Critical care medicine:

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

During the past decade, there has been an increased research focus on the prevalence, nature, and impact of newly acquired critical illness dysphagia. Disordered function can impact the safety and efficiency across all stages of the swallow mechanism, with detrimental impacts on patients' body systems, function, and participation. Accurate assessment of swallow function is key to informed diagnosis and enhances intervention planning. We discuss the current evidence base around dysphagia pathophysiology with a detailed discussion considering the modes of ventilation commonly received in intensive care units. Assessment and management across critical illness are evaluated and future research efforts are presented.

Decision-making for patients with stroke in neurocritical care is uniquely challenging because of the gravity and high preference sensitivity of these decisions. Shared decision-making (SDM) is recommended to align decisions with patient values. However, limited evidence exists on the experiences and perceptions of key stakeholders involved in SDM for neurocritical patients with stroke. This review aims to address this gap by providing a comprehensive analysis of the experiences and perspectives of those involved in SDM for neurocritical stroke care to inform best practices in this context. A qualitative meta-synthesis was conducted following the methodological guidelines of the Joanna Briggs Institute (JBI), using the thematic synthesis approach outlined by Thomas and Harden. Database searches covered PubMed, CIHAHL, EMBASE, PsycINFO, and Web of Science from inception to July 2023, supplemented by manual searches. After screening, quality appraisal was performed using the JBI Appraisal Checklist. Data analysis comprised line-by-line coding, development of descriptive themes, and creation of analytical themes using NVivo 12 software. The initial search yielded 7,492 articles, with 94 undergoing full-text screening. Eighteen articles from five countries, published between 2010 and 2023, were included in the meta-synthesis. These studies focused on the SDM process, covering life-sustaining treatments (LSTs), palliative care, and end-of-life care, with LST decisions being most common. Four analytical themes, encompassing ten descriptive themes, emerged: prognostic uncertainty, multifaceted balancing act, tripartite role dynamics and information exchange, and influences of sociocultural context. These themes form the basis for a conceptual model offering deeper insights into the essential elements, relationships, and behaviors that characterize SDM in neurocritical care. This meta-synthesis of 18 primary studies offers a higher-order interpretation and an emerging conceptual understanding of SDM in neurocritical care, with implications for practice and further research. The complex role dynamics among SDM stakeholders require careful consideration, highlighting the need for stroke-specific communication strategies. Expanding the evidence base across diverse sociocultural settings is critical to enhance the understanding of SDM in neurocritical patients with stroke.Trial registration This study is registered with PROSPERO under the registration number CRD42023461608.

No abstract available

PURPOSE OF REVIEW: Intracerebral hemorrhage (ICH) is the most devastating type of stroke resulting in severe disability and mortality. This review summarizes the emerging body of evidence supporting a new paradigm for care of patients called Code-ICH. It highlights the need for the adoption of time-based care bundles based on recent evidence, akin to those used in the management of acute ischemic stroke.

No abstract available

No abstract available

Determining the optimal protein intake for intensive care unit (ICU) and post-ICU patients is a multifaceted challenge. Firstly, it is essential to avoid both underdosing (<1.0 g/kg) and overdosing (>1.6 g/kg) of actual protein intake. Secondly, the actual protein intake may deviate from the prescribed amount. Thirdly, phenotyping and endotyping are becoming increasingly crucial in tailoring protein targets. Additionally, a gradual increase in protein intake is essential during the first 4 to 5 days of ICU stay. Furthermore, no established protein targets exist for post-ICU patients, indicating the need for nutritional intervention research to identify optimal protein intake strategies.