Point-of-View Articles

POINT-OF-VIEW

Biomarkers as Prognostic Predictors and Guide in Critically Ill Patients

An overview of promising biomarkers in critical care, characteristics a biomarker should have and how to ensure their usefulness in clinical practice. Precision medicine is a medical approach that tailors treatments based on individual patient characteristics and their unique response to therapies for a particular disease. The goal of precision medicine is to achieve accuracy in both diagnosis...

POINT-OF-VIEW

Detecting Euglycaemic Diabetic Ketoacidosis Associated With SGLT2 Inhibitors

SGLT2 inhibitor associated EDKA is becoming more prevalent due to the increasing use of SGLT2 inhibitors in cardiovascular medicine and type 2 diabetes. Physician awareness and knowledge about the disease and diagnostic tools need to improve for better management. Point of care blood testing for ketones can allow for rapid and accurate diagnosis. Euglycaemic diabetic ketoacidosis (EDKA) is an uncom...

Sepsis Diagnosis: Clinical Signs, Scores, and Biomarkers

Sepsis and antimicrobial resistance are two major public health problems. Sepsis is defined as a dysregulated response of the body to a bacterial infection with organ dysfunction. The 2021 Surviving Sepsis Campaign SSC guidelines proposed characterising the infection based on clinical assessment and the dysregulated host response using clinical scores. In children, the sepsis definition is based...

Sepsis Diagnosis: Pancreatic Stone Protein in Adults, Children, and Neonates

Based on the concepts and the checklist criteria for an ideal sepsis biomarker presented in the article Sepsis Diagnosis: Clinical signs, Scores, and Biomarkers in this issue of ICU Management & Practice, we update and review the potential use of Pancreatic Stone Protein (PSP) in adults, children, and neonates. First described in the 1970s, this protein was only evaluated as a potential...

Tachycardia in Sepsis: Friend or Foe?

An overview of tachycardia in sepsis, the importance of rate control and the beneficial effects of beta-blockers. During sepsis, the sympathetic nervous system plays a key role in maintaining cardiac output and blood pressure. This is achieved through changes in heart rate, contractility, and vascular tone. The proper function of the baroreflex system is important for maintaining haemodynamic homeostasis...

Improving Haemodynamic Management of ICU Patients: Decatecholaminisation & Cardiac Stress Reduction

A summary of a symposium organised by AOP Health with presentations from Ricard Ferrer, Vall d’Hebron University Hospital, Barcelona, Spain; Bruno Levy, Centre Hospitalier Universitaire de Nancy, CHU Nancy · Réanimation Médicale Brabois, France; and Michael Fries, St. Vincenz Krankenhaus Limburg, Department of Anesthesiology, Germany. Sepsis in critically ill patients should be considered a medical...

The Clinical Utility of Estimated Plasma Volume in Critical Care

An overview of clinical evidence that demonstrates the prognostic value of estimated plasma volume (ePVS) in critically ill patients. Plasma volume (PV) is the total volume of blood plasma – the extracellular fluid volume of the vascular space. It is associated with regulating interstitial and intravascular spaces; hence it can be an effective marker for volume overload (Kim et al. 2022). Monitoring...

Guiding Clinical Care Using Pancreatic Stone Protein

The role of point-of-care testing in the early identification and management of sepsis, the need for better markers to identify sepsis, an overview of the Pancreatic Stone Protein (PSP) and clinical evidence highlighting its effectiveness as a biomarker. Infections are a leading cause of morbidity and mortality among critically ill patients. The early detection of severe infections is essential to improve...

Pancreatic Stone Protein Biomarker for Sepsis, Antimicrobial Resistance and Nosocomial Infections

The problem of antimicrobial resistance and the use of a clinical decision score and point-of-care testing biomarkers, such as CRP and PSP, to help solve this problem. Infectious diseases are a public health issue around the world, with bacterial, viral, parasitic, or fungal-related diseases responsible for 26% of mortality worldwide, and the remaining 74% attributed to non-communicable diseases (cardiova...

Improving Clinical Outcomes With Early Enteral Nutrition

An overview of the benefits of early enteral nutrition, clinical evidence and recommendations, reasons for delayed enteral feeding in critically ill patients and optimal solutions. Early enteral nutrition is proven to improve clinical outcomes and reduce acute care costs. Nutrition clinicians support the belief that enteral nutrition is preferable to parenteral nutrition (Seres et al. 2013). The hazards o...

Short Acting Beta-Blockers in Critically Ill Patients With Heart Failure

An overview of the clinical evidence demonstrating the effectiveness of landiolol for the treatment of atrial fibrillation or atrial flutter with heart failure and effective heart rate control during arrhythmias. Supraventricular arrhythmias (SVTs) are common in post-operative and cardiac ICUs. SVTs increase the risk of death as well as the risk of neurological sequelae. Some common risk factors for atria...

Practical Implementation of the Pancreatic Stone Protein Sepsis Test

An overview of a discussion on sepsis and the Pancreatic Stone Protein (PSP) biomarker by Dr João Pereira, Hospital De Vila Franca De Xira, Portugal and how it can be used for early diagnosis of sepsis and facilitate decision-making regarding the administration of antibiotics. The discussion was chaired by Prof Pedro Póvoa, coordinator of the Intensive Care Unit (ICU) at Hospital de Sao Francisco Xavier,...

Nutrition Monitoring and Patient Data Management Systems

An overview of nutritional targets and their impact on critically ill patients and the need to use a systematic approach to nutritional support for optimal patient outcomes. Critically ill patients are often hypermetabolic and catabolic and are at a higher risk of underfeeding. Nutritional support for these patients can prevent energy deficits and improve outcomes (Villet et al. 2005). Underfeeding criti...

Septic Shock and Vasopressor Initiation: Why Earlier is Better

An overview of vasopressor management, current evidence and when to initiate vasopressor therapy for best possible patient outcome. Vasopressor management is a cornerstone in the haemodynamic management of septic shock for reversing hypotension by increasing systemic vascular resistance and improving organ perfusion. The Surviving Sepsis Campaign (SSC) guidelines 2021 recommend an initial target mean arte...

Rationale Behind Practice: Landiolol in Critical Care

A summary of data regarding the use of landiolol as a potential immunomodulator in septic patients and its effectiveness and safety in the management of new-onset postoperative atrial fibrillation (POAF). Cardiovascular dysfunction is a common complication of sepsis. Approximately 40 to 50% of patients with prolonged septic shock develop myocardial dysfunction. The changes induced by sepsis in circulating...

Gastric Residual Volume – Monitoring and Management

An overview of critical care guidelines for enteral nutrition (EN) and the use of gastric residual volume (GRV) management and monitoring as an essential component of EN patient care to help prevent complications. Disease-related malnutrition is a common problem among hospitalised patients. Specifically, in critically ill patients, oral food intake may not provide the required nutritional value. This may...

Diagnostic and Prognostic Value of Estimated Plasma Volume Status

An overview of estimated plasma volume (ePVS), recent evidence supporting the association of ePVS with clinical congestion and whether it can help improve outcomes in patients with heart failure (HF). Plasma volume (PV) is the level of intravascular fluid minus the red blood cells, white blood cells and platelets. PV in heart failure (HF) patients is associated with increases in fluid compartments. For ex...

The Importance of Accurate Glucose Monitoring in Critically Ill Patients

The complexity of glucose testing, the limitations of point-of-care blood glucose monitoring systems and the need for accuracy and reliability to ensure optimised patient outcomes. Critically ill patients are not found just in intensive care units, but throughout the hospital: emergency departments, post-anaesthesia care units, operating rooms, and many other environments now care for the critically ill....

Management of Acute Arrhythmias in Patients With Cardiac Dysfunction - Update of ESC Guidelines

In 2020, the ultra-short acting beta-blocker landiolol was first included in the ESC guidelines with a class I recommendation. The recommendations were based on study results demonstrating the rapid response, efficacy, and safety of this drug. At a recent symposium, during 2021 Heart Failure World Congress, cardiologists were invited to present their daily clinical practice of landiolol use. The discover...

Mitigating the Risk of Harm During the Transition From Controlled to Assisted Mechanical Ventilation

Monitoring the strength of the patient´s breathing effort, titrating the sedation, and selecting the correct mode of ventilation is vital when transitioning from controlled to assisted ventilation. One of the key issues with mechanical ventilation is the transition from fully controlled to assisted mechanical ventilation, which must be achieved as soon as possible to improve the patient’s outcomes. Th...