Topic Review
Ventilation-Perfusion Mismatch in the Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a heterogenous condition that is characterized by the development of inflammatory pulmonary edema and life-threatening hypoxemia, and it accounts for nearly 25% of patients who require mechanical ventilation. Acute respiratory distress syndrome (ARDS) remains an important clinical challenge with a mortality rate of 35–45%. It is being increasingly demonstrated that the improvement of outcomes requires a tailored, individualized approach to therapy, guided by a detailed understanding of each patient’s pathophysiology. In patients with ARDS, disturbances in the physiological matching of alveolar ventilation (V) and pulmonary perfusion (Q) (V/Q mismatch) are a hallmark derangement. The perfusion of collapsed or consolidated lung units gives rise to intrapulmonary shunting and arterial hypoxemia, whereas the ventilation of non-perfused lung zones increases physiological dead-space, which potentially necessitates increased ventilation to avoid hypercapnia.
  • 652
  • 12 Jan 2023
Topic Review
Prone Positioning and COVID-19-Related Acute Respiratory Distress
The prone position is a non-invasive technique resulting from the mobilization of the patient, where the person is lying horizontally face down. This technique has been used since the 1970s, but it has gained great relevance in the last year owing to the COVID-19 pandemic with the use of invasive mechanical ventilation.
  • 584
  • 15 Nov 2021
Topic Review
Iron Deficiency and Anemia Diagnostics
Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. 
  • 574
  • 14 Oct 2021
Topic Review
Extracorporeal Cytokine Removal
Cytokine removal can attenuate dysregulated immune response caused vasoplegia, leading to quicker hemodynamic stabilization and shock reversal. The most frequently used criteria to define shock reversal include normalization of serum lactate (<2.2 mmol/L) coupled with a significant (≥90%) reduction in norepinephrine dose requirements. The current paper has summarized the available data, which indicate the important contribution of early hemoadsorption in achieving rapid hemodynamic stabilization in patients with refractory vasoplegic shock.
  • 573
  • 07 Jul 2021
Topic Review
Endocrine Challenges with Continuous-Flow LVADs
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement.
  • 568
  • 02 Jul 2021
Topic Review
ML Application in ICU (MIMIC_Database)
Modern Intensive Care Units (ICUs) provide continuous monitoring of critically ill patients susceptible to many complications affecting morbidity and mortality. ICU settings require a high staff-to-patient ratio and generates a sheer volume of data. For clinicians, the real-time interpretation of data and decision-making is a challenging task. Machine Learning (ML) techniques in ICUs are making headway in the early detection of high-risk events due to increased processing power and freely available datasets such as the Medical Information Mart for Intensive Care (MIMIC). We conducted a systematic literature review to evaluate the effectiveness of applying ML in the ICU settings using the MIMIC dataset. A total of 322 articles were reviewed and a quantitative descriptive analysis was performed on 61 qualified articles that applied ML techniques in ICU settings using MIMIC data. We assembled the qualified articles to provide insights into the areas of application, clinical variables used, and treatment outcomes that can pave the way for further adoption of this promising technology and possible use in routine clinical decision-making.
  • 539
  • 22 Mar 2021
Topic Review
Changes of Endothelial Glycocalyx in Cardiac Surgery
Cardiac surgery is one of the highest-risk procedures, usually involving cardiopulmonary bypass and commonly inducing endothelial injury that contributes to the development of perioperative and postoperative organ dysfunction. Substantial scientific efforts are being made to unravel the complex interaction of biomolecules involved in endothelial dysfunction to find new therapeutic targets and biomarkers and to develop therapeutic strategies to protect and restore the endothelium. 
  • 534
  • 17 May 2023
Topic Review
COVID-19-Related Acute Respiratory Distress Syndrome
Lower respiratory tract invasion by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) results in widespread damage of type II alveolar and pulmonary capillary endothelial cells, disruption of the alveolar-capillary barrier, activation of coagulation, and diffuse thrombogenesis amplified by recruited monocytes and neutrophils and concurrent hypofibrinolysis. These pathobiological mechanisms are associated with a distinct form of acute respiratory distress syndrome (ARDS), characterized by relatively high lung compliance, progressively worsening hypoxemia, low potential for lung recruitment, hyperperfusion of nonaerated lung tissue, and diffuse small-vessel thrombosis.
  • 522
  • 14 Oct 2022
Topic Review
Emergency Airway Management
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, there remains significant morbidity and mortality associated with EAM.
  • 519
  • 10 Nov 2022
Topic Review
Cardiothoracic Surgical Critical Care Medicine
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry.
  • 518
  • 09 Jan 2023
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