Current opinion in critical care
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To discuss future research themes and study design in cardiogenic shock. ⋯ This review discusses research in this area focusing on the importance of phenotyping patients with cardiogenic shock, based on artificial intelligence, machine learning, and unravel new molecular mechanisms using proteomics and metabolomics. Further, the future research focus in mechanical circulatory support and targeting inflammation is reviewed. Finally, newer trial designs including adaptive platform trials are discussed.
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Curr Opin Crit Care · Aug 2024
ReviewCardiogenic shock trajectories: is the Society for Cardiovascular Angiography and Interventions definition the right one?
We review the current Society for Cardiovascular Angiography and Interventions (SCAI) cardiogenic shock classification system and consider alternatives or iterations that may enhance our current descriptions of cardiogenic shock trajectory. ⋯ Whilst the SCAI staging system remains a pivotal tool in cardiogenic shock assessment, communication and reassessment, it is vital that the sophistication with which we measure and assess shock trajectory evolves in parallel our understanding of the complexity and variability of clinical course and clinical outcomes.
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Curr Opin Crit Care · Aug 2024
ReviewThe enteroendocrine axis and its effect on gastrointestinal function, nutrition, and inflammation.
Gastrointestinal (GI) dysfunction limits enteral nutrition (EN) delivery in critical illness and contributes to systemic inflammation. The enteroendocrine (EE) axis plays an integral role in this interface between nutrition, inflammation, and GI function in critical illness. In this review, we present an overview of the EE system with a focus on its role in GI inflammation and function. ⋯ The EE system is key in maintaining GI homeostasis in critical illness, and how it is impacted and contributes to outcomes in the setting of dysbiosis , inflammation and different feeding strategies in critical illness should be considered.
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Curr Opin Crit Care · Aug 2024
ReviewBuilding a cardiogenic shock response team: key considerations necessary to improve outcomes.
This review provides key information about cardiogenic shock (CS) teams, including published evidence and practical recommendations to create a CS team and program. ⋯ CS teams provides a platform for expedited recognition of CS and timely, standardized, and multidisciplinary discussions regarding appropriate management and care.
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Curr Opin Crit Care · Aug 2024
ReviewMetabolic support for patients on extra-corporeal membrane oxygenation.
The purpose of the review is to summarize recent research on metabolic support during extracorporeal membrane oxygenation. In this review, we cover the evidence on nutritional supplementation, both the route of supplementation, timing of initiation of supplementation as well as quantities of supplementation needed. In addition, we discuss the recent trend in awake extracorporeal membrane oxygenation (ECMO) and its benefits to patients. ⋯ There is a role of optimal metabolic support in the early recovery of patients on ECMO that is currently under-recognized. Future directions of research that aim to improve post ECMO outcomes must focus on this area.