首页 > 最新文献

Current Opinion in Critical Care最新文献

英文 中文
Micronutrients as therapy in critical illness. 作为危重病治疗的微量营养素。
IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-04-01 Epub Date: 2024-01-05 DOI: 10.1097/MCC.0000000000001133
Christian Stoppe, Ellen Dresen, Angelique de Man

Purpose of review: Recent large-scale randomized controlled trials (RCTs) challenged current beliefs about the potential role of micronutrients to attenuate the inflammatory response and improve clinical outcomes of critically ill patients. The purpose of this narrative review is to provide an overview and critical discussion about most recent clinical trials, which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients.

Recent findings: None of the most recent large-scale RCTs could demonstrate any clinical benefits for a micronutrient administration in ICU patients, whereas a recent RCT indicated harmful effects, if high dose vitamin C was administered in septic patients. Following meta-analyses could not confirm harmful effects for high dose vitamin C in general critically ill patients and indicated benefits in the subgroup of general ICU patients with higher mortality risk. For vitamin D, the most recent large-scale RCT could not demonstrate clinical benefits for critically ill patients, whereas another large-scale RCT is still ongoing. The aggregated and meta-analyzed evidence highlighted a potential role for intravenous vitamin D administration, which encourages further research. In high-risk cardiac surgery patients, a perioperative application of high-dose selenium was unable to improve patients' outcome. The observed increase of selenium levels in the patients' blood did not translate into an increase of antioxidative or anti-inflammatory enzymes, which illuminates the urgent need for more research to identify potential confounding factors.

Summary: Current data received from most recent large-scale RCTs could not demonstrate clinically meaningful effects of an intervention with either vitamin C, vitamin D, or selenium in critically ill patients. More attention is needed to carefully identify potential confounding factors and to better evaluate the role of timing, duration, and combined strategies.

综述的目的:最近的大规模随机对照试验(RCTs)对微量营养素在减轻炎症反应和改善危重病人临床预后方面的潜在作用提出了质疑。本叙述性综述旨在概述和批判性讨论最近的临床试验,这些试验评估了重症患者服用维生素 C、维生素 D 或硒的临床意义:最近的大规模临床试验均未证明在重症监护室患者中应用微量营养素有任何临床益处,而最近的一项临床试验表明,如果在脓毒症患者中应用高剂量维生素 C,则会产生有害影响。随后的荟萃分析不能证实大剂量维生素 C 对普通危重病人有害,但表明对死亡率较高的普通 ICU 病人亚群有益。至于维生素 D,最新的大规模研究分析未能证明其对危重病人有临床益处,而另一项大规模研究分析仍在进行中。汇总和荟萃分析的证据强调了静脉注射维生素 D 的潜在作用,这鼓励了进一步的研究。在高风险心脏手术患者中,围手术期应用高剂量硒无法改善患者的预后。观察到的患者血液中硒含量的增加并没有转化为抗氧化或抗炎酶的增加,这说明迫切需要进行更多的研究,以确定潜在的混杂因素。总结:从最近大多数大规模临床试验中获得的数据无法证明维生素 C、维生素 D 或硒对重症患者的干预具有临床意义。我们需要更多的关注来仔细识别潜在的干扰因素,并更好地评估时机、持续时间和综合策略的作用。
{"title":"Micronutrients as therapy in critical illness.","authors":"Christian Stoppe, Ellen Dresen, Angelique de Man","doi":"10.1097/MCC.0000000000001133","DOIUrl":"10.1097/MCC.0000000000001133","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent large-scale randomized controlled trials (RCTs) challenged current beliefs about the potential role of micronutrients to attenuate the inflammatory response and improve clinical outcomes of critically ill patients. The purpose of this narrative review is to provide an overview and critical discussion about most recent clinical trials, which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients.</p><p><strong>Recent findings: </strong>None of the most recent large-scale RCTs could demonstrate any clinical benefits for a micronutrient administration in ICU patients, whereas a recent RCT indicated harmful effects, if high dose vitamin C was administered in septic patients. Following meta-analyses could not confirm harmful effects for high dose vitamin C in general critically ill patients and indicated benefits in the subgroup of general ICU patients with higher mortality risk. For vitamin D, the most recent large-scale RCT could not demonstrate clinical benefits for critically ill patients, whereas another large-scale RCT is still ongoing. The aggregated and meta-analyzed evidence highlighted a potential role for intravenous vitamin D administration, which encourages further research. In high-risk cardiac surgery patients, a perioperative application of high-dose selenium was unable to improve patients' outcome. The observed increase of selenium levels in the patients' blood did not translate into an increase of antioxidative or anti-inflammatory enzymes, which illuminates the urgent need for more research to identify potential confounding factors.</p><p><strong>Summary: </strong>Current data received from most recent large-scale RCTs could not demonstrate clinically meaningful effects of an intervention with either vitamin C, vitamin D, or selenium in critically ill patients. More attention is needed to carefully identify potential confounding factors and to better evaluate the role of timing, duration, and combined strategies.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"178-185"},"PeriodicalIF":3.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How to manage catatonia, Parkinson and dementia in ICU. 如何管理重症监护病房中的紧张症、帕金森症和痴呆症。
IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-04-01 Epub Date: 2024-02-02 DOI: 10.1097/MCC.0000000000001142
David Attali, Charlotte Calligaris, David Grabli, Arjen J C Slooter

Purpose of review: The rising prevalence of neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists with complex issues in the intensive care unit (ICU). This review article explores specific aspects of care for patients with catatonia, Parkinson's disease (PD), and dementia within the context of the ICU, shedding light on recent developments in these fields.

Recent findings: Catatonia, a neuropsychiatric syndrome with potentially life-threatening forms, remains underdiagnosed, and its etiologies are diverse. PD patients in the ICU present unique challenges related to admission criteria, dopaminergic treatment, and respiratory care. Dementia increases the risk of delirium. Delirium is associated with long-term cognitive impairment and dementia.

Summary: While evidence is lacking, further research is needed to guide treatment for ICU patients with these comorbidities.

回顾的目的:神经退行性疾病和精神疾病的发病率不断上升,再加上他们的虚弱所带来的挑战,给重症监护病房(ICU)的重症监护医生带来了复杂的问题。这篇综述文章探讨了在重症监护病房护理紧张症、帕金森病(PD)和痴呆症患者的具体问题,并阐明了这些领域的最新进展:紧张症是一种可能危及生命的神经精神综合征,但其诊断率仍然很低,病因也多种多样。重症监护病房中的帕金森病患者在入院标准、多巴胺能治疗和呼吸护理方面面临着独特的挑战。痴呆会增加谵妄的风险。谵妄与长期认知功能障碍和痴呆有关。总结:虽然缺乏证据,但仍需进一步研究,以指导对患有这些合并症的 ICU 患者的治疗。
{"title":"How to manage catatonia, Parkinson and dementia in ICU.","authors":"David Attali, Charlotte Calligaris, David Grabli, Arjen J C Slooter","doi":"10.1097/MCC.0000000000001142","DOIUrl":"10.1097/MCC.0000000000001142","url":null,"abstract":"<p><strong>Purpose of review: </strong>The rising prevalence of neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists with complex issues in the intensive care unit (ICU). This review article explores specific aspects of care for patients with catatonia, Parkinson's disease (PD), and dementia within the context of the ICU, shedding light on recent developments in these fields.</p><p><strong>Recent findings: </strong>Catatonia, a neuropsychiatric syndrome with potentially life-threatening forms, remains underdiagnosed, and its etiologies are diverse. PD patients in the ICU present unique challenges related to admission criteria, dopaminergic treatment, and respiratory care. Dementia increases the risk of delirium. Delirium is associated with long-term cognitive impairment and dementia.</p><p><strong>Summary: </strong>While evidence is lacking, further research is needed to guide treatment for ICU patients with these comorbidities.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"151-156"},"PeriodicalIF":3.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measurement and estimation of energy in the critically ill. 危重病人能量的测量和估算。
IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-04-01 Epub Date: 2024-01-03 DOI: 10.1097/MCC.0000000000001132
Amir Y Kamel

Purpose of review: Recent changes in guidelines recommendation during early phase of critical illness and use of indirect calorimetry. The aim of this review is to discuss methods of determining energy requirements in the critically ill and highlight factors impacting resting energy expenditure.

Recent finding: An appraisal of recent literature discussing indirect calorimetry guided-nutrition potential benefits or pitfalls. Recent attempts to devise strategy and pilot indirect calorimetry use in the critically ill patients requiring continuous renal replacement therapy or extracorporeal membrane oxygenation are also discussed. Additionally, we briefly touched on variability between guidelines recommended energy target and measured energy expenditure for adult critically ill patients with obesity.

Summary: While energy requirement in the critically ill continues to be an area of controversy, recent guidelines recommendations shift toward providing less aggressive calories during acute phase of illness in the first week of ICU.Use of indirect calorimetry may provide more accurate energy target compared to the use of predictive equations. Despite the absence of literature to support long term mortality benefits, there are many potential benefits for the use of indirect calorimetry when available.

审查目的:危重病人早期阶段的指南建议和间接热量测定法的使用最近发生了变化。本综述旨在讨论确定重症患者能量需求的方法,并强调影响静息能量消耗的因素:对近期讨论间接热量测定法指导营养的潜在益处或误区的文献进行评估。此外,还讨论了最近在需要持续肾脏替代疗法或体外膜氧合的重症患者中使用间接热量计的策略和试点尝试。此外,我们还简要介绍了指南推荐的能量目标与成年肥胖重症患者测量的能量消耗之间的差异。摘要:虽然重症患者的能量需求仍是一个有争议的领域,但最近的指南建议转向在重症监护室第一周的急性期提供较少的热量。与使用预测方程相比,使用间接热量计可能提供更准确的能量目标。尽管没有文献支持长期的死亡率益处,但使用间接热量测量法还是有很多潜在的益处。
{"title":"Measurement and estimation of energy in the critically ill.","authors":"Amir Y Kamel","doi":"10.1097/MCC.0000000000001132","DOIUrl":"10.1097/MCC.0000000000001132","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent changes in guidelines recommendation during early phase of critical illness and use of indirect calorimetry. The aim of this review is to discuss methods of determining energy requirements in the critically ill and highlight factors impacting resting energy expenditure.</p><p><strong>Recent finding: </strong>An appraisal of recent literature discussing indirect calorimetry guided-nutrition potential benefits or pitfalls. Recent attempts to devise strategy and pilot indirect calorimetry use in the critically ill patients requiring continuous renal replacement therapy or extracorporeal membrane oxygenation are also discussed. Additionally, we briefly touched on variability between guidelines recommended energy target and measured energy expenditure for adult critically ill patients with obesity.</p><p><strong>Summary: </strong>While energy requirement in the critically ill continues to be an area of controversy, recent guidelines recommendations shift toward providing less aggressive calories during acute phase of illness in the first week of ICU.Use of indirect calorimetry may provide more accurate energy target compared to the use of predictive equations. Despite the absence of literature to support long term mortality benefits, there are many potential benefits for the use of indirect calorimetry when available.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"186-192"},"PeriodicalIF":3.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Monitoring the venous circulation: novel techniques and applications. 监测静脉循环:新技术与应用。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-03-29 DOI: 10.1097/MCC.0000000000001155
August L Longino, Katharine Martin, Ivor J Douglas

Purpose of review: Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure.

Recent findings: Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclusive.

Summary: Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.

审查目的:静脉压是导致患者发病的一个常被忽略的原因。然而,床旁评估静脉压具有挑战性。我们回顾了静脉压测量的临床意义、现有技术,并介绍了静脉超负荷超声(VExUS)评分,这是一种使用多普勒超声评估静脉压的新方法:研究表明,静脉压升高与危重病人的不良预后之间存在明显关联。目前的静脉压测量技术包括体格检查、右心导管检查(RHC)、二维超声和各种劳动密集型研究重点生理操作。这些技术都有各自的缺陷,限制了它们在临床上的应用。为了弥补这些不足,Beaubien-Souligny 等人推出了 VExUS 评分,这是一种基于多普勒超声的新型方法,它将 IVC 直径与肝静脉、门静脉和肾静脉的多普勒测量结果相结合,生成静脉充血评估结果。研究表明,VExUS 评分与 RHC 测量值之间存在很强的相关性,VExUS 评分与心肾急性肾损伤的改善、利尿剂反应和体液状态改变之间也存在关联。小结:评估使用多普勒超声评估静脉充血的早期研究显示了前景,但还需要在不同的患者群体和临床环境中开展进一步研究。
{"title":"Monitoring the venous circulation: novel techniques and applications.","authors":"August L Longino, Katharine Martin, Ivor J Douglas","doi":"10.1097/MCC.0000000000001155","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001155","url":null,"abstract":"<p><strong>Purpose of review: </strong>Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure.</p><p><strong>Recent findings: </strong>Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclusive.</p><p><strong>Summary: </strong>Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Monitoring CO2 kinetics as a marker of cardiopulmonary efficiency. 监测二氧化碳动力学作为心肺效率的标志。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-03-29 DOI: 10.1097/MCC.0000000000001156
Fernando Suarez Sipmann, Juan Antonio Sanchez Giralt, Gerardo Tusman

Purpose of review: To describe current and near future developments and applications of CO2 kinetics in clinical respiratory and cardiovascular monitoring.

Recent findings: In the last years, we have witnessed a renewed interest in CO2 kinetics in relation with a better understanding of volumetric capnography and its derived parameters. This together with technological advances and improved measurement systems have expanded the monitoring potential of CO2 kinetics including breath by breath continuous end-expiratory lung volume and continuous noninvasive cardiac output. Dead space has slowly been gaining relevance in clinical monitoring and prognostic evaluation. Easy to measure dead space surrogates such as the ventilatory ratio have demonstrated a strong prognostic value in patients with acute respiratory failure.

Summary: The kinetics of carbon dioxide describe many relevant physiological processes. The clinical introduction of new ways of assessing respiratory and circulatory efficiency based on advanced analysis of CO2 kinetics are paving the road to a long-desired goal in clinical monitoring of critically ill patients: the integration of respiratory and circulatory monitoring during mechanical ventilation.

综述的目的:描述二氧化碳动力学在临床呼吸和心血管监测中当前和近期的发展与应用:最近几年,随着人们对容积式气压图及其衍生参数有了更深入的了解,二氧化碳动力学再次引起了人们的关注。这与技术进步和测量系统的改进一起,扩大了二氧化碳动力学的监测潜力,包括逐次呼吸连续呼气末肺活量和连续无创心排血量。死腔在临床监测和预后评估中的相关性正在慢慢增加。易于测量的死腔代用指标,如通气比值,已在急性呼吸衰竭患者中显示出很强的预后价值。基于二氧化碳动力学的高级分析,在临床上引入了评估呼吸和循环效率的新方法,为实现危重病人临床监测的一个长期愿望目标铺平了道路:在机械通气过程中整合呼吸和循环监测。
{"title":"Monitoring CO2 kinetics as a marker of cardiopulmonary efficiency.","authors":"Fernando Suarez Sipmann, Juan Antonio Sanchez Giralt, Gerardo Tusman","doi":"10.1097/MCC.0000000000001156","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001156","url":null,"abstract":"<p><strong>Purpose of review: </strong>To describe current and near future developments and applications of CO2 kinetics in clinical respiratory and cardiovascular monitoring.</p><p><strong>Recent findings: </strong>In the last years, we have witnessed a renewed interest in CO2 kinetics in relation with a better understanding of volumetric capnography and its derived parameters. This together with technological advances and improved measurement systems have expanded the monitoring potential of CO2 kinetics including breath by breath continuous end-expiratory lung volume and continuous noninvasive cardiac output. Dead space has slowly been gaining relevance in clinical monitoring and prognostic evaluation. Easy to measure dead space surrogates such as the ventilatory ratio have demonstrated a strong prognostic value in patients with acute respiratory failure.</p><p><strong>Summary: </strong>The kinetics of carbon dioxide describe many relevant physiological processes. The clinical introduction of new ways of assessing respiratory and circulatory efficiency based on advanced analysis of CO2 kinetics are paving the road to a long-desired goal in clinical monitoring of critically ill patients: the integration of respiratory and circulatory monitoring during mechanical ventilation.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Monitoring lung recruitment. 监测肺招募。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-03-28 DOI: 10.1097/MCC.0000000000001157
Gianmaria Cammarota, Rosanna Vaschetto, Luigi Vetrugno, Salvatore M Maggiore

Purpose of review: This review explores lung recruitment monitoring, covering techniques, challenges, and future perspectives.

Recent findings: Various methodologies, including respiratory system mechanics evaluation, arterial bold gases (ABGs) analysis, lung imaging, and esophageal pressure (Pes) measurement are employed to assess lung recruitment. In support to ABGs analysis, the assessment of respiratory mechanics with hysteresis and recruitment-to-inflation ratio has the potential to evaluate lung recruitment and enhance mechanical ventilation setting. Lung imaging tools, such as computed tomography scanning, lung ultrasound, and electrical impedance tomography (EIT) confirm their utility in following lung recruitment with the advantage of radiation-free and repeatable application at the bedside for sonography and EIT. Pes enables the assessment of dorsal lung tendency to collapse through end-expiratory transpulmonary pressure. Despite their value, these methodologies may require an elevated expertise in their application and data interpretation. However, the information obtained by these methods may be conveyed to build machine learning and artificial intelligence algorithms aimed at improving the clinical decision-making process.

Summary: Monitoring lung recruitment is a crucial component of managing patients with severe lung conditions, within the framework of a personalized ventilatory strategy. Although challenges persist, emerging technologies offer promise for a personalized approach to care in the future.

综述的目的:本综述探讨肺募集监测,涵盖技术、挑战和未来展望:各种方法,包括呼吸系统力学评估、动脉血气(ABGs)分析、肺部成像和食管压力(Pes)测量,都被用来评估肺募集情况。作为对 ABGs 分析的支持,利用滞后和募集与充气比对呼吸力学进行评估有可能评估肺募集情况并改善机械通气设置。肺部成像工具,如计算机断层扫描、肺部超声波和电阻抗断层扫描(EIT)证实了它们在跟踪肺部募集方面的实用性,而且超声波和电阻抗断层扫描具有无辐射和可在床边重复应用的优点。Pes 可通过呼气末转肺压力评估背侧肺的塌陷趋势。尽管这些方法很有价值,但在应用和数据解读方面可能需要更高的专业知识。然而,通过这些方法获得的信息可用于构建机器学习和人工智能算法,从而改善临床决策过程。摘要:在个性化通气策略框架内,监测肺募集是管理严重肺部疾病患者的重要组成部分。尽管挑战依然存在,但新兴技术为未来的个性化护理方法带来了希望。
{"title":"Monitoring lung recruitment.","authors":"Gianmaria Cammarota, Rosanna Vaschetto, Luigi Vetrugno, Salvatore M Maggiore","doi":"10.1097/MCC.0000000000001157","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001157","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores lung recruitment monitoring, covering techniques, challenges, and future perspectives.</p><p><strong>Recent findings: </strong>Various methodologies, including respiratory system mechanics evaluation, arterial bold gases (ABGs) analysis, lung imaging, and esophageal pressure (Pes) measurement are employed to assess lung recruitment. In support to ABGs analysis, the assessment of respiratory mechanics with hysteresis and recruitment-to-inflation ratio has the potential to evaluate lung recruitment and enhance mechanical ventilation setting. Lung imaging tools, such as computed tomography scanning, lung ultrasound, and electrical impedance tomography (EIT) confirm their utility in following lung recruitment with the advantage of radiation-free and repeatable application at the bedside for sonography and EIT. Pes enables the assessment of dorsal lung tendency to collapse through end-expiratory transpulmonary pressure. Despite their value, these methodologies may require an elevated expertise in their application and data interpretation. However, the information obtained by these methods may be conveyed to build machine learning and artificial intelligence algorithms aimed at improving the clinical decision-making process.</p><p><strong>Summary: </strong>Monitoring lung recruitment is a crucial component of managing patients with severe lung conditions, within the framework of a personalized ventilatory strategy. Although challenges persist, emerging technologies offer promise for a personalized approach to care in the future.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Disaster management - preparation and planning for acute care facilities. 灾害管理--急症护理设施的准备和规划。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-03-28 DOI: 10.1097/MCC.0000000000001151
António Gandra d'Almeida, Craig M Coopersmith

Purpose of review: Both human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each.

Recent findings: Evidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating.

Summary: Disaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.

审查目的:人为和自然发生的灾难都会对医疗系统和急症护理设施的应急能力造成压力。在这篇文章中,我们回顾了与制定灾难计划、设施规划原则、机构和团队准备、激增能力的概念、模拟演练以及各自优缺点相关的最新文献:有证据表明,每个机构都应制定灾难计划,并成立专门小组负责更新该计划。灾难计划必须以人为本,纳入不同的观点和意见,让所有利益相关者感到自己被纳入其中,并能为共同应对做出贡献。模拟演习是准备工作的基础,以便在灾害管理从理论计划过渡到实时执行计划的非常时期,团队能够无缝运作。然而,值得注意的是,不同国家之间,甚至同一国家或地区内部,与灾害管理相关的现实情况都大相径庭。遗憾的是,医院管理部门、董事会和投资者等主要利益相关者往往不认为自己在灾害管理规划或响应方面负有任何责任。此外,虽然机构内部通常都有灾难计划,但很多利益相关者往往并不了解或理解该计划。沟通、简单的计划和明确的职责是成功应对的最重要特征。在极端情况下,可能会采用调整民用设施的方法来处理大量与战争有关的伤害,但这种方法对系统内的常规医疗保健可能会造成破坏性后果。总结:灾难管理需要精心策划,听取多方利益相关者的意见,并通过反复准备经常更新计划,以确保团队在灾难发生时做好准备。从准备工作过渡到启动和执行灾难响应时,密切的沟通和明确的角色定位是成功的关键。
{"title":"Disaster management - preparation and planning for acute care facilities.","authors":"António Gandra d'Almeida, Craig M Coopersmith","doi":"10.1097/MCC.0000000000001151","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001151","url":null,"abstract":"<p><strong>Purpose of review: </strong>Both human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each.</p><p><strong>Recent findings: </strong>Evidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating.</p><p><strong>Summary: </strong>Disaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peep setting: let us come back to physiology. 窥视设置:让我们回到生理学上来。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-01-04 DOI: 10.1097/MCC.0000000000001129
Lise Piquilloud
{"title":"Peep setting: let us come back to physiology.","authors":"Lise Piquilloud","doi":"10.1097/MCC.0000000000001129","DOIUrl":"10.1097/MCC.0000000000001129","url":null,"abstract":"","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 1","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Editorial introductions. 编辑介绍。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-01-04 DOI: 10.1097/MCC.0000000000001128
{"title":"Editorial introductions.","authors":"","doi":"10.1097/MCC.0000000000001128","DOIUrl":"10.1097/MCC.0000000000001128","url":null,"abstract":"","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"30 1","pages":"v"},"PeriodicalIF":3.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Setting positive end-expiratory pressure in the severely obstructive patient. 为严重阻塞患者设定呼气末正压。
IF 3.3 3区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2023-12-11 DOI: 10.1097/mcc.0000000000001131
Amal Jubran
The response to positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation depends on the underlying pathophysiology. This review focuses on the pathophysiology of COPD, especially intrinsic PEEP (PEEPi) and its consequences, and the benefits of applying external PEEP during assisted ventilation when PEEPi is present.
需要机械通气的慢性阻塞性肺疾病(COPD)患者对呼气末正压(PEEP)的反应取决于潜在的病理生理学。本综述将重点关注 COPD 的病理生理学,尤其是内在 PEEP(PEEPi)及其后果,以及在辅助通气期间出现 PEEPi 时应用外部 PEEP 的益处。
{"title":"Setting positive end-expiratory pressure in the severely obstructive patient.","authors":"Amal Jubran","doi":"10.1097/mcc.0000000000001131","DOIUrl":"https://doi.org/10.1097/mcc.0000000000001131","url":null,"abstract":"The response to positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation depends on the underlying pathophysiology. This review focuses on the pathophysiology of COPD, especially intrinsic PEEP (PEEPi) and its consequences, and the benefits of applying external PEEP during assisted ventilation when PEEPi is present.","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"19 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Current Opinion in Critical Care
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1