Pulmonary hypertension in critical care.
Curr Opin Crit Care. 2011 Aug 12;
Authors: Gayat E, Mebazaa A
PURPOSE OF REVIEW: To review the contemporary management of patients with pulmonary hypertension in critical care. …

[Read more →]

Attributable mortality of ventilator-associated pneumonia.
Curr Opin Crit Care. 2011 Aug 12;
Authors: Timsit JF, Zahar JR, Chevret S
PURPOSE OF REVIEW: To critically discuss the attributable mortality of ventilator-ass…

[Read more →]

Nonconventional support of respiration.
Curr Opin Crit Care. 2011 Aug 5;
Authors: Patroniti N, Bellani G, Pesenti A
PURPOSE OF REVIEW: Several alternative treatments have been proposed to decrease mortality of patients…

[Read more →]

Management of severe acute asthma in the emergency department.
Curr Opin Crit Care. 2011 Jun 29;
Authors: Rowe BH, Sevcik W, Villa-Roel C
PURPOSE OF REVIEW: Asthma is one of the most common chronic diseases in most dev…

[Read more →]

Cardiac tamponade.
Curr Opin Crit Care. 2011 Jun 29;
Authors: Bodson L, Bouferrache K, Vieillard-Baron A
PURPOSE OF REVIEW: To re-emphasize the epidemiology, pathophysiology, diagnosis, and treatment of cardiac tampona…

[Read more →]

Increased blood troponin levels in ICU patients.
Curr Opin Crit Care. 2011 Jun 29;
Authors: Markou N, Gregorakos L, Myrianthefs P
PURPOSE OF REVIEW: Cardiac troponins in serum have become the biomarkers of choice for t…

[Read more →]

Rare roentgenologic manifestations of pulmonary edema.
Curr Opin Crit Care. 2011 Jun 10;
Authors: Myrianthefs P, Markou N, Gregorakos L
PURPOSE OF REVIEW: Unilateral pulmonary edema (UPE) is an unusual manifestation of…

[Read more →]

Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients.
Curr Opin Crit Care. 2011 Jun 14;
Authors: Bakker EJ, Ravensbergen NJ, Poldermans D
PURPOSE OF REVIEW: Cardiac…

[Read more →]

What is a fluid challenge?
Curr Opin Crit Care. 2011 Apr 19;
Authors: Cecconi M, Parsons AK, Rhodes A
PURPOSE OF REVIEW: The fluid challenge is used in the fluid management of many sick patients. The principle behind t…

[Read more →]

Delivering high-quality cardiopulmonary resuscitation in-hospital.
Curr Opin Crit Care. 2011 Apr 8;
Authors: Soar J, Edelson DP, Perkins GD
PURPOSE OF REVIEW: This review discusses recent data relating to delivering hi…

[Read more →]

Acute-on-chronic liver failure: from concept to a new syndrome.

Curr Opin Crit Care. 2011 Feb 24;

Authors: Jalan R

PMID: 21358404 [PubMed - as supplied by publisher]

[Read more →]

Early effects of resident work-hour restrictions on patient safety: a systematic review and plea for improved studies.

J Bone Joint Surg Am. 2011 Jan;93(2):e5

Authors: Baldwin K, Namdari S, Donegan D, Kamath AF, Mehta S

since the inception of the eighty-hour work week, work hour restrictions have incited considerable debate. Work hour policies were designed to prevent medical errors and to reduce patient morbidity and mortality. It is unclear whether work hour restrictions have been helpful in medicine in general and in orthopaedic surgery specifically. This systematic review of the literature was designed to determine the success of these restrictions in terms of patient mortality, medical errors, and complications.

PMID: 21248206 [PubMed - indexed for MEDLINE]

[Read more →]

Acute-on-chronic liver failure: concept, natural history, and prognosis.

Curr Opin Crit Care. 2011 Feb 14;

Authors: Olson JC, Kamath PS

PURPOSE OF REVIEW: A population of patients with previously compensated cirrhosis will develop acute deterioration resulting in multiorgan failure and high short-term mortality. Complications of cirrhosis frequently culminate in admissions to the ICU. This review advances the concept of acute-on-chronic liver failure as a distinct clinical entity. RECENT FINDINGS: Recently, the American Association for the Study of Liver Disease and the European Association for the Study of the Liver created a research consortium to advance the state of the science of acute-on-chronic liver failure. The goal of this consortium is aimed at improving outcomes, identification of a subset of patients with cirrhosis at high risk for deterioration, and the inciting events that lead to this deterioration. Liver transplant remains the only curative option for advanced cirrhosis; however, the limited number of available organs necessitates innovations in the care of advanced liver disease. Liver replacement therapies have not as yet demonstrated reduction in mortality, but have demonstrated improvements in other measures. Large-scale prospective studies of cirrhosis are required. SUMMARY: Acute-on-chronic liver failure may be a distinct clinical entity with a potential for reversibility when identified early and managed with aggressive critical care support.

PMID: 21326095 [PubMed - as supplied by publisher]

[Read more →]

Acute-on-chronic liver failure: the heart and systemic hemodynamics.

Curr Opin Crit Care. 2011 Feb 14;

Authors: Liu H, Lee SS

PURPOSE OF REVIEW: Circulatory abnormalities in cirrhosis include hyperdynamic circulation and cirrhotic cardiomyopathy. The extent of circulatory abnormalities is further exaggerated in acute-on-chronic liver failure (ACLF). The mechanism remains unclear and management also needs to be evaluated. RECENT FINDINGS: The predominant mechanism of ACLF is thought to be a systemic inflammatory reaction. Cardiovascular-active factors such as tumor necrosis factor and nitric oxide are increased and cortisol is decreased; the former further dilates the vasculature and the latter decreases the sensitivity to vasoconstrictors. The exaggerated vasodilatation further decreases the cardiac afterload. However, no study has yet demonstrated the benefit of vasodilators/vasoconstrictors in the management of ACLF. Standard medical treatment in this setting is associated with high mortality. Patients treated with molecular adsorbent recirculating system (MARS) had improved serum levels of inflammatory mediators such as tumor necrosis factor alpha and interleukin-6, but this was not associated with improved survival. Liver transplantation eventually reverses the cardiovascular abnormalities. SUMMARY: Circulatory abnormalities are exaggerated in ACLF. The predominant mechanism is a systemic inflammatory reaction. Modalities such as MARS improve serum markers of inflammation, but not survival. Liver transplantation is the definitive treatment of the cardiovascular abnormalities of ACLF.

PMID: 21326096 [PubMed - as supplied by publisher]

[Read more →]

Acute-on-chronic liver failure: the kidneys.

Curr Opin Crit Care. 2011 Feb 9;

Authors: Cárdenas A, Ginès P

PURPOSE OF REVIEW: Acute-on-chronic liver failure (ACLF) is defined as an abrupt deterioration of liver function in patients with established liver disease. Kidney function is almost universally altered in patients with ACLF due to underlying circulatory abnormalities. We review current advances during the past year in the diagnosis and management of renal failure in ACLF. RECENT FINDINGS: The adequate measurement of renal function by means of clearance methods remains the gold standard for estimation of the glomerular filtration rate in patients with cirrhosis. The new definition of acute kidney injury needs to be specifically studied in patients with cirrhosis. Alternative kidney biomarkers of renal function in cirrhosis are promising and need further investigation. The most common cause of renal failure in cirrhosis is that associated with infections followed by hypovolemia-induced renal failure, intrinsic renal diseases, hepatorenal syndrome, and drug-induced renal failure. Adrenal insufficiency commonly occurs in patients with cirrhosis and hemodynamic instability. The proper diagnosis relies on corticotropin stimulation testing and the role of hydrocortisone therapy in these patients merits further investigation. Hyponatremia in cirrhosis is a major risk factor for the development of hepatic encephalopathy and is associated with a poor outcome in patients with ACLF and also after deceased donor and living-related liver transplantation. Vasoconstrictor drugs, particularly terlipressin, are effective for the management of hepatorenal syndrome. Predictive factors of response to terlipressin include serum bilirubin levels and the presence of an early increase in mean arterial pressure. SUMMARY: The ongoing advances in the diagnosis and management of patients with ACLF and renal failure will improve the diagnosis, therapy and outcome of these patients.

PMID: 21311322 [PubMed - as supplied by publisher]

[Read more →]