Current opinion in critical care
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The review aims to discuss emerging evidence in the field of microbiome-dependent roles in host defense during critical illness with a focus on lung, kidney, and brain inflammation. ⋯ In health, a diverse microbiome might enhance host defense, while during critical illness, the dysbiotic microbiome might contribute to comorbidity and organ dysfunction. Future research should be aimed at further establishing the causes and consequences of dysbiosis seen in the critically ill, which will provide perspective for developing new strategies of intervention.
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Curr Opin Crit Care · Aug 2017
ReviewThe value of dynamic preload variables during spontaneous ventilation.
To discuss the physiological significance and clinical value of dynamic preload variables in spontaneously breathing patients. ⋯ Although originally intended to be used only during mechanical ventilation, 'dynamic parameters' may offer valuable clinical information in spontaneously breathing patients.
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Fluid responsiveness prediction is not always possible with well established dynamic approaches such as passive leg raising or pulse pressure variation in the ICU. The purpose of the present review is to summarize emerging alternative techniques for fluid responsiveness prediction in adult critically ill patients and discuss their methodology and applicability. In addition, the future role of fluid responsiveness prediction in the ICU is discussed. ⋯ Emerging techniques are encouraging for broader applicability of fluid responsiveness prediction. Still, the clinical impact of correctly predicting fluid responsiveness remains to be investigated in the critically ill and the research community should have a clear aim of moving toward that type of studies.
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Curr Opin Crit Care · Aug 2017
ReviewMinimally invasive cardiac output technologies in the ICU: putting it all together.
Haemodynamic monitoring is a cornerstone in the diagnosis and evaluation of treatment in critically ill patients in circulatory distress. The interest in using minimally invasive cardiac output monitors is growing. The purpose of this review is to discuss the currently available devices to provide an overview of their validation studies in order to answer the question whether these devices are ready for implementation in clinical practice. ⋯ Minimally and noninvasive monitoring devices may not be sufficiently accurate to replace (trans)pulmonary thermodilution in estimating cardiac output. The current paradigm shift to explore trending ability rather than investigating agreement of absolute values alone is to be applauded. Future research should focus on the effectiveness of these devices in the context of (functional) haemodynamic monitoring before adoption into clinical practice can be recommended.
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Lipid peroxidation has long been established as a key player in the pathophysiology of critical illness. Recent developments in oxidative lipidomics have aided in deciphering the molecular mechanisms of lipid oxidation in health and disease. This review discusses recent achievements and recent developments in oxidative lipidomics and its contribution to the understanding of critical illness. ⋯ Multiple lipid oxidation products are formed either through enzymatic pathways or through random chemical reactions. These products are often biologically active and can contribute to the regulation of cellular signaling. Oxidative lipidomics has contributed to the identification and quantification of lipid peroxidation products, the mechanism and time course of their production after injury, and synergistic functioning with other regulatory processes in the body. These advances in knowledge will help guide the future development of interventions in critical illness.