New therapies in acute decompensated heart failure

The critically ill obstetric patient - Recent concepts

Obstetric patients admitted to an Intensive Care Unit (ICU) present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.

Cardiorenal syndrome and heart failure

PURPOSE OF REVIEW

Concomitant anemia, heart failure, and renal disease can be seen in a large proportion of patients with heart failure. The purpose of this review is to discuss the current definitions and mechanisms involved in this pathophysiological relationship, as well as the potential management and treatment options available for these patients.

RECENT FINDING

Dysfunctional heart can promote the dysfunction of the kidneys through a variety of pathophysiological mechanism, the reciprocal holds true as well. Heart failure has been considered as the most common type of cardiovascular complication seen in patients with renal failure. Central to this relationship lies anemia, which can be the result or the cause of either heart or kidney disease.

SUMMARY

Cardiorenal syndrome is a complex condition, which requires the collaboration and resources from cardiology, cardiac surgery, nephrology, and critical care. Of great importance is recognizing the presence of cardiorenal syndrome and appreciating the impact it can play on treatment options and survival.

Update on ventricular assist device management in the ICU

PURPOSE OF REVIEW

Mechanical circulatory support has a progressively increasing impact in the treatment of heart failure. The results of mechanical circulatory support are limited not only by the severity of the disease, which necessitated initiation of support, but also by the serious device-related adverse events. Optimized patient selection, improved patient management, and advanced device technology are interdependent key factors that contributed to the recently improved outcomes. The aim of this article is to summarize the current experience in application of mechanical circulatory support, focusing on the ICU management.

RECENT FINDINGS

Management should aim to prevent rather than treat serious complications and adverse events. Timing of intervention, optimization of the preimplantation patient status, patient and device management to ensure optimal hemodynamics, infection prevention, nutritional support, careful anticoagulation, and vigilance for early recognition and prompt treatment of 'minor' events before progression into major complications are essential elements of successful treatment.

SUMMARY

Critical patient care is a valuable adjunct to successful application of mechanical circulatory support, but it cannot counterbalance a late intervention, neither can it be fruitful in treating irreversible organ damage. Current management includes careful application of treatment protocols adjusted to recent experience, and also individualized care by a specialized team.