What's New in SHOCK, January 2018?
The January melting pot of clinical and basic research offers two review articles, six of the former (clinical) and seven of the latter (basic) sort. The first review focuses on the most vulnerable patient groups including the aged and malnourished and those with severe systemic infections and trauma. Nomellini et al. (1) concentrate on the development of chronic illness phenomenon characterized by concurrent signs of persistent inflammation and immunosuppression. The article integrates the most recent concepts of chronic illness in the critical care patients. It analyzes the main triggers of chronic illness, its progression pathways as well as current definition deficits and knowledge gaps precluding its comprehension. The authors argue that the immune dysfunction in chronic critical illness shares many common denominators regardless by which specific “vulnerability pathway” progresses the decline in the affected patients. Thus, those common chronic illness blueprints, once clearly defined and standardized, could be potentially exploited for patient risk stratification and more efficient treatment strategies. The second review by the Chinese colleagues addresses hemodynamic monitoring in critically ill patients (2). The timing of this article is just right given the ongoing controversy on the early goal-directed therapy in septic shock patients after the recently published findings from the ProCESS, ARISE, and ProMISe trials. He et al. describe the concept of “critical hemodynamic therapy” as an appropriate balance between therapeutic target and therapeutic endpoint using targeting of the oxygen (delivery)—(blood) flow–(perfusion) pressure triad as an example. They also discuss the phenomenon of resuscitation incoherence (i.e., improved macrohemodynamics does not automatically translate into better microcirculation function) in the context of its early recognition and correction during resuscitation in critically ill patients— certainly an interesting read for all intensivists (and beyond).
The first paper of the Clinical Science Aspects is Chouihed et al. (3) tackled quite a different topic in their work: effective life support strategy for patients with refractory out of hospital cardiac arrested (ROHCA). They tested a new strategy (OSCAR-ECLS acronym) that optimizes access of ROHCA patients to extracorporeal life support (ECLS). Although the study has a preliminary character (46 patients; single center) its results are promising; OSCAR-ECLS strategy decreased time to ECLS implementation in ROHCA patients which translated to 18% improvement of survival. One can only hope that these findings will be reconfirmed in larger follow-up studies. The next paper by Gui et al. (4) remains in the general field of cardiovascular research. By using the collapsibility index measurement (by ultrasonography) in inferior vena cava (IVC), the authors investigated the early changes of intravascular volume triggered by passive leg rising in healthy volunteers.