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Topic Review
Prone Positioning in COVID and Non-COVID ARDS
Prone positioning (PP) represents a therapeutic intervention with the proven capacity of ameliorating gas exchanges and ventilatory mechanics indicated in acute respiratory distress syndrome (ARDS). When PP is selectively applied to moderate-severe cases of ARDS, it sensitively affects clinical outcomes, including mortality.
  • 935
  • 18 Feb 2024
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. 
  • 924
  • 21 Dec 2021
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.
  • 911
  • 22 Feb 2022
Topic Review
GCR Expression in Critical Illness and Sepsis
Critical illness refers to a state of poor health where the vital organs are not functioning properly and immediate care is necessary to prevent the risk of imminent death. This condition may however have the potential for reversal. The actions of cortisol are mediated through two types of corticosteroid receptors: the mineralocorticoid receptor (MR) and the glucocorticoid receptor (GCR). The MR is primarily involved in regulating electrolyte balance, while the GCR plays a crucial role in regulating the immune response and inflammation.
  • 902
  • 29 Jun 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.
  • 895
  • 06 May 2024
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.
  • 893
  • 30 May 2023
Topic Review
Anticoagulation Strategies in Patients with Extracorporeal Membrane Oxygenation
The use of extracorporeal membrane oxygenation (ECMO) has recently increased exponentially. ECMO has become the preferred mode of organ support in refractory respiratory or circulatory failure. The fragile balance of haemostasis physiology is massively altered by the patient’s critical condition and specifically the aetiology of the underlying disease. Furthermore, an application of ECMO conveys another disturbance of haemostasis due to blood-circuit interaction and the presence of an oxygenator. 
  • 893
  • 06 Oct 2023
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.
  • 888
  • 29 Dec 2022
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.
  • 887
  • 09 Feb 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. 
  • 884
  • 10 Jan 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.
  • 879
  • 11 Jul 2022
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.
  • 867
  • 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.
  • 860
  • 02 Nov 2021
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.
  • 857
  • 25 Mar 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.
  • 833
  • 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. 
  • 827
  • 26 Sep 2023
Topic Review
Corticosteroids in Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is frequently associated with sepsis. ARDS and sepsis exhibit a common pathobiology, namely excessive inflammation. Corticosteroids are powerful anti-inflammatory agents that are routinely used in septic shock and in oxygen-dependent SARS-CoV-2 related acute respiratory failure.
  • 824
  • 18 May 2023
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.
  • 814
  • 18 Oct 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.
  • 810
  • 16 Oct 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. 
  • 802
  • 08 Nov 2023
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