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.

Status epilepticus - time is brain and treatment considerations Purpose of review Status epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of continuous anesthetics or adjunctive anticonvulsant, the cause of the status epilepticus, and use of nonpharmacologic therapies. Recent findings Status epilepticus remains undertreated and mortality persists to be unchanged over the past 30 years. New anticonvulsant choices, such as levetiracetam and lacosamide have been explored as alternative emergent therapies. Anecdotal reports on the use of other generation anticonvulsants and nonpharmacologic therapies for the treatment of refractory and super-refractory status epilepticus have been described. Finally, recent evidence has examined etiology-guided management of status epilepticus in certain patient populations, such as immune-mediated, paraneoplastic or infectious encephalitis and anoxic brain injury. Summary Randomized clinical trials are needed to determine the role for newer generation anticonvulsants and nonpharmacologic modalities for the treatment of epilepticus remains and evaluate the long-term outcomes associated with continuous anesthetics. Correspondence to Jan Claassen, MD, Neurological Institute, Columbia University New York Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY 10032, USA. Tel: +1 212 305 7236; fax: +1 212 305 2792; e-mail: jc1439@columbia.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Acute kidney injury in hematopoietic stem cell transplantation Purpose of review Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality. Recent findings Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients Summary This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI. Video abstracthttp://links.lww.com/COCC/A29 Correspondence to Rimda Wanchoo, MD, Associate Professor of Medicine, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA. E-mail rwanchoo1@northwell.edu 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.

Ultrasound in the surgical ICU: uses, abuses, and pitfalls Purpose of review Point-of-care ultrasound (POCUS) has become an integral component of daily care in the surgical ICU. There have been many novel advancements in the past two decades, too numerous to count. Many are of critical importance to the intensive care physician, whereas others are still accumulating evidence. Without appropriate training, diligence, and incorporation of the ultrasound findings into the whole clinical picture, this technique can be gravely misused. This review examines POCUS use in the surgical ICU, as well as highlights potential hazards and common pitfalls. Recent findings POCUS is essential for guidance of vascular access procedures, as well as in the characterization and treatment of respiratory failure, shock, and unstable blunt abdominal trauma. Ultrasound has growing evidence for rapidly evaluating many other diseases throughout the entire body, as well as guidance for procedures. Using advanced ultrasound techniques should only be done with corresponding levels of training and experience. Summary Ultrasound in the critical care setting has become an essential component of the assessment of most ICU patients. As more evidence accumulates, along with ever-increasing availability of ultrasound technology, its use will continue to expand. It, thus, behoves clinicians to not only ensure they are adept at obtaining and interpreting POCUS images but also efficiently incorporate these skills into holistic bedside care without delaying lifesaving therapies. Correspondence to Lawrence M. Gillman, MD, MMedEd, FRCSC, FACS, Department of Surgery, Section of General Surgery, University of Manitoba, GF439 – 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. E-mail: lawrence.gillman@umanitoba.ca 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.

Acute kidney injury in interstitial nephritis Purpose of review The purpose of this review is to describe the most common causes of acute interstitial nephritis (AIN), the diagnostic work-up and the therapeutic management. Recent findings Several case series and registries have found an increasing incidence of AIN, especially among older patients. Drug-induced AIN still represents the most common cause. Early withdrawal of the culprit drug together with corticosteroid therapy remain the mainstay of treatment, although recent studies have shown that prolonged treatment beyond 8 weeks does not further improve kidney function recovery. Summary AIN is a common cause of acute kidney injury, and therefore, physicians should suspect this entity especially in patients exposed to multiple medications. While immune-allergic reaction to numerous drugs is the most common cause of AIN, other underlying systemic diseases may also be involved, and therefore, every patient should undergo a complete diagnostic evaluation. Kidney biopsy provides the definitive diagnosis of AIN, and certain histologic features may help to identify the underlying condition. In drug-induced AIN, an early discontinuation of the culprit drug is the mainstay of therapy, and unless a rapid recovery of kidney function is observed, a course of glucocorticoid therapy should be initiated. Correspondence to Manuel Praga, Department of Nephrology, Hospital 12 de Octubre, Avda de Córdoba s/n, 28041 Madrid, Spain. Tel: +34 913908208; e-mail: mpragat@senefro.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.