Current opinion in critical care
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Clostridium difficile infection (CDI) is becoming a large healthcare burden with increasing incidence, high recurrence rates, and associated morbidity and mortality. Disease severity varies from mild to severe and complicated presentations. Current mainstays of therapy in severe CDI include: fluid resuscitation, support of organ dysfunction, discontinuation of inciting agents, and antibiotic treatment. ⋯ With further understanding of the pathogenesis and shortcomings of current therapies, the future of management of CDI may include a multimodal approach focusing on microbiota and immunologic therapies that could result in improved cure with reduced recurrence.
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The current review summarizes different aspects of assessment of gastrointestinal function and provides a practical approach to management of adult patients with gastrointestinal dysfunction in the ICU. ⋯ Defining gastrointestinal failure remains challenging but broad consensus needs to be reached and disseminated soon to allow conduct of interventional studies. A systematic approach to management of gastrointestinal problems is recommended.
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Curr Opin Crit Care · Apr 2016
ReviewPediatric neurocritical care in the 21st century: from empiricism to evidence.
Approximately one in five children admitted to a pediatric ICU have a new central nervous system injury or a neurological complication of their critical illness. The spectrum of neurologic insults in children is diverse and clinical practice is largely empirical, as few randomized, controlled trials have been reported. This lack of data poses a substantial challenge to the practice of pediatric neurocritical care (PNCC). PNCC has emerged as a novel subspecialty, and its presence is expanding within tertiary care centers. This review highlights the recent advances in the field, with a focus on traumatic brain injury (TBI), cardiac arrest, and stroke as disease models. ⋯ There is an unmet need for clinicians with expertise in the practice of brain-directed critical care for children. Although much of the practice of PNCC may remain empiric, a focus on the regionalization of care, creating defined training paths, practice within multidisciplinary teams, protocol-directed care, and improved measures of long-term outcome to quantify the impact of such care can provide evidence to direct the maturation of this field.
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Curr Opin Crit Care · Apr 2016
ReviewIncreased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome.
This article reviews recent developments related to intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) and clinical practice guidelines published in 2013. ⋯ In the last 15 years, investigators have better clarified the pathogenesis, epidemiology, diagnosis, and appropriate prevention of IAH/ACS. Subsequent study should be aimed at understanding which treatments effectively lower intra-abdominal pressure and whether these treatments ultimately affect patient-important outcomes.
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Curr Opin Crit Care · Apr 2016
ReviewNoninvasive ventilation for neuromuscular respiratory failure: when to use and when to avoid.
Neuromuscular respiratory failure can occur from a variety of diseases, both acute and chronic with acute exacerbation. There is often a misunderstanding about how the nature of the neuromuscular disease should affect the decision on how to ventilate the patient. This review provides an update on the value and relative contraindications for the use of noninvasive ventilation in patients with various causes of primary neuromuscular respiratory failure. ⋯ Noninvasive ventilation can be very effective to treat acute respiratory failure caused by myasthenia gravis and to prevent reintubation in other neuromuscular patients, but should be used cautiously for other indications, particularly Guillain-Barre syndrome.