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Topic Review
Lung Microbiome in Critically Ill Patients
The microbiome is a diverse ecosystem that includes all host-associated microorganisms and their genomes. These microorganisms belong to various kingdoms including some potential pathogens such as bacteria, viruses and fungi. To obtain a comprehensive view of the lung microbiome, including not only bacterial but also viral and fungal data, is of great value to improve our understanding of critical lung illnesses such as VAP or ARDS. The evolution of the lung microbiome over time and the description of its dysbiosis will be key elements to improve diagnosis and preventive measures in ventilated patients.
  • 539
  • 24 Jan 2022
Topic Review
Platelets in Severe Infection
Beyond their role in hemostasis, platelets have emerged as key contributors in the immune response; accordingly, the occurrence of thrombocytopenia during sepsis/septic shock is a well-known risk factor of mortality and a marker of disease severity.
  • 539
  • 22 Feb 2022
Topic Review
Vasopressin in Sepsis and Other Shock States
Septic shock is defined by the need for vasopressors to correct hypotension and lactic acidosis secondary to infection, with a high mortality rate. The Surviving Sepsis Campaign guidelines recommend vasopressin as a second-line vasopressor, added to norepinephrine. 
  • 532
  • 07 Nov 2023
Topic Review
Potential Antioxidant Multitherapy against Complications Occurring in Sepsis
Septic shock represents one of the main causes of mortality in critical patient units with an increase in its incidence, and it is also associated with a high burden of morbidity in surviving patients. Within the pathogenesis of sepsis, oxidative stress plays an important role. The excessive formation of reactive oxygen species (ROS) leads to mitochondrial damage and vasomotor dysfunction that characterizes those patients who fall into septic shock. Despite numerous studies carried out in patients with septic shock of different causes, effective therapies have not yet been developed to reduce the morbidity and mortality associated with this pathology. Despite the contribution of ROS in the pathophysiology of sepsis and septic shock, most studies performed in humans, with antioxidant monotherapies, have not resulted in promising data. Nevertheless, some interventions with compounds such as ascorbate, N-acetylcysteine, and selenium would have a positive effect in reducing the morbidity and mortality associated with this pathology.
  • 530
  • 17 Dec 2022
Topic Review
Next-Generation Sequencing and Sepsis
Next-generation sequencing (NGS) is a novel procedure among molecular methods for pathogen diagnostics, and it is able to analyse the overall DNA fragments in the sample.
  • 527
  • 02 Nov 2021
Topic Review
Monocyte and Neutrophil Function Immunomonitoring in Critically-Ill Patients
Immune cells and mediators play a crucial role in the critical care setting but are understudied. It is clear that, for critically ill, one size does not fit all and that immune phenotyping of critically ill patients may allow the development of a more personalized approach with tailored immunotherapy for the specific patient. 
  • 525
  • 21 Dec 2021
Topic Review
Endotoxin Adsorption in the Treatment of Septic Shock
Lipopolysaccharide, the main component of the outer membrane of Gram-negative bacteria is a highly potent endotoxin responsible for organ dysfunction in sepsis. It is present in the blood stream not only in Gram-negative infections, but also in Gram-positive and fungal infections, presumably due to sepsis-related disruption of the intestinal barrier. Various pathways, both extra- and intracellular, are involved in sensing endotoxin and non-canonical activation of caspase-mediated pyroptosis is considered to have a major role in sepsis pathophysiology. Endotoxin induces specific pathological alterations in several organs, which contributes to poor outcomes. The adverse consequences of endotoxin in the circulation support the use of anti-endotoxin therapies, yet more than 30 years of experience with endotoxin adsorption therapies have not provided clear evidence in favor of this treatment modality. The results of small studies support timely endotoxin removal guided by measuring the levels of endotoxin; unfortunately, this has not been proven in large, randomized studies. The presence of endotoxemia can be demonstrated in the majority of patients with COVID-19, yet only case reports and case series describing the effects of endotoxin removal in these patients have been published to date. The place of blood purification therapies in the treatment of septic shock has not yet been determined.
  • 514
  • 16 Feb 2022
Topic Review
Neuromuscular Blocking Agents Use in ARDS
Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified.
  • 502
  • 18 Oct 2022
Topic Review
Pharmacokinetics of Sepsis
Septic patients commonly have decreased concentrations of albumin, which directly impacts the pharmacokinetic (PK) of antibiotics. Hypoalbuminemia increases the unbound antibiotic concentration, which leads to a lower, probably suboptimal, antimicrobial concentration. These should be accounted for if therapeutic drug monitoring (TDM) is used, and the direct measurement of free drug levels should be preferred.
  • 499
  • 29 Dec 2022
Topic Review
Toxic Epidermal Necrolysis
Toxic Epidermal Necrolysis is a rare dermatological condition with high mortality and serious consequences on its survivors. Despite having been first described in 1956, its pathophysiology remains uncertain, mainly regarding its mechanisms, although it seems that certain apoptosis pathways are pivotal in starting keratinocytes’ apoptosis and in activating T cells, especially those mediated by tumour necrosis factor, Fas-FasL and granulysin. In general, its aetiology and presentation are consensual, being defined as a generalized necrolysis of the epidermis that occurs as an uncontrolled immune response to a specific drug or one of its metabolites, highlighting cotrimoxazole and allopurinol as the most important. This necrolysis leads to a massive shedding of the epidermal layer of the skin, with stronger incidences in the torso, upper limbs and face. Its complications tend to be severe, noting that septic ones are responsible for over half of the disease’s mortality. Nearly all survivors develop long-term sequelae, namely hypertrophic scarring and skin pigmentation anomalies.
  • 496
  • 18 Aug 2022
Topic Review
Genetics of Facioscapulohumeral Muscular Dystrophy
Facioscapulohumeral muscular dystrophy (FSHD) represents the third most common form of muscular dystrophy and is characterized by muscle weakness and atrophy. FSHD is caused by the altered expression of the transcription factor double homeobox 4 (DUX4), which is involved in several significantly altered pathways required for myogenesis and muscle regeneration. 
  • 482
  • 26 Sep 2023
Topic Review
Treatment Advances in Sepsis and Septic Shock
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it affects over 25 million people every year. Even more severe, septic shock is a subset of sepsis defined by persistent hypotension, and hospital mortality rates are higher than 40%. As new pathophysiological mechanisms have been uncovered, immunostimulatory therapy has emerged as a promising path forward. Highly investigated treatment strategies include cytokines and growth factors, immune checkpoint inhibitors, and even cellular therapies.
  • 472
  • 04 May 2023
Topic Review
Markov Modeling of Acute Respiratory Distress Syndrome
This project focuses on utilizing mathematical Markov chain modeling as a stochastic process to analyze the stages of Acute Respiratory Distress Syndrome (ARDS). ARDS, characterized by a spectrum of severity ranging from floors to death, presents a complex clinical challenge. By employing Markov chain modeling, we aim to provide a structured framework for understanding the dynamic progression of ARDS. Our approach involves constructing a Markov chain that represents the transition of patients through various stages of ARDS, including floors, mild, moderate, severe, and ultimately death. Each stage is associated with specific clinical characteristics and outcomes, forming the basis of our modeling framework. In addition to describing the natural progression of ARDS, our project involves reviewing current clinical guidelines for managing the condition. We propose to examine the impact of each guideline on patient outcomes and the transition through different ARDS stages. By systematically analyzing the effects of various interventions and treatment strategies, we aim to provide insights into optimizing patient care and improving outcomes in ARDS management. Ultimately, this project serves as a comprehensive exploration of ARDS progression, providing healthcare professionals with a valuable framework for thinking about the condition. By integrating mathematical modeling with clinical guidelines, we seek to enhance our understanding of ARDS and contribute to more effective treatment approaches tailored to individual patient needs.
  • 468
  • 06 May 2024
Topic Review
Prolonged Mechanical Ventilation: Outcomes and Management
Prolonged mechanical ventilation (PMV) is defined as successful extubation after more than three spontaneous breathing trials or taking more than 14 days. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs.
  • 444
  • 24 Jun 2022
Topic Review
Telemedicine in Providing Palliative Care to Cancer Patients
Telemedicine, or the use of telecommunications to provide health services, is a technology that has been long studied to help increase access to health care.
  • 443
  • 16 May 2022
Topic Review
Hypercoagulability in End-Stage Liver Disease
End-stage liver disease (ESLD) is associated with significant changes in a patient’s coagulation profile. These changes are unique in that they involve all branches of the coagulation system. The hypercoagulability is associated with significant endothelial dysfunction (ED) due to nitric oxide dysregulation.
  • 442
  • 16 Oct 2023
Topic Review
Necessity of Cardiothoracic Surgical Critical Care Medicine Training
Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. 
  • 427
  • 01 Jan 2023
Topic Review
Basic Signs and Complete Lung Ultrasound Examination
Lung ultrasound (LUS) has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures. The integration of bedside ultrasonography in the daily clinical activity of intensivists could reduce the risk of radiation exposure, need of patient transport, and hospital costs and may redirect patient’s management. A qualitative LUS approach is based on interpreting artifacts (A- and B-lines) and real images to distinguish between normal and pathological context. If a qualitative approach gives important information on the morphological assessment of the lung for the diagnosis, a quantitative approach allows us to extend the utility of the examination to lung monitoring.
  • 419
  • 30 May 2023
Topic Review
Management Strategies in Septic Coagulopathy
One of the ‘organs’ that can be affected by sepsis is the coagulation system. Coagulopathy in sepsis may take the form of sepsis-induced coagulopathy (SIC) or sepsis-associated disseminated intravascular coagulation (DIC). It is important to identify SIC early, as at this stage of coagulopathy anticoagulants may be of the greatest benefit. The mainstream management strategies in septic coagulopathy include the causal treatment of sepsis, unfractionated heparin, low-molecular-weight heparin, antithrombin, and recombinant human thrombomodulin. The last two have been associated with the highest survival benefit. Nevertheless, the indiscriminate use of these anticoagulants should be avoided due to the lack of mortality benefit and increased risk of bleeding. The early diagnosis of SIC and monitoring of coagulation status during sepsis is crucial for the timely management and selection of the most suitable treatment at a time. 
  • 418
  • 01 Feb 2023
Topic Review
ECMO Management in Severely Hypothermic Cardiac Arrest Patients
Accidental hypothermia, defined as an unintentional drop of the body core temperature below 35 °C, is one of the causes of cardiocirculatory instability and reversible cardiac arrest. Currently, extracorporeal life support (ECLS) rewarming is recommended as a first-line treatment for hypothermic cardiac arrest patients. The aim of the ECLS rewarming is not only rapid normalization of core temperature but also maintenance of adequate organ perfusion. Veno-arterial extracorporeal membrane oxygenation (ECMO) is a preferred technique due to its lower anticoagulation requirements and potential to prolong circulatory support. Although highly efficient, ECMO is acknowledged as an invasive treatment option, requiring experienced medical personnel and is associated with the risk of serious complications. 
  • 415
  • 08 Nov 2023
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