New insights into the gut as the driver of critical illness and organ failure.

Abstract:

PURPOSE OF REVIEW:The gut has long been hypothesized to be the 'motor' of multiple organ dysfunction syndrome. This review serves as an update on new data elucidating the role of the gut as the propagator of organ failure in critical illness. RECENT FINDINGS:Under basal conditions, the gut absorbs nutrients and serves as a barrier that prevents approximately 40 trillion intraluminal microbes and their products from causing host injury. However, in critical illness, gut integrity is disrupted with hyperpermeability and increased epithelial apoptosis, allowing contamination of extraluminal sites that are ordinarily sterile. These alterations in gut integrity are further exacerbated in the setting of preexisting comorbidities. The normally commensal microflora is also altered in critical illness, with increases in microbial virulence and decreases in diversity, which leads to further pathologic responses within the host. SUMMARY:All components of the gut are adversely impacted by critical illness. Gut injury can not only propagate local damage, but can also cause distant injury and organ failure. Understanding how the multifaceted components of the gut interact and how these are perturbed in critical illness may play an important role in turning off the 'motor' of multiple organ dysfunction syndrome in the future.

journal_name

Curr Opin Crit Care

authors

Meng M,Klingensmith NJ,Coopersmith CM

doi

10.1097/MCC.0000000000000386

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

143-148

issue

2

eissn

1070-5295

issn

1531-7072

journal_volume

23

pub_type

杂志文章,评审
  • EBM vs. EBM: combining evidence-based and experienced-based medicine in resuscitation research.

    abstract:PURPOSE OF REVIEW:To discuss the clear rationale for evidence-based medicine (EvBM) in the challenging realms of resuscitation research, yet also provide case examples in which even the well designed, multicentered randomized clinical trial may have had unrecognized limitations, and thus misleading results. This is whe...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000413

    authors: Pepe PE,Aufderheide TP

    更新日期:2017-06-01 00:00:00

  • Neurocritical care: a distinct discipline?

    abstract:PURPOSE OF REVIEW:We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine. RECENT FINDINGS:Over the past 20 years, neuro-intensive care units have evolved from neurosurgical units focused primarily on postoperative monitoring to units that provide comprehensive medical and sp...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e32808255c6

    authors: Rincon F,Mayer SA

    更新日期:2007-04-01 00:00:00

  • Effects of alcohol on the heart.

    abstract::Some evidence suggests that light to moderate alcohol consumption protects against cardiovascular diseases. However, this cardioprotective effect of alcohol consumption in adults is absent at the population level. Approximately 20 to 30% of patients admitted to a hospital are alcohol abusers. In medical practice, it i...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200110000-00004

    authors: Spies CD,Sander M,Stangl K,Fernandez-Sola J,Preedy VR,Rubin E,Andreasson S,Hanna EZ,Kox WJ

    更新日期:2001-10-01 00:00:00

  • Optimal and responsible use of antibiotics.

    abstract:PURPOSE OF REVIEW:In this review, we focus on the dual face of antibiotic therapy in the critically ill that must harmonize the need for early, appropriate and adequate antibiotic therapy in the individual-infected patient with the obligation to limit antibiotic selection pressure as much as possible to preserve its fu...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000645

    authors: Depuydt P,De Waele JJ

    更新日期:2019-10-01 00:00:00

  • Cardiogenic pulmonary edema: mechanisms and treatment - an intensivist's view.

    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

    authors: Ingbar DH

    更新日期:2019-08-01 00:00:00

  • Safety of vitamin C in sepsis: a neglected topic.

    abstract:PURPOSE OF REVIEW:Although vitamin C is essentially a nontoxic vitamin; however, it is important to be aware regarding the safety of high doses before the wide clinical use. RECENT FINDINGS:Minor side effects of vitamin C have been reported, many being reported in earlier studies. High doses of vitamin C (up to 1.5 g/...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000622

    authors: Khoshnam-Rad N,Khalili H

    更新日期:2019-08-01 00:00:00

  • Education and simulation techniques for improving reliability of care.

    abstract:PURPOSE OF REVIEW:Multiple factors influence the dependability of intensive care provision. The management of a group of unstable, critically ill patients requires focused attention from the clinical team. Medical simulation is an important tool to improve safety and team work within the ICU. RECENT FINDINGS:The criti...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3282f1bb32

    authors: Fox-Robichaud AE,Nimmo GR

    更新日期:2007-12-01 00:00:00

  • Outcome prediction in critical care: the Mortality Probability Models.

    abstract:PURPOSE OF REVIEW:The comparison of morbidity, mortality, and length-of-stay outcomes in patients receiving critical care requires adjustment based on their presenting illness. These adjustments are made with severity-of-illness models. These models must be periodically updated to reflect current medical practices. Thi...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283101643

    authors: Higgins TL,Teres D,Nathanson B

    更新日期:2008-10-01 00:00:00

  • Medication-induced acute kidney injury.

    abstract:PURPOSE OF REVIEW:The present article will review the current state of our understanding of nephrotoxic medication-associated acute kidney injury (AKI) and provide strategies to reduce its impact. RECENT FINDINGS:Nephrotoxic medications contribute to a substantial proportion of AKI in hospitalized patients. The previo...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000355

    authors: Goldstein SL

    更新日期:2016-12-01 00:00:00

  • Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac diseases during pregnancy.

    abstract:PURPOSE OF REVIEW:Part II of this review gives an overview of the different maternal cardiac problems during pregnancy and their management, and developments over recent years. RECENT FINDINGS:Many studies published over the last 5 years provided new insights on different cardiac diseases in pregnancy. Publications di...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000179806.15328.b9

    authors: van Mook WN,Peeters L

    更新日期:2005-10-01 00:00:00

  • Update in intensive care medicine: acute liver failure. Initial management, supportive treatment and who to transplant.

    abstract:PURPOSE OF REVIEW:Acute liver failure (ALF) is associated with significant mortality. Although specific therapies may be available, the evidence base for these and for many aspects of supportive therapy has been slow to emerge. Liver transplantation continues to be a cornerstone of treatment, and the management of ALF,...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000073

    authors: Willars C

    更新日期:2014-04-01 00:00:00

  • Clinical relevance of monitoring respiratory mechanics in the ventilator-supported patient: an update (1995-2000).

    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

    authors: Appendini L,Confalonieri M,Rossi A

    更新日期:2001-02-01 00:00:00

  • The glutamine debate in surgery and critical care.

    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

    authors: Wischmeyer PE

    更新日期:2019-08-01 00:00:00

  • Refractory status epilepticus.

    abstract:PURPOSE OF REVIEW:Although conventional anticonvulsant agents can terminate status epilepticus in most cases, a substantial minority of patients develops medically refractory status and requires more aggressive care. This review explores the options available. RECENT FINDINGS:Increasing numbers of previously unexpecte...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000157079.72999.87

    authors: Bleck TP

    更新日期:2005-04-01 00:00:00

  • Airway and ventilator management in trauma patients.

    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

    authors: Beckers SK,Brokmann JC,Rossaint R

    更新日期:2014-12-01 00:00:00

  • Urgent chemotherapy in hematological patients in the ICU.

    abstract:PURPOSE OF REVIEW:Over the past decades, survival of critically ill hematological patients has dramatically improved, and these patients are more frequently referred to the ICU for intensive treatment, including a rising need for administering anticancer-therapy in this setting. RECENT FINDINGS:The scarce literature o...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000254

    authors: Moors I,Pène F,Lengline É,Benoit D

    更新日期:2015-12-01 00:00:00

  • Health-related quality of life: implications for critical care interventional studies and why we need to collaborate with patients.

    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

    authors: Ramsay P

    更新日期:2011-10-01 00:00:00

  • Coupling microcirculation to systemic hemodynamics.

    abstract:PURPOSE OF REVIEW:To discuss the role of microcirculatory abnormalities in critically ill patients and the link between systemic hemodynamics and microvascular perfusion. RECENT FINDINGS:Microcirculatory alterations have been repeatedly observed in patients with severe sepsis, but recent findings show that these also ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283383621

    authors: De Backer D,Ortiz JA,Salgado D

    更新日期:2010-06-01 00:00:00

  • Quality of life and prognosis among survivors of out-of-hospital cardiac arrest.

    abstract:PURPOSE OF REVIEW:We reviewed the topic of quality of life and prognosis of out-of-hospital cardiac arrest survivors, focusing on more recent developments. RECENT FINDINGS:In 2003 to 2004, published experiences from Canada, the United States, and Europe indicate that the quality of life among out-of-hospital cardiac a...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000125494.84614.fb

    authors: Rea TD,Paredes VL

    更新日期:2004-06-01 00:00:00

  • New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist, and fractal ventilation.

    abstract::Increased knowledge of the mechanisms that determine respiratory failure has led to the development of new technologies aimed at improving ventilatory treatment. Proportional assist ventilation and neurally adjusted ventilatory assist have been designed with the goal of improving patient-ventilator interaction by matc...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200302000-00010

    authors: Navalesi P,Costa R

    更新日期:2003-02-01 00:00:00

  • Eyeing up the injured brain: automated pupillometry and optic nerve sheath diameter.

    abstract:PURPOSE OF REVIEW:Multimodal monitoring has emerged as a novel paradigm of care in acute brain injury, and in this context the value of noninvasive devices is increasingly under scrutiny. This narrative review summarizes recent clinical investigation focused on the role of automated infrared pupillometry (AIP) and opti...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000710

    authors: Romagnosi F,Bongiovanni F,Oddo M

    更新日期:2020-04-01 00:00:00

  • Statins in the intensive care unit.

    abstract:PURPOSE OF REVIEW:Statins are effective lipid-lowering agents used extensively in medical practice. This review summarizes the evidence for statin treatment of cardiovascular patients in the intensive care unit and briefly discusses the role of statins in prevention and treatment of sepsis as a potential future applica...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccx.0000235207.00322.96

    authors: Merx MW,Weber C

    更新日期:2006-08-01 00:00:00

  • Reappraising Starling: the physiology of the microcirculation.

    abstract:PURPOSE OF REVIEW:Vascular permeability is traditionally explained by Starling's principle, describing two opposing forces across the endothelial cell line to maintain compartments in balance. Several contradictions to this principle have recently questioned its validity. RECENT FINDINGS:Hydraulic conductivity is kept...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0b013e3283632d5e

    authors: Jacob M,Chappell D

    更新日期:2013-08-01 00:00:00

  • Integrating palliative care in the ICU.

    abstract:PURPOSE OF REVIEW:Although providing palliative care in the ICU has become a priority, the success of different methods to integrate palliative care into the ICU has varied. This review examines the current evidence supporting the different models of palliative care delivery and highlights areas for future study. RECE...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000149

    authors: Hua M,Wunsch H

    更新日期:2014-12-01 00:00:00

  • Community-acquired pneumonia as an emergency condition.

    abstract:PURPOSE OF REVIEW:Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP. RECENT FINDINGS:There i...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/MCC.0000000000000550

    authors: Cillóniz C,Dominedò C,Garcia-Vidal C,Torres A

    更新日期:2018-12-01 00:00:00

  • Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic.

    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

    authors: Cantón R,Gijón D,Ruiz-Garbajosa P

    更新日期:2020-10-01 00:00:00

  • Nosocomial pneumonia: emerging concepts in diagnosis, management, and prophylaxis.

    abstract::Nosocomial pneumonia is a dynamic disease with multiple etiologic agents and a changing natural history. The highest attack rates and mortality occur in patients with ventilator-associated pneumonia. Diagnosis of nosocomial pneumonia is often made by clinical criteria that are sensitive but lack specificity. The use o...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200210000-00009

    authors: Craven DE,De Rosa FG,Thornton D

    更新日期:2002-10-01 00:00:00

  • Acetylcysteine for radiocontrast nephropathy.

    abstract::Radiocontrast nephropathy may in part be mediated by generation of reactive oxygen species causing direct toxic damage to renal tubular epithelial cell and renal medullary ischemia. Data from experimental studies indicated that antioxidants, eg, acetylcysteine, may prevent radiocontrast-induced nephropathy. Recently, ...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章,评审

    doi:10.1097/00075198-200112000-00004

    authors: Tepel M,Zidek W

    更新日期:2001-12-01 00:00:00

  • Post-conditioning to improve cardiopulmonary resuscitation.

    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

    authors: Bartos JA,Debaty G,Matsuura T,Yannopoulos D

    更新日期:2014-06-01 00:00:00

  • When and how should we do a tracheostomy?

    abstract::Tracheostomy is one of the most common surgical procedures in the intensive care unit. Since the introduction of percutaneous techniques, tracheostomy has become increasingly popular. The technique is relatively easy, and the early and late complication rates are relatively low.It is unknown at which moment tracheosto...

    journal_title:Current opinion in critical care

    pub_type: 杂志文章

    doi:10.1097/00075198-200008000-00005

    authors: van Heurn LW

    更新日期:2000-08-01 00:00:00