Cardiovascular

Advances in resuscitation and deresuscitation

Summary This review discusses significant recent developments in fluid resuscitation and deresuscitation practices within critical care, highlighting a paradigm shift toward conservative, personalized fluid management. Advances in fluid stewardship, goal-directed fluid therapy (GDFT), and innovative monitoring tools, including automated closed-loop systems and machine learning, support a precision medicine approach. The authors advocate for balanced resuscitation […]

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Respiratory

Driving pressure vs. oxygenation-based PEEP titration strategies in ARDS patients: a physiological study

Summary This prospective observational study compared the physiological effects of three different positive end-expiratory pressure (PEEP) titration strategies in patients with acute respiratory distress syndrome (ARDS): a driving pressure-based clinical approach, an empirical oxygenation-based method (high PEEP/FiO₂ table), and fixed PEEP levels (5 or 15 cmH₂O) determined by ARDS severity. Findings revealed that clinical titration

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Cardiovascular

Cardiogenic shock syndrome unraveled: understanding the different layers of heterogeneity

Summary Cardiogenic shock (CS) represents a heterogeneous clinical syndrome characterized by sustained tissue hypoperfusion due to cardiac dysfunction, encompassing diverse etiological, hemodynamic, and molecular profiles. The paper emphasizes the need for recognizing CS heterogeneity through clinical classification, ventriculo-arterial coupling, macro- and microcirculatory considerations, and molecular subphenotyping. These multiple layers of complexity suggest that personalized medicine

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Mechanical Ventilation

Bedside Assessment of the Respiratory System During Invasive Mechanical Ventilation

Summary The article provides an in-depth review of bedside methods for assessing respiratory mechanics in patients receiving invasive mechanical ventilation. It emphasizes physiological principles guiding clinical management and differentiates between extensive and intensive ventilatory parameters. Detailed methods for evaluating passive patients and those making spontaneous respiratory efforts are outlined, aiming to minimize ventilator-induced lung injury

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Cardiovascular, Circulatory

Does targeted temperature management at 33 °C improve outcome after cardiac arrest?

Summary The article explores targeted temperature management (TTM) at 33°C as a treatment for patients following cardiac arrest, presenting arguments both in favor and against its use. TTM has been extensively debated due to conflicting clinical trial outcomes, variability in evidence from systematic reviews, and differences in interpretation of clinical utility. This review critically assesses

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Does targeted temperature management at 33 °C improve outcome after cardiac arrest? Read Post »

Miscellaneous, Uncategorized

Demystifying Volume Status

Summary Accurate evaluation of patient volume status is crucial yet challenging, impacting critical decisions on fluid management and vasoactive therapies. Traditional clinical methods often lack precision due to complexities in fluid distribution and homeostasis. This review provides a structured physiologic framework leveraging point-of-care ultrasound (POCUS) to assess volume status comprehensively. It emphasizes integrating central venous

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Circulatory

Central venous pressure: current uses and prospects for an old parameter

Summary The article revisits the clinical relevance of central venous pressure (CVP), a traditional yet often underutilized hemodynamic parameter, given its historical inability to predict fluid responsiveness. It emphasizes that CVP still holds considerable diagnostic and management utility beyond fluid responsiveness, particularly as an indicator of venous return dynamics, organ perfusion, and right ventricular filling

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Mechanical Ventilation

Preoxygenation strategies for endotracheal intubation in resource-limited settings: reframing the basics

Summary This editorial reviews evidence-based strategies for preoxygenation during endotracheal intubation (ETI) specifically tailored to resource-limited settings (LRS). The authors underscore the challenges faced in achieving optimal preoxygenation where advanced devices are unavailable. They propose practical, low-cost alternatives and highlight recent evidence supporting the effectiveness of methods such as high-flow nasal cannula (HFNC), non-invasive positive

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Sepsis

Fluid resuscitation management in patients with sepsis and septic shock: a network meta-analysis

Summary This network meta-analysis of 28 randomized controlled trials (8,770 patients) compares fluid resuscitation strategies in sepsis/septic shock. Balanced crystalloids (BC) demonstrated significant advantages, reducing 90-day mortality compared to saline (RR 0.89) and low-molecular-weight hydroxyethyl starch (L-HES; RR 0.84). Hyperoncotic albumin showed promise for renal protection but BC ranked highest overall, with superior outcomes for

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Circulatory, Miscellaneous

Measurement and interpretation of central venous pressure: a narrative review

Summary This narrative review explores the historical development, physiological underpinnings, measurement techniques, and clinical relevance of central venous pressure (CVP) in perioperative and critical care settings. Although traditionally used as a marker for fluid responsiveness and intravascular volume status, evidence now emphasizes that CVP alone is unreliable for guiding fluid therapy. Nonetheless, when used alongside

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