Current opinion in critical care
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Curr Opin Crit Care · Dec 2021
ReviewPostoperative blood pressure management in patients treated in the ICU after noncardiac surgery.
Blood pressure management is a cornerstone of hemodynamic management in patients treated in the ICU after noncardiac surgery. Postoperative blood pressure management is challenging, because blood pressure alterations after surgery can be profound and have numerous causes. ⋯ Future research on postoperative blood pressure management in patients treated in the ICU after noncardiac surgery needs to assess whether the prevention or treatment of postoperative blood pressure alterations - especially postoperative hypotension - reduces the incidence of postoperative adverse outcomes.
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Curr Opin Crit Care · Dec 2021
ReviewAdvanced cardiac life support: lessons from recent trials on how to move forward.
This review discusses potential reasons why many recent large trials in advanced cardiac life support have failed to demonstrate a difference in outcomes and suggests some points for consideration in planning future trials. ⋯ Refining our ability to select patients with potential to benefit from an intervention, providing those interventions earlier, and tailoring the specifics of an intervention to the individual patient all may be important in design of cardiac arrest trials, as illustrated by the large effect seen in the ARREST trial.
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Curr Opin Crit Care · Dec 2021
ReviewTiming of renal-replacement therapy in intensive care unit-related acute kidney injury.
The optimal timing of renal-replacement therapy (RRT) initiation for the management of acute kidney injury (AKI) in the intensive care unit (ICU) is frequently controversial. An earlier-strategy has biological rationale, even in the absence of urgent indications; however, a delayed-strategy may prevent selected patients from receiving RRT and avoid complications related to RRT. ⋯ Early preemptive initiation of RRT in critically ill patients with AKI does not confer clear clinical benefits. However, protracted delays in RRT initiation may be harmful.
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To describe recent science in basic life support (BLS) after cardiac arrest and how evolving knowledge in resuscitation is changing current guidelines and practices. ⋯ This review highlights the importance of strengthening both community and emergency medical services efforts to improve outcomes in cardiac arrest. Strategies that enhance the communication and collaboration between lay rescuers and professional resuscitation systems are important new avenues to pursue in developing systems that save more lives.
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European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation prioritize treatments like chest compression and defibrillation, known to be highly effective for cardiac arrest from cardiac origin. This review highlights the need to modify this approach in special circumstances. ⋯ Cardiac arrests from reversible causes happen with lower incidence. Return of spontaneous circulation and neurologically intact survival can hardly be achieved without a modified approach focusing on immediate treatment of the underlying cause(s) of cardiac arrest.