scholarly journals Barriers to Nutritional Therapy in the Critically Ill Patient with COVID‐19 Disease

2021 ◽  
Author(s):  
Sally Suliman ◽  
Stephen A. McClave ◽  
Beth E. Taylor ◽  
Jayshil Patel ◽  
Endashaw Omer ◽  
...  
Keyword(s):  
Critically Ill ◽  
Nutritional Therapy ◽  
Critically Ill Patient

scholarly journals Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 171
Author(s):  
Rogobete ◽  
Grintescu ◽  
Bratu ◽  
Bedreag ◽  
Papurica ◽  
...  
Keyword(s):  
Real Time ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Nutritional Therapy ◽  
Carbon Dioxide Production ◽  
Energy Requirements ◽  
Critically Ill Patient ◽  
Trauma Patients ◽  
Mechanically Ventilated ◽  
Multiple Trauma Patients

The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.

Drug-and Nutrition-Induced Hypophosphatemia: Mechanisms and Relevance in the Critically Ill

1994 ◽  
Vol 28 (5) ◽  
pp. 626-632 ◽  
Author(s):  
Glen R. Brown ◽  
Jan K. Greenwood
Keyword(s):  
Critically Ill ◽  
Case Reports ◽  
Data Extraction ◽  
Chronic Administration ◽  
Nutritional Therapy ◽  
Individual Case ◽  
Serum Phosphate ◽  
Critically Ill Patient ◽  
Beta Adrenergic Agonists ◽  
Study Selection

OBJECTIVE: To provide an outline of the drugs and nutritional therapy that could contribute to the development of hypophosphatemia in the critically ill patient. DATA SOURCES: Computerized abstracting services, references to primary literature articles, and review publications were screened for references to drug- or nutrition-related hypophosphatemia. STUDY SELECTION: Studies primarily describing responses in adults were selected. Animal research is described that illustrates findings in humans. DATA EXTRACTION: Information was abstracted from the findings of individual case reports and clinical trials. DATA SYNTHESIS: Data are organized by mechanism of possible effect on serum phosphate concentration. No reference is made to drugs that do not have an effect on phosphate metabolism. CONCLUSIONS: Hypophosphatemia can have significant effects that would hinder recovery of the critically ill patient. Antacids, catecholamines, beta-adrenergic agonists, sodium bicarbonate, and acetazolamide are commonly used therapeutic agents that could contribute significantly to the development of hypophosphatemia. Provision of nutrition 10 the chronically malnourished individual or chronic administration of phosphate-depleted parenteral nutrition could produce symptoms associated with hypophosphatemia. Other drugs could have a mild effect on lowering serum phosphate concentrations, but would be unlikely to produce symptoms unless combined with other etiologies of hypophosphatemia.

Anemia in the Critically Ill Patient

2008 ◽  
Vol 21 (6) ◽  
pp. 405-410
Author(s):  
Erkan Hassan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Patient ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Therapy ◽  
Critically Ill Patient ◽  
Multiprofessional Team ◽  
Allogenic Blood ◽  
Proinflammatory Mediators

Anemia in critically ill patients has been described as an acute form of anemia of inflammatory disease and is characterized by a blunted erythropoietic response due in part to proinflammatory mediators. Management of anemia in critically ill patients is a complex issue and is best approached via a multiprofessional team regarding the use of allogenic blood, iron, nutritional therapy, and erythropoietic agents. Indiscriminant, ``routine'' red blood cell transfusions may not only be unnecessary, but may pose unnecessary risk to the intensive care unit patient. Most intensive care unit patients can tolerate lower hemoglobin/hematocrit concentrations than the typically accepted ``10/30 rule.'' Lower transfusion triggers with an overall transfusion strategy is warranted in the intensive care unit patient. The use of recombinant human erythropoietic agents may not be necessary with appropriate transfusion practices.

The timing of tracheostomy in critically ill patient

ORL ro ◽  
2017 ◽  
Vol 2 (35) ◽  
pp. 20
Author(s):  
Liliana Mirea ◽  
Raluca Ungureanu ◽  
Daniel Mirea ◽  
Mirela Țigliș ◽  
Ioana Cristina Grințescu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

scholarly journals Simultaneous spontaneous pneumomediastinum and pneumopericardium in a critically ill patient with COVID-19

2021 ◽  
Author(s):  
Mohammad Javad Behzadnia ◽  
Abbas Samim ◽  
Fatemeh Saboori ◽  
Mosa Asadi ◽  
Mohammad Javanbakht
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient ◽  
Spontaneous Pneumomediastinum
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