2020 most popular articles in Critical Care
Featured Reviews
Biomarkers in critical care nutrition
The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Optimization of nutrition delivery should thus improve ICU clinical outcomes. C. Stoppe et al. discuss the development of biological markers to identify patients who are most likely to benefit from nutrition interventions and monitor the effects of nutrition support.
Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance
Optimized nutrition care of the ICU COVID-19 patients is important to maintain gastrointestinal tract function, sustain immune defenses, and avoid severe loss of muscle mass and function. As for any other ICU patients, the latter is crucial to promote short- and long-term recovery. R. Thibault et al. provide a practical guidance of the nutritional treatment of the patient with COVID-19 in the ICU.
Featured Research
The effect of the timing of norepinephrine initiation on clinical outcomes in patients with septic shock is uncertain. In this study the authors evaluate the impact of early and late start of norepinephrine support on clinical outcomes in patients with septic shock. Early initiation of norepinephrine in patients with septic shock seems to be associated with decreased short-term mortality, shorter time to achieved target MAP, and less volume of intravenous fluids within 6 h.
Mechanical ventilation remains a cornerstone of ARDS management, however, the mechanical forces (pressure, volume, and flow) generated by the interactions between the ventilator and the respiratory system can further damage the lung, a process known as ventilator-induced lung injury (VILI). In this study, D. Chiumello et al. compare the geometric method to measure MP, considered the reference standard, with the algebraic formulas, both for volume and pressure-controlled ventilation in a group of sedated and paralyzed patients, to understand whether the easier to use surrogate formulas were suitable for the everyday clinical practice.
ECCO2R therapy in the ICU: consensus of a European round table meeting
With recent advances in technology, patients with acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (ae-COPD) could benefit from extracorporeal CO2 removal (ECCO2R). However, current evidence in these indications is limited. A European ECCO2R Expert Round Table Meeting was convened to further explore the potential for this treatment approach.
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak is spreading worldwide. To date, no specific treatment has convincingly demonstrated its efficacy. Hydroxychloroquine and lopinavir/ritonavir have potential interest, but virological and clinical data are scarce, especially in critically ill patients. The present report took the opportunity of compassionate use and successive drug shortages to compare the effects of two therapeutic options, lopinavir/ritonavir and hydroxychloroquine, as compared to standard of care only.
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Featured Editorial
COVID-19 and ethics in the ICU
The COVID-19 pandemic has brought into focus many medical ethics questions; several have burdened intensive care unit physicians in particular. The aim of this article is to provide a frank yet thoughtful discussion of the many facets of these ethical dilemmas.
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