Current opinion in critical care
-
Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts. ⋯ DCS remains an important treatment strategy in the management of specific patient cohorts. Continued developments in early trauma care will likely result in a further decline in the required use of DCS in severely injured patients.
-
We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. ⋯ Though the early resuscitation of sepsis and septic shock is key to improving outcomes, ideal resuscitation targets are elusive. Distinction should be drawn between microcirculatory and macrocirculatory changes, and corresponding targets. Common components of resuscitation bundles such as large volume resuscitation and high-dose vasopressors may not be universally beneficial. Microcirculatory targets, individualized resuscitation goals, and reassessment of completed trials using the updated septic shock criteria should be focus areas for future research.
-
Stroke is common and often presents as a neurologic emergency that requires rapid evaluation and treatment to minimize debilitation. Recent advances in therapy expanded time windows for intra-arterial thrombectomy in ischemic stroke, and surgical interventions for clot evacuation in large intracranial hemorrhage have recently proven feasible. This review discusses recent data regarding new therapeutic options in both ischemic and hemorrhagic stroke, notably in scenarios in which therapy was previously limited to supportive care. ⋯ Advancing therapeutics in ischemic and hemorrhagic stroke are changing acute care intervention and broadening potential candidates for what were once thought to be nonintervenable conditions. Execution of best practices in stroke will continue to evolve and will require understanding advanced imaging techniques, as well as selection criteria for procedural and surgical interventions.
-
Curr Opin Crit Care · Dec 2017
ReviewDrug-induced kidney disease in the ICU: mechanisms, susceptibility, diagnosis and management strategies.
Acute kidney injury (AKI) is a common complication in the critically ill population, is multifactorial and associated with increased mortality. Drug-induced kidney injury is a significant contributor to the development of AKI. The purpose of this review is to provide updates in the epidemiology, susceptibility and management of drug-induced kidney disease (DIKD). ⋯ Standard criteria for DIKD should be applied in clinical trials to improve our understanding of the frequency of these events. Adjudication of these events will improve the clinician's ability to evaluate the causal relationship and relative contribution of specific drugs to the AKI event.
-
Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse. ⋯ The crashing patient remains a clinical challenge. Using an integrated approach with bedside ultrasound, dynamic parameters for the evaluation of fluid responsiveness and surrogates of evaluation of tissue perfusion have made the assessment of the patient in shock faster, safer and more physiologic.