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Topic Review
Therapeutic Plasma Exchange in the ICU
Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient’s plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. 
  • 297
  • 09 Jan 2024
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.
  • 297
  • 01 Mar 2024
Topic Review
Surfactant Abnormalities in Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a major cause of hypoxemic respiratory failure in adults, leading to the requirement for mechanical ventilation and poorer outcomes. Dysregulated surfactant metabolism and function are characteristic of ARDS. A combination of alveolar epithelial damage leading to altered surfactant synthesis, secretion, and breakdown with increased functional inhibition from overt alveolar inflammation contributes to the clinical features of poor alveolar compliance and alveolar collapse.
  • 295
  • 27 Oct 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.
  • 274
  • 14 Dec 2023
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. 
  • 254
  • 05 Mar 2024
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.
  • 235
  • 01 Feb 2024
Topic Review
ICU-Acquired Colonization and Infection in COVID-19 Patients
A large proportion of ICU-acquired infections are related to multidrug-resistant bacteria (MDR). Infections caused by these bacteria are associated with increased mortality, and prolonged duration of mechanical ventilation and ICU stay.  Although a huge amount of literature is available on COVID-19 and MDR bacteria, only a few clinical trials have properly evaluated the association between them using a non-COVID-19 control group and accurate design and statistical methods. The results of these studies suggest that COVID-19 patients are at a similar risk of ICU-acquired MDR colonization compared to non-COVID-19 controls. However, a higher risk of ICU-acquired infection related to MDR bacteria has been reported in several studies, mainly ventilator-associated pneumonia and bloodstream infection. Several potential explanations could be provided for the high incidence of ICU-acquired infections related to MDR. Immunomodulatory treatments, such as corticosteroids, JAK2 inhibitors, and IL-6 receptor antagonist, might play a role in the pathogenesis of these infections. Additionally, a longer stay in the ICU was reported in COVID-19 patients, resulting in higher exposure to well-known risk factors for ICU-acquired MDR infections, such as invasive procedures and antimicrobial treatment. Another possible explanation is the surge during successive COVID-19 waves, with excessive workload and low compliance with preventive measures. Further studies should evaluate the evolution of the incidence of ICU-acquired infections related to MDR bacteria, given the change in COVID-19 patient profiles. A better understanding of the immune status of critically ill COVID-19 patients is required to move to personalized treatment and reduce the risk of ICU-acquired infections. The role of specific preventive measures, such as targeted immunomodulation, should be investigated.
  • 227
  • 27 Sep 2023
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.
  • 207
  • 12 Sep 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.
  • 200
  • 13 Mar 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. 
  • 175
  • 15 Jan 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.
  • 175
  • 08 Feb 2024
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.
  • 167
  • 29 Feb 2024
Topic Review
The Relationship between Hypercarbia and Hypoxia
Ventilation and gas exchange are fundamental to maintaining proper levels of oxygen (PaO₂) and carbon dioxide (PaCO₂) in the blood. Minute ventilation (V̇E), the total volume of air moved in and out of the lungs per minute, is normally around 5-8 L/min in healthy adults. However, only a portion of this air reaches the alveoli for gas exchange, a process known as effective alveolar ventilation (V̇A), which is crucial for regulating PaCO₂ levels. When effective ventilation is reduced or dead space in the lungs increases, carbon dioxide clearance decreases, leading to elevated PaCO₂, known as hypercapnic respiratory failure. Hypercapnic respiratory failure occurs due to two main mechanisms: decreased effective alveolar ventilation or increased dead space. Reduced ventilation may result from a lower respiratory rate or smaller tidal volumes, often caused by sedative drugs, brainstem injuries, neuromuscular weakness, or physical factors such as obesity. Alternatively, conditions like COPD or acute respiratory distress syndrome (ARDS) increase dead space, meaning more of the inhaled air does not participate in gas exchange due to inadequate blood perfusion in certain lung areas. This dead space effect prevents sufficient CO₂ elimination, even if minute ventilation is normal or elevated. Patients with chronic hypercapnia, such as those with advanced COPD, may tolerate higher levels of PaCO₂ (90-120 mm Hg) without symptoms. In contrast, healthy individuals typically begin to experience symptoms of hypercapnia when PaCO₂ rises above 70-80 mm Hg. On the oxygen side, the alveolar gas equation helps explain how PaO₂ depends on both inspired oxygen and the amount of carbon dioxide in the alveoli. Inadequate oxygen levels, or hypoxemia, can occur when effective ventilation is compromised, as seen in conditions that reduce alveolar ventilation or increase dead space.
  • 31
  • 11 Nov 2024
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