Transfusion management in the trauma patient
Purpose of review
Transfusion of blood products is lifesaving in the trauma ICU. Intensivists must be familiar with contemporary literature to develop the optimal transfusion strategy for each patient.
Recent findings
A balanced ratio of red-blood cells to plasma and platelets is associated with improved mortality and has therefore become the standard of care for resuscitation. There is a dose-dependent relationship between units of product transfused and infections. Liquid and freeze-dried plasma are alternatives to fresh frozen plasma that can be administered immediately and may improve coagulation parameters ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Craig Coopersmith Source Type: research
Neurotrauma
Purpose of review
This review will highlight the latest research relevant to the clinical care of traumatic brain injury (TBI) patients over the last 2 years while underscoring the implications of these advances in the understanding of diagnosis, treatment, and prognosis of TBI.
Recent findings
Brain tissue oxygenation monitoring can identify hypoperfusion as an adjunct to intracerebral pressure monitoring. Multiple biomarker assays are now available to help clinicians screen for mild TBI and biomarker elevations correlate with the size of intracranial injury. Beta-blocker exposure following TBI has demonstrated...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Craig Coopersmith Source Type: research
Intensive care management of liver transplant recipients
Purpose of review
Liver transplantation remains the only definitive treatment for advanced liver disease and liver failure. Current allocation schemes utilized for liver transplantation mandate a ‘sickest first’ approach, thus most liver transplants occur in patients with severe systemic illness. For intensive care providers who care for liver transplant recipients, a foundation of knowledge of technical considerations of orthotopic liver transplantation, basic management considerations, and common complications is essential. This review highlights the authors’ approach to intensive care management of the postope...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Craig Coopersmith Source Type: research
Acute mesenteric ischaemia
Purpose of review
To summarize the recent evidence on acute mesenteric ischaemia (AMI).
Recent findings
The overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce.
Clinical suspicion of AMI is the key to timely ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Craig Coopersmith Source Type: research
Intra-abdominal hypertension and abdominal compartment syndrome
Purpose of review
Intra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS.
Recent findings
The impact of IAH and ACS on kidney function and other outcomes continues to ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: THE SURGICAL PATIENT: Edited by Craig Coopersmith Source Type: research
Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers
Purpose of review
We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW.
Recent findings
The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14–47%), burnout (45–85%), a...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Lung transplantation in patients with lung disease secondary to coronavirus disease 2019 infection
Purpose of review
In this article, we describe preoperative patient selection and outcomes of patients with lung disease secondary to infection from COVID-19 who receive lung transplantation.
Recent findings
Lung transplants for patients with lung disease secondary to infection from COVID-19 have been performed successfully in over 200 patients in the United States. The preoperative course of these patients is somewhat atypical in comparison with patients who have had lung transplants related to chronic lung diseases, where there are more traditional indications for lung transplants. COVID-19 patients have more ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Selection criteria and triage in extracorporeal membrane oxygenation during coronavirus disease 2019
Purpose of review
Coronavirus disease 2019 (COVID-19) pandemic changed the way we had to approach hospital- and intensive care unit (ICU)-related resource management, especially for demanding techniques required for advanced support, including extracorporeal membrane oxygenation (ECMO).
Recent findings
Availability of ICU beds and ECMO machines widely varies around the world. In critical conditions, such a global pandemic, the establishment of contingency capacity tiers might help in defining to which conditions and subjects ECMO can be offered. A frequent reassessment of the resource saturation, possibly integr...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Impact of ICU strain on outcomes
Purpose of review
Acute surge events result in health capacity strain, which can result in deviations from normal care, activation of contingencies and decisions related to resource allocation. This review discusses the impact of health capacity strain on patient centered outcomes
Recent findings
This manuscript discusses the lack of validated metrics for ICU strain capacity and a need for understanding the complex interrelationships of strain with patient outcomes. Recent work through the coronavirus disease 2019 pandemic has shown that acute surge events are associated with significant increase in hospital mor...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Providing respiratory and ventilation care in the face of shifting evidence: current opinion in critical care
Purpose of review
To review the clinical problem and noninvasive treatments of hypoxemia in critically-ill patients with coronavirus disease 2019 pneumonia and describe recent advances in evidence supporting bedside decision making.
Recent findings
High-flow nasal oxygen and noninvasive ventilation, along with awake prone positioning are potentially helpful therapies for acute hypoxemic respiratory failure. High-flow nasal oxygen therapy has been widely implemented as a form of oxygen support supported by prepandemic randomized controlled trials showing possible benefit over noninvasive ventilation. Given the sh...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
COVID-19: dealing with ventilator shortage
Purpose of review
To describe different strategies adopted during coronavirus disease 2019 pandemic to cope with the shortage of mechanical ventilators.
Recent findings
Short-term interventions aimed to increase ventilator supply and decrease demand. They included: redistributing and centralizing patients, repurposing operating rooms into intensive care units (ICUs) and boosting ventilator production and using stocks and back-ups; support by the critical care outreach team to optimize treatment of patients in the ward and permit early discharge from the ICU, ethical allocation of mechanical ventilators to patien...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Fundamental drivers of nurses’ experiences of ICU surging during the coronavirus disease 2019 (COVID-19) pandemic
Purpose of review
Nurses working in intensive care units have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review summarizes the current state of the evidence regarding intensive care nurses experience of the pandemic.
Recent findings
The pandemic has had an impact on: nursing workload, the organization of nurse staffing, experiences of staff redeployed into ICU, nurses’ perceptions of the safety and quality of patient care, and staff health. In the few comparative studies, mental health was worse for nurses than other healthcare workers in intensive care. Despite some of thi...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
Surging ICU during COVID-19 pandemic: an overview
The objective of this review is to provide an overview on how ICU surging was managed during COVID-19 pandemic, with a special focus on papers published in the last 18 months.
Recent findings
From the onset of the COVID-19 pandemic, it was apparent that the biggest challenge was the inequity of access to an adequately equipped and staffed ICU bed. The first wave was overwhelming; large surge of patients required critical care, resources were limited and non-COVID-19 care processes were severely compromised. Various approaches were used to address ICU staffing shortage and to expand the physical ICU space capacity....
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: ICU EXPERIENCES FROM COVID 19: Edited by Luigi Camporota Source Type: research
COVID-19-associated AKI
Purpose of review
While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19.
Recent findings
Large observational studies and meta-analyses report an AKI incidence of 28–34% in all inpatients and 46–77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in d...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research
Pragmatic platform trials to improve the outcome of patients with acute kidney injury
Purpose of review
There is an important need for improved diagnostic strategies and treatment among patients with acute kidney injury (AKI). Classical randomized clinical trials have generated relevant results in AKI but are associated with shortcomings, such as high costs and sometimes lack of generalizability. In this minireview, we discuss the value and limits of pragmatic trials and platform trials for AKI research.
Recent findings
The implementation of pragmatic and platform trials in critical care settings has generated relevant clinical evidence impacting clinical practice. Pragmatic and platform designs ...
Source: Current Opinion in Critical Care - November 3, 2022 Category: Nursing Tags: RENAL SYSTEM: Edited by Sean M. Bagshaw Source Type: research