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 where experienced-based medicine (ExBM) helps to resolve the issue. RECENT FINDINGS:Recent publications have brought to task the conclusions drawn from various clinical trials of resuscitative interventions. These articles have indicated that some major clinical trials that later determined the universal guidelines for resuscitative protocols may have been affected by unrecognized confounding variables, effect modifiers and other problems such as delayed timing. Many interventions, deemed to be ineffective because of these study factors, may actually have lifesaving effects that would have been confirmed had the proper circumstances been in place. With the right mindset, the clinician-researcher can often identify and address those situations. SUMMARY:When clinical trials indicate ineffectiveness of an intervention that worked very well in other circumstances, both preclinical and clinical, clinician-investigators should continue to re-search the issues and not always take conclusions at face value.
journal_name
Curr Opin Crit Carejournal_title
Current opinion in critical careauthors
Pepe PE,Aufderheide TPdoi
10.1097/MCC.0000000000000413subject
Has Abstractpub_date
2017-06-01 00:00:00pages
199-203issue
3eissn
1070-5295issn
1531-7072journal_volume
23pub_type
杂志文章,评审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: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:PURPOSE OF REVIEW:There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies. RECENT FINDINGS:Critical i...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000734
更新日期:2020-08-01 00:00:00
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
更新日期:2018-12-01 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: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
更新日期:2007-04-01 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: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:Mechanical ventilation is the main supportive therapy for patients with acute respiratory distress syndrome. As with any therapy, mechanical ventilation has side effects and may induce lung injury. This review will focus on stretch-dependent activation of alveolar epithelial and endothelial cells and ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200502000-00013
更新日期:2005-02-01 00:00:00
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
更新日期:2005-04-01 00:00:00
abstract:PURPOSE OF REVIEW:To describe recent data about Acinetobacter baumannii pneumonia epidemiology and the therapeutic options including adjunctive nebulized therapy. RECENT FINDINGS:A. baumannii is a major cause of nosocomial pneumonia in certain geographic areas affecting mainly debilitated patients, with prolonged hosp...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000649
更新日期:2019-10-01 00:00:00
abstract:PURPOSE OF REVIEW:To review advances over the last year in the prevention, diagnosis and management of acute pancreatitis. RECENT FINDINGS:Obesity is an independent risk factor for severity in acute pancreatitis, and heavy alcohol consumption for the development of necrosis in severe acute pancreatitis. Biochemical ma...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3282f6a3f9
更新日期:2008-04-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of this study is to review the prevalence and significance of gasping in patients experiencing cardiac arrest. RECENT FINDINGS:In a recent study by Bobrow et al., gasping was identified in 33% of patients who arrested after the arrival of emergency medical services (EMS). Patients who arr...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283298e00
更新日期:2009-06-01 00:00:00
abstract:PURPOSE OF REVIEW:To provide a summary of the recent literature on extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome (ARDS), focusing on advances in equipment, current conventional and unconventional indications, complications, and future applications. RECENT FINDINGS...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000170
更新日期:2015-02-01 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: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
更新日期:2016-12-01 00:00:00
abstract:PURPOSE OF REVIEW:To summarize clinical evidence for intraoperative ventilation settings, which could protect against postoperative pulmonary complications (PPCs) in surgical patients with uninjured lungs. RECENT FINDINGS:There is convincing evidence for protection against PPCs by low tidal volumes: benefit was found ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000215
更新日期:2015-08-01 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:The ultimate goal of cardiopulmonary resuscitation is long-term neurologically intact survival. Despite numerous well-designed studies, the medications currently used in advanced cardiac life support have not demonstrated success in this regard. This review describes the novel therapeutics under inves...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328364d7b1
更新日期:2013-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Therapeutic hypothermia following out-of-hospital cardiac arrest improves neurological recovery. Coupled with neurological benefit, multiple complications including infection have been associated with therapeutic hypothermia following out-of-hospital cardiac arrest. In this review, we will discuss the...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000125
更新日期:2014-10-01 00:00:00
abstract:PURPOSE OF REVIEW:This review will provide an overview of actual data concerning perioperative risk. Furthermore, strategies to prevent, detect and treat perioperative complications will be discussed. RECENT FINDINGS:Perioperative in-hospital mortality rate of 0.4-4% has not improved over the last years possibly resul...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000221
更新日期:2015-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk. RECENT FINDINGS:Gastroparesis frequently results in the inability to feed critically ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283356679
更新日期:2010-04-01 00:00:00
abstract:PURPOSE OF REVIEW:Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000134
更新日期:2014-10-01 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:Cardiac arrest is one of the most challenging disease processes to study with clinical trials due to the emergent and unpredictable nature of these events and complexity of the patient population. In recent years, there has been a major push to complete more large, multicentre trials. In many cases, h...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000765
更新日期:2020-12-01 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:Survivorship or addressing impaired quality of life (QoL) in ICU survivors has been named 'the defining challenge of critical care' for this century to address this challenge; in addition to optimal nutrition, we must learn to employ targeted metabolic/muscle assessment techniques and utilize structur...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000748
更新日期:2020-08-01 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: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
更新日期:2014-04-01 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