Acute respiratory failure: nonintubation assist methods for the acutely deteriorating patient Purpose of review Noninvasive ventilation is strongly recommended in acute hypercapnic respiratory failure, whereas high-flow nasal oxygen therapy could be an alternative in de novo respiratory failure. Recent findings High-flow nasal oxygen may improve the outcome of patients de novo respiratory failure as compared with standard oxygen. Its success within 2 h after initiation is well predicted by a ROX index (ratio of SpO2/FiO2 to respiratory rate) greater than 4.88, as failure when less than 3.85 at 12 h after initiation. However, the superiority of high-flow nasal oxygen to standard oxygen has not been confirmed in immunocompromised patients. Although noninvasive ventilation may be deleterious through barotrauma in patients with de novo respiratory failure, its use seems to be an optimal strategy for preoxygenation before intubation in preventing severe hypoxemia in most hypoxemic patients. In mild hypoxemic patient, high-flow nasal oxygen may be more efficient than bag-valve mask in preventing severe adverse events. After anesthetic induction further positive-pressure ventilation can better secure intubation procedure than absence of ventilation. Summary Despite the growing use of high-flow nasal oxygen, new studies are needed to confirm its superiority to standard oxygen in de novo respiratory failure and others causes of acute respiratory failure in place of standard oxygen. Correspondence to Jean-Pierre Frat, MD, Médecine Intensive Réanimation, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers Cedex, France. Tel: +33 549444007; e-mail: jean-pierre.frat@chu-poitiers.fr Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Failure to rescue in the surgical patient: a review Purpose of review Evaluating patient outcomes is essential in a healthcare environment focused on quality. Mortality after surgery has been considered a useful quality metric. More important than mortality rate, failure to rescue (FTR) has emerged as a metric that is important and may be improveable. The purpose of this review is to define FTR, describe patient and hospital level factors that lead to FTR, and highlight possible solutions to this problem. Recent findings FTR is defined as a death following a complication. Depending on the patient population, FTR rates vary from less than 1% to over 40%. Numerous patient factors including frailty, congestive heart failure (CHF), renal failure, serum albumin <3.5, COPD, cirrhosis, and higher ASA class may predispose patients to FTR. Hospital factors including technology, teaching status, increased nurse-to-patient ratios, and closed ICUs may help reduce FTR. More difficult to measure variables, such as hospital culture and teamwork may also influence FTR rates. Early warning systems may allow earlier identification of the deteriorating patient. Summary FTR is a major clinical concern and efforts aimed at optimizing patient and hospital factors, culture and communication, as well as early identification of the deteriorating patient may improve FTR rate. Correspondence to Matthew E. Lissauer, MD, FACS, FCCM, Associate Professor of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Patterson Street, CAB 6300, New Brunswick, NJ 08901, USA. Tel: +1 732 235 7766; e-mail: ml1141@rwjms.rutgers.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Emergency bedside ultrasound-benefits as well as caution: Part 2: Echocardiography Purpose of review Critical care echocardiography (CCE) has become an important component of general critical care ultrasonography, and a current review of its performance is presented. Recent findings Basic CCE should be performed as a goal-directed examination to better identify specific signs and to answer important clinical questions concerning acute hemodynamic concerns. It has evolved in the ICU and also in the emergency department not only for improved diagnostic capability but also as an effective part of the triage process. It remains an efficacious procedure even in patients with respiratory failure when combined with lung ultrasonography. Numerous acronyms were proposed, but in all cases, CCE responds to the same rules as fundamental echocardiography. Basic CCE requires accessible and comprehensive training for physicians and is mandatory for all intensivists. Development of pocket echo devices may increase the use of basic CCE as has miniaturization of other medical technologies. Performance should be managed by guidelines, and the CCE training program should be standardized worldwide. More trials are welcome to evaluate its impact on patient outcomes. Summary Thanks to its ability to quickly obtain a diagnostic orientation at the bedside and to implement targeted therapy, basic CCE over the past decade has become an essential tool for hemodynamic assessment of the cardiopulmonary unstable patient. Its more recent incorporation into the education of trainees in medical school and residencies/fellowships has reinforced its perceived importance in critical care management, despite the relative paucity as yet of rigorous scientific evidence demonstrating positive outcome modification from its use. Correspondence to Antoine Vieillard-Baron, Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Paris, France. Tel: +33 149095603; e-mail: antoine.vieillard-baron@aphp.fr Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Vitamin C in surgical sepsis Purpose of review The current review discusses the supplemental use of vitamin C as an adjunct in the management of sepsis and septic shock. Recent findings The antioxidant properties of vitamin C are touted to be useful in modulating the inflammatory response, decreasing vasopressor requirements, and improving resuscitation. Current resuscitation practices are focused on addressing the hemodynamic instability and ensuring adequate oxygen delivery to tissues. The conceptual framework of the use of vitamin C during a resuscitation is to modulate in a beneficial fashion the inflammatory response to sepsis while concomitantly resuscitating and treating the infection. While there is promising animal and burn-related data on improved fluid resuscitation with the use of vitamin C as an adjunct, the most recent meta-analyses of the available data fail to show a survival benefit in sepsis, and concerns regarding nephrotoxicity remain. Summary Although there are large number of animal studies, only a few small prospective and retrospective studies in humans address the use of vitamin C to treat sepsis. Further research in a controlled and randomized fashion is needed to determine if vitamin C is effective in this role. While there is a promise of ascorbate's addition to the sepsis bundle as an adjunct to resuscitation, the evidence is not conclusive. Correspondence to Gregory J. Jurkovich, Lloyd F. & Rosemargaret Donant Chair in Trauma Medicine, Department of Surgery, UC Davis Health, 2335 Stockton Blvd, North Addition Office Building, Room 6017, Sacramento, CA 95817, USA. E-mail: gjjurkovich@ucdavis.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Massive pulmonary embolism: embolectomy or extracorporeal membrane oxygenation? Purpose of review To highlight updates on the use of extracorporeal membrane oxygenation (ECMO) and surgical embolectomy in the treatment of massive pulmonary embolism. Recent findings Outcomes for surgical embolectomy for massive pulmonary embolism have improved in the recent past. More contemporary therapeutic options include catheter embolectomy, which although offer less invasive means of treating this condition, need further study. The use of ECMO as either a bridge or mainstay of treatment in patients with contraindications to fibrinolysis and surgical embolectomy, or have failed initial fibrinolysis, has increased, with data suggesting improved outcomes with earlier implementation in selected patients. Summary Although surgical embolectomy continues to be the initial treatment of choice in massive pulmonary embolism with contraindications or failed fibrinolysis, the use of ECMO in these high-risk patients provides an important tool in managing this often fatal condition. Correspondence to Duane S. Pinto, MD, MPH, FACC, Division of Cardiology, Beth Israel Deaconess Medical, Center 1 Deaconess Road, Boston, MA 02115, USA. Tel: +1 617 632 7501; fax: +617 632 7460; e-mail: dpinto@bidmc.harvard.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Initial management of severe burn injury Purpose of review Patients with severe burn injuries pose significant challenges for the intensivist. Though average burn sizes have decreased over time, severe burn injuries involving greater than 20% of the total body surface area still occur. Verified burn centers are limited, making the management of severely burn injured patients at nonspecialized ICUs likely. Current practices in burn care have increased survivability even from massive burns. It is important for intensivists to be aware of the unique complications and therapeutic options in burn critical care management. This review critically discusses current practices and recently published data regarding the evaluation and management of severe burn injury. Recent findings Burn patients have long, complex ICU stays with accompanying multiorgan dysfunction. Recent advances in burn intensive care have focused on acute respiratory distress syndrome from inhalation injury, acute kidney injury (AKI), and transfusion, resulting in new strategies for organ failure, including renal replacement therapy and extracorporeal life support. Summary Initial evaluation and treatment of acute severe burn injury remains an ongoing area of study. This manuscript reviews current practices and considerations in the acute management of the severely burn injured patient. Correspondence to Tina L. Palmieri, MD, Department of Surgery, University of California Davis Medical Center, Firefighters Burn Institution Reginal Burn Center, 2315 Stockton Blvd, Shriners Hospital for Children Northern California; Sacramento, CA 95817, USA. Tel: +1 916 397 0024; e-mail: tlpalmieri@ucdavis.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Abdominal compartment syndrome and intra-abdominal hypertension Purpose of review Abdominal compartment syndrome (ACS) is a severe complication resulting from an acute and sustained increase in intra-abdominal pressure (IAP), causing significant morbidity and mortality. Although prospective double-blinded, randomized trials, and evidence-based analysis are lacking there is new evidence that still demonstrates high morbidity and mortality in critically ill populations because of intra-abdominal hypertension (IAH) in the 21st century. The objective of this review is to alert the health professional about this important diagnosis and to highlight the latest updates proposed by the World Abdominal Compartment Society. Recent findings The present article reviews the clinical conditions of ACS and IAH and the latest updates from pathophysiology to the new management flowchart resulting from the implantation of point-of-care ultrasound in the monitoring and assistance of medical treatment of IAH/ACS. Summary The present review emphasizes the importance of IAH in daily clinical practice and brings new WSACS updates on monitoring and treatment. Correspondence to Bruno M. Pereira, MD, MSC, PhD, Campinas, Jose Paulino ST, 1248, 9° andar, sala 2, Centro, 13.013-001, Brazil. E-mail: dr.bruno@gruposurgical.com.br Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Acute kidney injury in pregnancy Purpose of review Pregnancy-related acute kidney injury (Pr-AKI) is associated with increased maternal and fetal morbidity and mortality and remains a large public health problem. Recent findings Pr-AKI incidence has globally decreased over time for the most part. However, the cause presents a disparity between developing and developed countries, reflecting differences in socioeconomic factors and healthcare infrastructure – with the noteworthy outlier of increased incidence in the United States and Canada. Although Pr-AKI can be secondary to conditions affecting the general population, in most cases it is pregnancy specific. Septic abortion, hyperemesis gravidarum, and hemorrhage have become less prevalent with access to healthcare but are being displaced by thrombotic microangiopathies, such as preeclampsia, hemolysis, elevated liver enzymes, low platelets syndrome, thrombotic thrombocytopenic purpura, and pregnancy-associated hemolytic-uremic syndromes, as well as acute fatty liver of pregnancy. Understanding these conditions plays a pivotal role in the timely diagnosis and enhancement of therapeutic approaches. Summary In this review, we focus on the renal physiology of the pregnancy, epidemiology, and specific conditions known to cause Pr-AKI, summarizing diagnostic definition, insights in pathophysiology, clinical considerations, and novel treatment approaches, thus providing the reader a framework of clinically relevant information for interdisciplinary management. Correspondence to Belinda Jim, MD, Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY 10461, USA. Tel: +1 718 918 5762; e-mail: belindajim286@gmail.com Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Sudden unresponsive patient with normal vital signs: what is going on? Purpose of review To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU. Recent findings Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management. Summary Sudden unresponsiveness with normal vital signs should trigger immediate and focused diagnostic evaluation to find or exclude those conditions requiring urgent, and possibly life-saving, management. Correspondence to Mathieu van der Jagt, Department of Intensive Care Adults, Erasmus MC-University Medical Center, Room Ne-415, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel: +31 10 7040704; e-mail: m.vanderjagt@erasmusmc.nl Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Persistent pollutants: focus on perfluorinated compounds and kidney Purpose of review There is increasing interest in the environmental and human damage caused by pollutants. Big efforts are continuously made to monitor their levels and identify safe thresholds. For this purpose, an essential step is to prioritize harmful substances and understand their effect on human body. Perfluorinated compounds (PFCs) deserve particular attention because of their wide diffusion and potential correlation with different diseases including glucose intolerance, hyperlipidaemia, thyroid diseases, gestational diabetes mellitus and hypertension, testicular and genitourinary cancer as well as impaired kidney function. This review focuses on the renal effects of PFCs, with the attempt to clarify their occurrence and pathogenetic mechanisms. Recent findings We reviewed MEDLINE and EMBASE citations between 31 October 2017 and 31 May 2019 and selected human studies measuring PFCs exposure, kidney function markers and the ability of haemodialysis to remove PFCs from the circulating blood. It has been currently clarified that exposure to PFCs is linked with an impaired kidney function and that they can be removed by blood purification. Summary Further studies are required on the potential synergic negative effect of PFCs co-exposure with other pollutants as well as animal studies about the removal capacity of different haemodialysis membranes. Correspondence to Fiorenza Ferrari, MD, MSc, Intensive Care Unit, I.R.C.C.S. Fondazione Policlinico San Matteo, International Renal Research Institute of Vicenza (IRRIV), Viale Camillo Golgi, 19, Pavia 27100, Lombardia, Italy. Tel: +393283751837; fax: +390382502486; e-mail: fioreferrari28@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-criticalcare.com). Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.