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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. 
  • 393
  • 06 Oct 2023
Topic Review
Neuromuscular Blocking Agents
The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient–ventilator asynchrony.
  • 387
  • 06 Mar 2024
Topic Review
Artificial Intelligence in the Intensive Care Unit
The development of artificial intelligence (AI) allows for the construction of technologies capable of implementing functions that represent the human mind, senses, and problem-solving skills, leading to automation, rapid data analysis, and acceleration of tasks. These solutions has been initially implemented in medical fields relying on image analysis; however, technological development and interdisciplinary collaboration allows for the introduction of AI-based enhancements to further medical specialties. During the COVID-19 pandemic, novel technologies established on big data analysis experienced a rapid expansion. Yet, despite the possibilities of advancements with these AI technologies, there are number of shortcomings that need to be resolved to assert the highest and the safest level of performance, especially in the setting of the intensive care unit (ICU). Within the ICU, numerous factors and data affect clinical decision making and work management that could be managed by AI-based technologies. Early detection of a patient’s deterioration, identification of unknown prognostic parameters, or even improvement of work organization are a few of many areas where patients and medical personnel can benefit from solutions developed with AI.
  • 371
  • 05 Jun 2023
Topic Review
Therapeutic Drug Monitoring of Beta-Lactam Antibiotics
Here describes various aspects of beta-lactams use in the critical care, focusing on clinical antibiotic stewardship in the ICU. Pharmacokinetics / pharmacodynamics (PK/PD) characteristics of beta-lactams are described and main factors of PK/PD variability in critically ill patients. Toxicity of beta-lactams, a frequently overlooked issue, is outlined. Analytical methods used in therapeutic drug monitoring (TDM) of beta-lactams are discussed. The evidence supporting antibiotic guidance based on therapeutic drug monitoring (TDM) in critically ill patients is analysed.
  • 365
  • 19 Jun 2023
Topic Review
Peripheral Nerve Blocks of the Chest Wall
Pectoralis nerve blocks, serratus anterior plane blocks, erector spinae plane blocks, paravertebral blocks, and parasternal blocks can provide valuable supplements in the portfolio of multi-modal analgesic approaches in chest wall pain. While the indication spectrum and covered areas for some of these blocks might overlap, the feasibility and, thereby, the choice of one of these blocks might differ according to the specifics of the concrete ICU patient.
  • 364
  • 20 Feb 2024
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.
  • 354
  • 29 Jun 2023
Topic Review
Pathophysiology of Acute Kidney Injury
In clinical practice, one of the most common interventions is volume expansion in those with perceived hypovolemia. Intravenous fluid administration is easily performable with crystalloid and colloid infusions or with various blood products. In the era, the isotonic but non-physiologic 0.9% saline and balanced solutions are available as crystalloid infusions, whereas the 6% hydroxyethyl starch (HES) (130/0.4 or 0.42) and the 5% or 20% human albumin are available as colloids, respectively.
  • 354
  • 21 Aug 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.
  • 352
  • 18 May 2023
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.
  • 352
  • 18 Feb 2024
Topic Review
Adjunctive Hemoadsorption Therapy with CytoSorb in Septic/Vasoplegic Shock
There are no approved therapies to modulate the excessive immune response and limit hyperinflammation with the goal of preventing related organ failure and death. In this context, extracorporeal blood purification therapies aiming at the alteration of the host inflammatory response through broad-spectrum, non-selective removal of inflammatory mediators have come into focus. A novel hemoadsorption device (CytoSorb®, CytoSorbents Inc., Princeton, NJ, USA) has shown promising results in patients with hyperinflammation from various origins. Although a significant body of literature exists, there is ongoing research to address many important remaining questions, including the optimal selection of patient groups who might benefit the most, optimal timing for therapy initiation, optimal schedule for adsorber exchanges and therapy duration, as well as an investigation into the potential removal of concomitant antibiotics and other medications. 
  • 350
  • 04 Dec 2023
Topic Review
Children Kidney Injury after Hematopoietic Stem Cell Transplant
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypo-perfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypo-perfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI.
  • 346
  • 29 May 2023
Topic Review
Pain Management at the End of Life
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis.
  • 346
  • 14 Jul 2023
Topic Review
CAR-T Cell Therapy Recipients Admitted to the ICU
To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the intensive care unit (ICU) admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. 
  • 346
  • 23 Oct 2023
Topic Review
TDM-Guided Recommendations in Septic Critically Ill Patients
Optimizing the entire therapeutic regimen in septic critically ill patients should be based not only on improving antibiotic use but also on optimizing the entire therapeutic regimen by considering possible drug–drug or drug–nutrient interactions. There are reports of endocarditis, meningitis, peritonitis, or pneumonia associated with probiotics in critically ill patients. In addition, probiotics are associated with risk of the spread of antimicrobial resistance. The therapeutic drug monitoring (TDM)-guided method ensures a true optimization of antibiotic therapy, and particular efforts should be applied globally.
  • 332
  • 15 Mar 2023
Topic Review
Nutrition Therapy in Patients with Liver Disease
Nutrition therapy in critically ill patients with liver disease represents a challenge for Intensive Care Units (ICUs). Nutritional status is correlated with the degree of hepatic dysfunction and the presence of malnutrition worsens outcomes in these patients. The nutritional risk that critically ill patients represent, together with the pathophysiological alterations of liver disease, especially in terms of nutrition intake and protein depletion, leads to malnutrition and sarcopenia. Nutrition therapy improves the survival of these patients; however, this is challenging since they more frequently experience difficulties with nutrition delivery. In consequence, both evaluation of nutritional status and an individualized approach seem mandatory for achieving nutrition objectives.
  • 331
  • 16 Oct 2023
Topic Review
Adults Supplemental Parenteral Nutrition at End of Life
“End of life” is a stage defined by the existence of an irreversible prognosis that ends with a person’s death. One of the aspects of interest regarding end of life focuses on parenteral nutrition, which is usually administered in order to avoid malnutrition and associated complications.
  • 331
  • 20 Feb 2024
Topic Review
Septic Acute Kidney Injury
Sepsis is a life-threatening condition that results from a profoundly dysregulated response to infection. It can lead to organ failure distant from the primary site of the infection, particularly in the kidneys. Sepsis can cause acute kidney injury (AKI). Sepsis and AKI form a vicious cycle, as sepsis is one of the main drivers of critical illness.
  • 322
  • 08 Nov 2023
Topic Review
Postoperative Cognitive Dysfunction Management in Cirrhotic Patients
Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. POCD is roughly defined as decreased cognitive performance in patients undergoing anesthesia. Various risk factors, including increased age, baseline cognition level, depth of anesthesia, or postoperative pain level, were described to be involved in the development of POCD. In the cirrhotic patient, POCD is described as a “more than expected” decline in cognitive function. The judicious use of anesthetic agents and techniques, the monitoring of the depth of anesthesia, and the application of ERAS protocols may prove to be advantageous in this setting. However, specific and targeted therapies for POCD are lacking. 
  • 315
  • 16 Jun 2023
Topic Review
Antibiotic Therapy of Sepsis Stewardship
The main recent change observed in the field of critical patient infection has been the universal awareness of the need to make better use of antimicrobials, especially in the most seriously ill patients, beyond the application of simple formulas and rigid protocols. The greatest challenge, therefore, of decision making in this context lies in determining an effective, optimal, and balanced empirical antibiotic treatment. This is sepsis stewardship.
  • 306
  • 07 Feb 2024
Topic Review
Thyroid Storm Complicated with Myocardial Involvement and Shock
Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The myocardial involvement in terms of injury, dysrhythmia, cardiomyopathy, failure, and cardiogenic shock (CS) during TS and the modalities of treatment and their efficiency, including pharmacological, mechanical, and surgical options are explored.
  • 299
  • 27 Sep 2023
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