Annals of intensive care
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The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead to situations of major caregiver sufferings. ⋯ With this in mind, we aimed to point out some critical ethical choices with which ICU caregivers have been confronted during the Covid-19 pandemic and to underline their limits. The formalized strategies integrating the relevant tools of ethical reflection were disseminated without deviating from usual practices, leaving to intensivists the ultimate choice of decision.
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Annals of intensive care · Feb 2020
ReviewDosing vitamin C in critically ill patients with special attention to renal replacement therapy: a narrative review.
The primary aim of the present contribution is to find a literature-based agreement on dose adjustments of vitamin C in critically ill patients undergoing renal replacement therapy (RRT). ⋯ Supplementing vitamin C 1 g twice daily to critically ill patients has a solid pathophysiological rationale and a good safety profile. Patients on RRT probably need similar doses as critically ill patients not receiving RRT. Intravenous vitamin C in a dose of 2 g/day may be necessary to achieve normal plasma concentrations during RRT. However, data on dose adjustment of vitamin C during intermittent or chronic RRT are sparse and require more thorough pharmacokinetic and dose-response studies.
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Annals of intensive care · Jan 2020
ReviewPrevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation.
Mortality in acute respiratory distress syndrome (ARDS) remains unacceptably high at approximately 39%. One of the only treatments is supportive: mechanical ventilation. However, improperly set mechanical ventilation can further increase the risk of death in patients with ARDS. ⋯ The new paradigm in TCAV is configuring each breath guided by the previous one, which achieves real-time titration of ventilator settings and minimizes instability induced tissue damage. This novel methodology changes the current approach to mechanical ventilation, from arbitrary to personalized and adaptive. The outcome of this approach is an open and stable lung with reduced regional strain and greater lung protection.
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Annals of intensive care · May 2019
ReviewEffects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis.
Low levels of ascorbic acid (AA) have been detected in critically ill patients in which AA supplementation leads to promising outcomes. However, the ability of AA to reduce mortality in critically ill patients remains controversial. In this study, we have performed a meta-analysis to evaluate the effects of AA dose on the mortality of critically ill adults. ⋯ Intravenous AA reduces the duration of vasopressor support and mechanical ventilation; 3-10 g AA results in lower overall mortality rates. Given the limitations of the primary literature, further studies are required to fully clarify the effectiveness of AA during the management of critically ill patients.
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Annals of intensive care · Apr 2019
ReviewVentilation in patients with intra-abdominal hypertension: what every critical care physician needs to know.
The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. ⋯ During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.