Current opinion in critical care
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Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. ⋯ Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.
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Curr Opin Crit Care · Aug 2020
ReviewThe place of extracorporeal life support in cardiogenic shock.
Temporary circulatory support (TCS) devices are increasingly used as a salvage therapy for patients with refractory cardiogenic shock. The exact place of the different TCS devices in the management of cardiogenic shock patients remains unclear and intensely debated. This article provides an overview on new cardiogenic shock classification, currently available devices, place of TCS in the management of cardiogenic shock patients, and discusses the results of recent case series and trials in this setting. ⋯ TCS devices have become the cornerstone of the management of patients with refractory cardiogenic shock. VA-ECMO has emerged as the first-line support system in this setting, with a growing number of accepted indications. Large adequately powered randomized controlled trials are now underway and should help to determine the respective place of different TCS devices in strategies to treat cardiogenic shock patients.
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Curr Opin Crit Care · Aug 2020
ReviewMetabolic support in sepsis: corticosteroids and vitamins: the why, the when, the how.
Sepsis is a global health issue, and there is a need for effective, low-cost adjunct metabolic treatments. Corticosteroids have been investigated in many trials for decades, and recently the administration of vitamin C, thiamine (vitamin B1), and vitamin D have been proposed as novel therapies in patients with sepsis. ⋯ Evidence from high-quality research is still insufficient to support the use of vitamin C, thiamine, and vitamin D as metabolic support in sepsis treatment.
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Mortality rates for acute decompensated heart failure and cardiogenic shock remain unacceptably high despite advances in medical therapy and mechanical circulatory support. Systems designed to quickly and accurately identify and risk stratify these patients are needed in order to improve survival. ⋯ Assessing the severity of heart failure is a critical step in enabling the targeting of appropriate therapies to the appropriate patients. A novel classification system allows for accurate and reproducible identification and risk stratification.
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Curr Opin Crit Care · Aug 2020
ReviewMitochondrial dysfunction in critical illness during acute metabolic stress and convalescence: consequences for nutrition therapy.
Mitochondrial dysfunction is associated with increased morbidity and mortality during and after critical illness. The concept of adaptive mitochondrial metabolic-bio-energetic downregulation rather than bio-energetic failure during the acute phase of critical illness has gained traction. As mitochondria are not able to utilize substrate during adaptive hibernation and aggressive feeding induces further harm, this condition has consequences for nutrition therapy. ⋯ Optimal nutrition therapy in the early phase of critical illness should avoid overfeeding and preserve (adaptive) mitochondrial function. Micronutrient supplementation probably requires a strategic cocktail instead of a high dosage of a single nutrient. Focus on identification of distinct metabolic phases to adapt nutrition during and after critical illness is essential.