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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.
  • 362
  • 17 Dec 2022
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. 
  • 214
  • 16 Jun 2023
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.
  • 433
  • 22 Feb 2022
Topic Review
Plant-Derived Bioactive Compounds as Anti-Cancerous Agents
Cancer is one of the major deadly diseases globally. The alarming rise in the mortality rate due to this disease attracks attention towards discovering potent anticancer agents to overcome its mortality rate. Based on their particular activity, a number of other plant-derived bioactive compounds are in the clinical development phase against cancer, such as gimatecan, elomotecan, etc. Additionally, the conjugation of natural compounds with anti-cancerous drugs, or some polymeric carriers particularly targeted to epitopes on the site of interest to tumors, can generate effective targeted treatment therapies. 
  • 798
  • 27 Dec 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.
  • 362
  • 29 Dec 2022
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.
  • 130
  • 20 Feb 2024
Topic Review
Peptide Nucleic Acid
Peptide nucleic acid (PNA) is an artificial DNA analog in which the negatively charged phosphodiester backbone is replaced by a charge-neutral pseudopeptide backbone. PNA exhibits several conformational flexibilities. It can adopt the A and B helical structures upon binding to target RNA and DNA, respectively, and form antiparallel and parallel duplexes. The antiparallel duplex is generally more stable than the parallel one.
  • 303
  • 03 Nov 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.
  • 209
  • 21 Aug 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.
  • 191
  • 14 Jul 2023
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.
  • 399
  • 11 Jul 2022
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