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Topic Review
Mechanisms of Carbapenem Resistance
Carbapenem antibiotics are the most effective antimicrobials for the treatment of infections caused by the most resistant bacteria. They belong to the category of β-lactams that include the penicillins, cephalosporins, monobactams and carbapenems. This class of antimicrobials has a broader spectrum of activity than most other beta-lactams antibiotics and are the most effective against Gram-positive and Gram-negative bacteria. All β-lactams antibiotics have a similar molecular structure: the carbapenems together with the β-lactams. 
  • 707
  • 13 Apr 2022
Topic Review
COVID-19-Related Acute Respiratory Distress Syndrome
Lower respiratory tract invasion by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) results in widespread damage of type II alveolar and pulmonary capillary endothelial cells, disruption of the alveolar-capillary barrier, activation of coagulation, and diffuse thrombogenesis amplified by recruited monocytes and neutrophils and concurrent hypofibrinolysis. These pathobiological mechanisms are associated with a distinct form of acute respiratory distress syndrome (ARDS), characterized by relatively high lung compliance, progressively worsening hypoxemia, low potential for lung recruitment, hyperperfusion of nonaerated lung tissue, and diffuse small-vessel thrombosis.
  • 706
  • 14 Oct 2022
Topic Review
ML Application in ICU (MIMIC_Database)
Modern Intensive Care Units (ICUs) provide continuous monitoring of critically ill patients susceptible to many complications affecting morbidity and mortality. ICU settings require a high staff-to-patient ratio and generates a sheer volume of data. For clinicians, the real-time interpretation of data and decision-making is a challenging task. Machine Learning (ML) techniques in ICUs are making headway in the early detection of high-risk events due to increased processing power and freely available datasets such as the Medical Information Mart for Intensive Care (MIMIC). We conducted a systematic literature review to evaluate the effectiveness of applying ML in the ICU settings using the MIMIC dataset. A total of 322 articles were reviewed and a quantitative descriptive analysis was performed on 61 qualified articles that applied ML techniques in ICU settings using MIMIC data. We assembled the qualified articles to provide insights into the areas of application, clinical variables used, and treatment outcomes that can pave the way for further adoption of this promising technology and possible use in routine clinical decision-making.
  • 687
  • 22 Mar 2021
Topic Review
Fluid Resuscitation in Sepsis
The importance of fluid resuscitation therapy during the early stages of sepsis management is a well-established principle. Current Surviving Sepsis Campaign (SSC) guidelines recommend the early administration of intravenous crystalloid fluids for sepsis-related hypotension or hyperlactatemia due to tissue hypoperfusion, within the first 3 h of resuscitation and suggest using balanced solutions (BSs) instead of normal saline (NS) for the management of patients with sepsis or septic shock.
  • 654
  • 08 Jun 2023
Topic Review
Big Data in Laboratory Medicine
Laboratory medicine is a digital science. Every large hospital produces a wealth of data each day—from simple numerical results from, e.g., sodium measurements to highly complex output of “-omics” analyses, as well as quality control results and metadata. Processing, connecting, storing, and ordering extensive parts of these individual data requires Big Data techniques. Whereas novel technologies such as artificial intelligence and machine learning have exciting application for the augmentation of laboratory medicine, the Big Data concept remains fundamental for any sophisticated data analysis in large databases. To make laboratory medicine data optimally usable for clinical and research purposes, they need to be FAIR: findable, accessible, interoperable, and reusable. This can be achieved, for example, by automated recording, connection of devices, efficient ETL (Extract, Transform, Load) processes, careful data governance, and modern data security solutions. Enriched with clinical data, laboratory medicine data allow a gain in pathophysiological insights, can improve patient care, or can be used to develop reference intervals for diagnostic purposes. 
  • 646
  • 30 Aug 2022
Topic Review
Blood Stream Infections
Blood Stream Infections (BSIs) are defined by positive blood culture or cultures (with an isolate of the same species grown in at least one blood culture bottle) in a patient with systemic signs of infection (i.e., a patient who has evidence of one or more of the symptoms or signs, which are fever (body temperature > 38 °C), hypothermia (body temperature < 36 °C), chills, hypotension, oliguria, or high lactate levels).
  • 636
  • 23 Nov 2021
Topic Review
Electrical Impedance Tomography
Electrical Impedance Tomography (EIT) is a non-invasive bedside imaging technique that provides real-time lung ventilation information on critically ill patients. EIT can potentially become a valuable tool for optimising mechanical ventilation, especially in patients with acute respiratory distress syndrome (ARDS).
  • 626
  • 27 Oct 2023
Topic Review
Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness
Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome.
  • 622
  • 22 May 2023
Topic Review
Endocrine Aspects of ICU-Hospitalized COVID-19 Patients
The unprecedented scale of the current SARS-CoV-2/COVID-19 pandemic has led to an extensive—yet fragmented—assessment of its endocrine repercussions; in many reports, the endocrine aspects of COVID-19 are lumped together in intensive care unit (ICU) patients and non-ICU patients.
  • 612
  • 18 Oct 2022
Topic Review
TAVIs
The first TAVI was performed by Alain Cribier in an inoperable patient in 2002, and since that moment, transcatheter valve intervention has become an optimal alternative therapy to SAVR for patients with AS. TAVI was introduced in 2004 to treat comorbid patients at high surgical risk, avoiding cardiac arrest and cardiopulmonary bypass while reducing surgical trauma. During the subsequent years, modern transcatheter heart valves (THVs) have become more efficient, and the outcomes of TAVI have constantly improved.
  • 610
  • 06 Sep 2021
Topic Review
Multi-Drug Resistance Bacterial Infections
It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance.
  • 589
  • 30 Aug 2021
Topic Review
Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation (ECMO) is a specialized temporary life support for patients with severe cardiac or pulmonary failure bridging the time for organ recovery, transplant, or permanent assistance.
  • 581
  • 09 Feb 2023
Topic Review
High Flow through Nasal Cannula
High Flow through Nasal Cannula (HFNC) delivers heated and humidified air–oxygen mixture to the patient, with an inspiratory fraction of oxygen (FiO2) ranging from 21 to 100% and a flow up to 60 L/min through a large bore nasal cannula.
  • 557
  • 25 Mar 2022
Topic Review
Consequence of Alveolar Hyperoxia and Systemic Hyperoxaemia
Acute hypoxic respiratory failure (AHRF) is a prominent feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) critical illness. The need for a high FiO2 to normalise arterial hypoxemia and tissue hypoxia can result in alveolar hyperoxia. This in turn can lead to local alveolar oxidative stress with associated inflammation, alveolar epithelial cell apoptosis, surfactant dysfunction, pulmonary vascular abnormalities, resorption atelectasis, and impairment of innate immunity predisposing to secondary bacterial infections. While oxygen is a life-saving treatment, alveolar hyperoxia may exacerbate pre-existing lung injury.
  • 556
  • 20 Nov 2023
Topic Review
Peptide Nucleic Acid
Peptide nucleic acid (PNA) is an artificial DNA analog in which the negatively charged phosphodiester backbone is replaced by a charge-neutral pseudopeptide backbone. PNA exhibits several conformational flexibilities. It can adopt the A and B helical structures upon binding to target RNA and DNA, respectively, and form antiparallel and parallel duplexes. The antiparallel duplex is generally more stable than the parallel one.
  • 554
  • 03 Nov 2023
Topic Review
COVID-19 Pandemic Management of LMICs
The World Bank has historically classified countries according to their per capita gross national income (GNI) into three groups: high-income countries (or HICs), middle-income countries (or MICs), and low-income countries (or LICs). In 2020, LICs were 32, suffering high rates of illnesses and infections due to the lack of clean water, low sanitation levels, malnutrition, and the lack of access to quality medical care. Approximately 5 billion people lived in MICs, representing over 70% of the world population. There are a total of 105 MICs. Only 77 countries were classified by the World Bank as HICs. The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. 
  • 551
  • 10 Jan 2022
Topic Review
Advanced and Invasive Cardiopulmonary Resuscitation Techniques
Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged. Technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. 
  • 551
  • 20 Dec 2022
Topic Review
Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients
The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.
  • 550
  • 11 Jul 2022
Topic Review
Targeted Temperature Management
International guidelines recommend targeted temperature management (TTM) to improve the neurological outcomes in adult patients with post-cardiac arrest syndrome (PCAS). Several studies have indicated that the beneficial effect of hypothermic TTM differs according to the severity of PCAS, suggesting that there may be a subgroup of PCAS patients that is especially likely to benefit from hypothermic TTM. 
  • 546
  • 13 Dec 2021
Topic Review
Zinc Functions
Zinc is a structural component of proteins, functions as a catalytic co-factor in DNA synthesis and transcription of hundreds of enzymes, and has a regulatory role in protein–DNA interactions of zinc-finger proteins.
  • 542
  • 15 Nov 2023
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