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Topic Review
Lymphocyte Subpopulations during the Process of Sepsis
Sepsis remains a global challenge, especially in low- and middle-income countries, where there is an urgent need for easily accessible and cost-effective biomarkers to predict the occurrence and prognosis of sepsis. Lymphocyte counts are easy to measure clinically, and a large body of animal and clinical research has shown that lymphocyte counts are closely related to the incidence and prognosis of sepsis.
  • 616
  • 01 Mar 2024
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.
  • 604
  • 16 Oct 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. 
  • 595
  • 23 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.
  • 579
  • 20 Feb 2024
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.
  • 578
  • 29 May 2023
Topic Review
Kidney Replacement Therapy for Weaning
Acute kidney injury (AKI) is a common pathology in critical care settings, affecting more than half of all patients, 10% of whom require kidney replacement therapy (KRT). Modalities of KRT currently available include intermittent hemodialysis and continuous renal replacement therapies (continuous veno-venous hemodialysis or hemo/dia/filtration). Though a better survival using continuous compared with intermittent RRT has not been evidenced, the former has gained wide application in ICUs, often supplanting intermittent modalities because of the belief that it is better tolerated in hemodynamically unstable patients. Regardless of the modality used, the need for KRT considerably increases in-hospital mortality, which then fluctuates between 40% and 60%. More than three-fourths of patients who survive this acute episode develop chronic renal failure, 10 to 30% of whom remain dependent on KRT. In the long term, they remain exposed to a worsening of their morbidity and mortality, and a deterioration in their quality of life.
  • 574
  • 01 Feb 2024
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.
  • 553
  • 15 Mar 2023
Topic Review
Microbiome-Directed Therapies
Loss of commensal microbiota and excessive growth of potentially pathogenic bacteria are the main features of the gut microbiota in critically ill adult patients. Gut microbiota imbalance can increase the risk of secondary infection, immunosuppression, and even organ dysfunction, leading to an increased incidence of opportunistic infections and sepsis, aggravated various target organ damage, and worsened patient condition. Additionally, even after recovery from sepsis, the slow recolonization of patients’ normal microbiota may lead to long-term immunosuppression and poor prognosis. Therefore, different strategies related to the gut microbiota, such as using probiotics and prebiotics alone or in combination (synthetic preparations,) have been proposed in order to prevent the further growth of pathogens and improve the outcomes of critically ill patients.
  • 538
  • 14 Dec 2023
Topic Review
Extracorporeal Blood Purification Techniques for Septic Hyperinflammation
Various techniques for extracorporeal blood purification can decrease levels of elevated proinflammatory cytokines in septic shock, potentially mitigating the severity of the systemic inflammatory response. Some methods are effective in removing endotoxins, especially in sepsis caused by Gram-negative bacteria, which may aid in stabilizing the patient’s condition. Blood purification can enhance hemodynamic stability and reduce the need for vasopressors, crucial for managing septic shock. Techniques like continuous renal replacement therapy (CRRT) offer simultaneous management of acute kidney injury—a frequent complication in septic shock—alongside the removal of toxins and cytokines.
  • 534
  • 13 Mar 2024
Topic Review
miR-Based Treatments for Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome (ARDS) is characterized by lung inflammation and increased membrane permeability, which represents the leading cause of mortality in ICUs. Mechanical ventilation strategies are at the forefront of supportive approaches for ARDS. Recently, an increasing understanding of RNA biology, function, and regulation, as well as the success of RNA vaccines, has spurred enthusiasm for the emergence of novel RNA-based therapeutics. The most common types of RNA seen in development are silencing (si)RNAs, antisense oligonucleotide therapy (ASO), and messenger (m)RNAs that collectively account for 80% of the RNA therapeutics pipeline. These three RNA platforms are the most mature, with approved products and demonstrated commercial success. 
  • 496
  • 05 Mar 2024
Topic Review
CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis
Infective endocarditis (IE) is a rare but severe disease with high morbidity and mortality. Cardiac surgery plays a major role in the contemporary clinical management of IE patients.
  • 487
  • 08 Feb 2024
Topic Review
Pain Management Analgesia
Effective pain management in hospitalized patients involves a multimodal approach tailored to the severity and type of pain (mild, moderate, or severe) and the patient's clinical condition. The goal is to provide adequate pain relief while minimizing side effects and preventing complications like opioid dependence or gastrointestinal and renal issues from NSAIDs. Mild Pain: Managed with non-opioid analgesics such as acetaminophen or NSAIDs. Topical agents like lidocaine patches or capsaicin cream may be used for localized pain. Moderate Pain: Combines non-opioid analgesics with low-potency opioids (e.g., tramadol). Adjuncts like topical therapies or neuropathic pain medications (e.g., gabapentin) may also be employed. Severe Pain: Requires short-acting opioids (e.g., morphine, hydromorphone) often administered via scheduled dosing or patient-controlled analgesia. Long-acting opioids are reserved for chronic conditions like cancer-related pain. Special considerations include adjusting treatment for patients with chronic pain, hepatic or renal dysfunction, or risk factors for adverse drug reactions. Preventive measures, such as bowel regimens for opioid-induced constipation, and regular reassessment of pain control are critical components of care. The approach prioritizes not just the relief of pain but also the functional improvement and safety of patients. Consultation with pain management or palliative care teams is advised for complex or refractory cases.
  • 429
  • 25 Nov 2024
Topic Review
Toll-like Receptors and Eicosanoids in Sepsis
Sepsis is the leading cause of death from infection. Its incidence is on the rise. Sepsis is characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection, and it can occur after major surgery and injury. TLRs (toll-like receptors) regulate free radical generation, macrophage and leukocyte function, and modulate eicosanoid synthesis, and thus have a critical role in inflammation, immune response, and development and/or recovery from sepsis.
  • 426
  • 12 Sep 2023
Topic Review
COVID-19 and the Kidney
The new respiratory infectious disease coronavirus disease 2019 (COVID-19) that originated in Wuhan, China, in December 2019 and caused by a new strain of zoonotic coronavirus, named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Most of the deceased patients had pre-existing comorbidities; over 20% had chronic kidney disease (CKD). Furthermore, although SARS-CoV-2 infection is characterized mainly by diffuse alveolar damage and acute respiratory failure, acute kidney injury (AKI) has developed in a high percentage of cases.
  • 413
  • 29 Feb 2024
Topic Review
Computed Tomography Scan in ARDS
Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. 
  • 378
  • 15 Jan 2024
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