Current opinion in critical care
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Curr Opin Crit Care · Aug 2021
ReviewVitamin D in critical care: where are we now and what is next?
To summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19. ⋯ Although research on this topic is still ongoing, it appears reasonable to recommend at least the standard vitamin dose for the healthy population (600--800 IU of native vitamin D3). Many questions remain on the actual role, the best metabolite, regime, and so forth. However, the role for vitamin D in bone health is clear. Elderly ICU survivors have a high risk for osteoporosis/fractures, so at least in this population, an optimal vitamin D status should be targeted.
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Blood lactate concentrations are frequently measured in critically ill patients and have important prognostic value. Here, we review some key questions related to their clinical use in sepsis. ⋯ Lactate concentrations respond too slowly to be used to guide acute changes in therapy, but can help evaluate overall response. Hyperlactatemia should not be considered as a problem in itself, but as a warning of altered cell function.
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Recent studies have failed to show significant benefit from a uniform strategy, suggesting that hemodynamic management must be individually adapted in septic shock depending on different phenotypes. Different approaches that may be used to this end will be discussed. ⋯ Different hemodynamic phenotypes can occur at any stage of sepsis and be associated with one another. The clinician must regularly assess dynamic changes in phenotypes in septic shock patients. Statistical approaches based on machine learning need to be validated by prospective studies.
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Curr Opin Crit Care · Jun 2021
ReviewOptimizing hemodynamic function during cardiopulmonary resuscitation.
The purpose of this narrative review is to provide an update on hemodynamics during cardiopulmonary resuscitation (CPR) and to describe emerging therapies to optimize perfusion. ⋯ Modern imaging techniques may help increase our understanding on the mechanism of forward flow during CPR. This could provide new information on how to optimize perfusion. Head-up CPR and the use of REBOA during CPR are novel methods that might improve cerebral perfusion during CPR; both techniques do, however, still await clinical testing.
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Curr Opin Crit Care · Jun 2021
ReviewActivation of citizen responders to out-of-hospital cardiac arrest.
To discuss different approaches to citizen responder activation and possible future solutions for improved citizen engagement in out-of-hospital cardiac arrest (OHCA) resuscitation. ⋯ Implementation of citizen responder programs holds the potential to improve bystander intervention in OHCA, with advancing technology offering new improvement possibilities. Information on how to best activate citizen responders as well as the effect on survival following OHCA is warranted to evaluate the cost-effectiveness of citizen responder programs.