Current opinion in critical care
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Curr Opin Crit Care · Dec 2024
ReviewDoes targeted temperature management at 33 °C improve outcome after cardiac arrest?
Following successful resuscitation from cardiac arrest, a complex set of pathophysiologic processes are acutely triggered, leading to substantial morbidity and mortality. Postarrest management remains a major challenge to critical care providers, with few proven therapeutic strategies to improve outcomes. One therapy that has received substantial focus is the intentional lowering of core body temperature for a discrete period of time following resuscitation. In this review, we will discuss the key trials and other evidence surrounding TTM and present opposing arguments, one 'against' the use of postarrest TTM and another 'for' the use of this therapeutic approach. ⋯ There are several arguments for and against the use of TTM targeting 33 °C for alleviating brain injury after cardiac arrest. More studies are on the way that will hopefully provide more robust evidence and hopefully allow for consensus on this important topic.
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Curr Opin Crit Care · Dec 2024
ReviewNew ultrasound techniques for acute kidney injury diagnostics.
Acute kidney injury (AKI) is common in critical illness and associated with adverse outcomes. Imaging, specifically ultrasound, is increasingly finding a role in AKI diagnostics. This includes the assessment of arterial and venous blood flow, tissue perfusion and the condition of the renal parenchyma. This review provides an update on ultrasound techniques and their application to AKI in critical care. ⋯ Ultrasound continues to demonstrate great promise in the diagnosis and management of AKI, offering a noninvasive means to diagnose perfusion deficits and assess response to treatments. Further research, with standardization of techniques, may allow multifaceted renal ultrasound assessment in the critically ill for more accurate diagnosis and tailored intervention in AKI.
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To discuss the role of hemodynamic management in critically ill patients with acute kidney injury. ⋯ Recent studies have refined the impact of the various hemodynamic interventions on renal perfusion and function in critically ill patients with AKI. Though several of these interventions improve renal perfusion, their impact on renal function is more variable.
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Curr Opin Crit Care · Dec 2024
ReviewProtective mechanical ventilation in critically ill patients after surgery.
This review aims to provide an updated overview of lung protective strategies in critically ill patients after surgery, focusing on the utility of postoperative open-lung ventilation during the transition from the operating room to the intensive care unit. ⋯ Mechanical ventilation in surgical patients should adhere to lung protective strategies (i.e., individualizing positive end expiratory pressure and prioritize alveolar recruitment) during the transition from the operating room to the intensive care unit.
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This review discusses novel concepts of acute kidney injury (AKI), including subphenotyping, which may facilitate the development of target treatment strategies for specific subgroups of patients to achieve precision medicine. ⋯ Subphenotyping of AKI may provide a new understanding of this syndrome and guide targeted treatment strategies in order to improve patient outcomes.