Year in Review 2021: Noteworthy Literature in Cardiothoracic Critical Care

Abstract

This year marked a number of milestones in critical care. As vaccines for the SARS-CoV-2 virus became widely available and were confirmed to be exceptionally effective against severe illness and hospitalization, we were then faced with new variants and the resource-intense responses necessary to combat them. Despite challenges new and old, we have persevered and continued to provide excellent care to our patients while pushing the boundaries of clinical research. This article is a collection of studies published in 2021 relevant to critical care, with a specific focus on cardiothoracic critical care. To ignore the impact of the COVID-19 pandemic would do a disservice to our colleagues, many of whom have made incredible breakthroughs in novel therapies to the coronavirus, and yet we present additional themes of delirium, acute kidney injury, lung transplant, advances in ECMO as well as biomarkers of sepsis.

2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers

“…A recent study evaluating the administration the use of dexamethasone did show a reduction in post-operative delirium, but it was unable to demonstrate statistical significance. 5 An additional study demonstrated a reduction in the amount of time on mechanical ventilation in addition to time in the ICU, and these results correlate with prior studies. 5 Predicting patients at risk for post-operative AKI after cardiac surgery is an ongoing topic of discussion, given that post-op AKI itself is a risk factor for increased mortality.…”

“…5 An additional study demonstrated a reduction in the amount of time on mechanical ventilation in addition to time in the ICU, and these results correlate with prior studies. 5 Predicting patients at risk for post-operative AKI after cardiac surgery is an ongoing topic of discussion, given that post-op AKI itself is a risk factor for increased mortality. The authors discuss a feasibility study evaluating a noninvasive device which measures urine oxygen partial pressure (predictive of post-operative AKI in cardiac surgery patients) to determine its ability to predict patients who may go on to develop AKI based on urine oxygen partial pressure cutoffs following CPB.…”

“…The authors discuss a feasibility study evaluating a noninvasive device which measures urine oxygen partial pressure (predictive of post-operative AKI in cardiac surgery patients) to determine its ability to predict patients who may go on to develop AKI based on urine oxygen partial pressure cutoffs following CPB. 5 Though this was a small feasibility trial, the results indicate an ability to predict the development of AKI prior to a visible rise in serum creatinine. This obviously offers additional time to begin treatment of any factors that may be contributing to worsening renal function.…”

“…5 A recent meta-analysis showed that dexmedetomidine was able to reduce the number of days on mechanical ventilation when compared to other agents. 5 Peri-operative glucocorticoids are suggested to reduce the inflammatory response after surgery and thus are expected to reduce the incidence of post-operative delirium. A recent study evaluating the administration the use of dexamethasone did show a reduction in post-operative delirium, but it was unable to demonstrate statistical significance.…”

“…The authors highlight a study comparing cardiac surgery patients who received either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP); this study showed a reduction in further hemostatic treatment requirements at 4 and 24 h after PCC when compared to FFP administration and an overall 42% reduction in required blood products in the PCC group. 5 No review of ICU literature from 2021 would be complete without updates to the treatment regimens for COVID-19. The authors highlight studies evaluating the efficacy of two additional treatment options: baricitinib and prostacyclin.…”