Current opinion in critical care
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Because of heart-lung interactions, weaning from mechanical ventilation induces strong hemodynamic changes that can lead to weaning-induced cardiac failure. Cardiac patients are particularly at risk for this complication. In this review, we will summarize the most recent advances concerning the mechanisms, diagnosis and treatment of weaning-induced cardiac failure. ⋯ Nowadays, the diagnosis of weaning-induced pulmonary edema can be easily made. Identifying such an event is important as an appropriate treatment, guided by the suspected mechanisms leading to the cardiac failure, should hasten weaning from mechanical ventilation.
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Curr Opin Crit Care · Oct 2014
ReviewIs there still a role for low-dose dopamine use in acute heart failure?
Acute heart failure (AHF) is a major health problem worldwide, with no proven therapy. Low-dose dopamine has been used in this entity to improve renal outcomes in the past decades. The aim of this article is to review the former and recent clinical trials about the use of low-dose dopamine in AHF. ⋯ On the basis of the current data, there is no role for the routine use of low-dose dopamine in nonhypotensive patients with AHF. Further studies are needed to define the role of low-dose dopamine in patients with AHF and hypotension. Until the availability of more data, the use of dopamine in AHF should be individualized.
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We aim to help clinicians to use and interpret high-sensitivity cardiac troponins (cTns) in different acute care settings. This guidance is timely and relevant as high-sensitivity cTns are currently replacing conventional cTn assays in most parts of the world. ⋯ In all of these, elevated levels of high-sensitivity cTn are associated with increased mortality risk. In some of these, concepts are evolving as to how the pathophysiological signal of cardiomyocyte injury could be used to alter patient management and potentially improve outcomes.
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Curr Opin Crit Care · Oct 2014
ReviewAntibiotic treatment of ventilator-associated tracheobronchitis: to treat or not to treat?
To evaluate the data on antimicrobial therapy for ventilator-associated tracheobronchitis (VAT) to prevent ventilator-associated pneumonia (VAP), and its impact on patient outcomes. ⋯ This review focuses on diagnostic criteria for VAT and VAP, etiologic agents, rationale and benefits of initiating pre-emptive, appropriate antibiotic treatment for VAT to prevent VAP, improve patient outcomes and associated acute and chronic healthcare costs.
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Therapeutic hypothermia following out-of-hospital cardiac arrest improves neurological recovery. Coupled with neurological benefit, multiple complications including infection have been associated with therapeutic hypothermia following out-of-hospital cardiac arrest. In this review, we will discuss therapeutic hypothermia, and more broadly, temperature management, as a risk for ICU infection. ⋯ Studies demonstrate increased rate of pneumonia and bacteremia but decreased rate of other infections, suggesting redistribution but no overall increased risk of infection per se. The diagnosis of infection during therapeutic hypothermia does not impact mortality or neurological recovery.