
abstract:PURPOSE OF REVIEW:We discuss the goals of resuscitation, in both the early and the later phases, measures of organ perfusion, fluid responsiveness and the consequences of tissue edema. RECENT FINDINGS:The cost of over-aggressive fluid resuscitation is increased organ failure and mortality. In anticipation of the upcom...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000116
更新日期:2014-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Increased use of advanced life-sustaining measures in patients with poor long-term expectations secondary to more chronic organ dysfunctions, comorbidities and/or a poor quality of life has become a worrying trend over the last decade. This can lead to futile, disproportionate or inappropriate care in...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000026
更新日期:2013-12-01 00:00:00