scholarly journals Rectal swabs in critically-ill patients provide discordant representations of the gut microbiome compared to stool samples: a brief methodologic report

2019 ◽  
Author(s):  
Katherine Fair ◽  
Daniel G. Dunlap ◽  
Adam Fitch ◽  
Alison Morris ◽  
Bryan J. McVerry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gut Microbiome ◽  
Time Points ◽  
Rectal Swabs ◽  
Stool Samples ◽  
Microbiome Profiling

AbstractThe role of the gut microbiome in critical illness is being actively investigated, but the optimal sampling methods for sequencing studies of gut microbiota remain unknown. Stool samples are generally considered gold-standard but are not practical to obtain in the intensive care unit (ICU), and thus, rectal swabs are often used. However, the reliability of rectal swabs for gut microbiome profiling has not been established in this clinical setting. In this study, we compared 16S rRNA gene sequencing results between rectal swab and stool samples collected at three timepoints in mechanically-ventilated critically-ill adults. Rectal swabs comprised 89% of samples collected at the baseline timepoint, but stool samples became more available at later time-points. Significant differences in alpha and beta-diversity between rectal swabs and stool samples were observed (p<0.003), but these differences were primarily due to baseline samples. Higher relative abundance of Actinobacteria phyla (typically skin microbes) was present in rectal swabs compared to stool samples (p<0.02), a difference that was attenuated overtime. The progressive similarity of rectal swabs and stool samples likely results from increasing stool coating of the rectal vault and direct soiling of the rectal swabs taken at later time points. Therefore, inferences about the role of the gut microbiome in critical illness should be drawn cautiously and take into account the actual type and timing of samples analyzed.Statement of ImportanceRectal swabs are considered reliable alternatives to stool samples for gut microbiome profiling in outpatients or healthy adults, but their reliability in critically-ill patients has not been defined. Because stool sampling is not practical or often feasible in the intensive care unit, we performed a detailed comparison of gut microbial sequencing profiles between rectal swabs vs. stool samples in a longitudinal cohort of critically-ill patients. We identified systematic differences in gut microbial profiles between rectal swabs and stool samples, and highlighted that timing of rectal swabbing had a significant impact on sequencing results. Our methodological findings should inform future investigations of the role of the gut microbiome in critical illness.

scholarly journals Rectal Swabs from Critically Ill Patients Provide Discordant Representations of the Gut Microbiome Compared to Stool Samples

mSphere ◽  
2019 ◽  
Vol 4 (4) ◽  
Author(s):  
Katherine Fair ◽  
Daniel G. Dunlap ◽  
Adam Fitch ◽  
Tatiana Bogdanovich ◽  
Barbara Methé ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gut Microbiome ◽  
Rectal Swab ◽  
Time Points ◽  
Rectal Swabs ◽  
Stool Samples ◽  
Microbiome Profiling

ABSTRACT The role of the gut microbiome in critical illness is being actively investigated, but the optimal sampling methods for sequencing studies of gut microbiota remain unknown. Stool samples are generally considered the reference standard but are not practical to obtain in the intensive care unit (ICU), and thus, rectal swabs are often used. However, the reliability of rectal swabs for gut microbiome profiling has not been established in the ICU setting. In this study, we compared 16S rRNA gene sequencing results between rectal swab and stool samples collected at three time points from mechanically ventilated critically ill adults. Rectal swabs comprised 89% of the samples collected at the baseline time point, but stool samples became more extensively available at later time points. Significant differences in alpha-diversity and beta-diversity between rectal swabs and stool samples were observed, but these differences were primarily due to baseline samples. Higher relative abundances of members of the Actinobacteria phylum (typically skin microbes) were present in rectal swabs than in stool samples (P = 0.05), a difference that was attenuated over time. The progressively increasing similarity of rectal swabs and stool samples likely resulted from increasing levels of stool coating of the rectal vault and direct soiling of the rectal swabs taken at later time points. Therefore, inferences about the role of the gut microbiome in critical illness should be drawn cautiously and should take into account the type and timing of samples analyzed. IMPORTANCE Rectal swabs have been proposed as potential alternatives to stool samples for gut microbiome profiling in outpatients or healthy adults, but their reliability in assessment of critically ill patients has not been defined. Because stool sampling is not practical and often not feasible in the intensive care unit, we performed a detailed comparison of gut microbial sequencing profiles between rectal swabs and stool samples in a longitudinal cohort of critically ill patients. We identified systematic differences in gut microbial profiles between rectal swabs and stool samples and demonstrated that the timing of the rectal swab sampling had a significant impact on sequencing results. Our methodological findings should provide valuable information for the design and interpretation of future investigations of the role of the gut microbiome in critical illness.

scholarly journals Rectal and Naris Swabs: Practical and Informative Samples for Analyzing the Microbiota of Critically Ill Patients

mSphere ◽  
2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Saumya Bansal ◽  
Jenny P. Nguyen ◽  
Aleksandra Leligdowicz ◽  
Yu Zhang ◽  
Kevin C. Kain ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Diseases ◽  
Rrna Gene ◽  
Anatomical Site ◽  
Sample Type ◽  
Icu Patients ◽  
Rectal Swabs ◽  
Stool Samples

ABSTRACT Commensal microbiota are immunomodulatory, and their pathological perturbation can affect the risk and outcomes of infectious and inflammatory diseases. Consequently, the human microbiota is an emerging diagnostic and therapeutic target in critical illness. In this study, we compared four sample types—rectal, naris, and antecubital swabs and stool samples—for 16S rRNA gene microbiota sequencing in intensive care unit (ICU) patients. Stool samples were obtained in only 31% of daily attempts, while swabs were reliably obtained (≥97% of attempts). Swabs were compositionally distinct by anatomical site, and rectal swabs identified within-patient temporal trends in microbiota composition. Rectal swabs from ICU patients demonstrated differences from healthy stool similar to those observed in comparing stool samples from ICU patients to those from the same healthy controls. Rectal swabs are a useful complement to other sample types for analysis of the intestinal microbiota in critical illness, particularly when obtaining stool may not be feasible or practical. IMPORTANCE Perturbation of the microbiome has been correlated with various infectious and inflammatory diseases and is common in critically ill patients. Stool is typically used to sample the microbiota in human observational studies; however, it is often unavailable for collection from critically ill patients, reducing its utility as a sample type to study this population. Our research identified alternatives to stool for sampling the microbiota during critical illness. Rectal and naris swabs were practical alternatives for use in these patients, as they were observed to be more reliably obtained than stool, were suitable for culture-independent analysis, and successfully captured within- and between-patient microbiota differences.

Myopathy and Neuropathy Acquired in the Intensive Care Unit

2019 ◽  
pp. 677-684
Author(s):  
Priya S. Dhawan ◽  
Jennifer A. Tracy
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Peripheral Neuropathy ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Illness Polyneuropathy ◽  
Muscle Disorder

Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.

The need to know: experiences of critically ill patients

2000 ◽  
Vol 9 (3) ◽  
pp. 192-198 ◽  
Author(s):  
JE Hupcey ◽  
HE Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Second Phase ◽  
The Past ◽  
Intensive Care Unit Nurses ◽  
Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

ABC’s of Vitamin Supplementation in Critical Illness

2020 ◽  
pp. 089719002095823 ◽  
Author(s):  
Melissa Chudow ◽  
Beatrice Adams
Keyword(s):  
Oxidative Stress ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Phase Reactant ◽  
Organ Damage ◽  
Vitamin Supplementation ◽  
Critically Ill Patient ◽  
Enhanced Production

Critical illness commonly presents as a systemic inflammatory process. Through this inflammation, there is an enhanced production of reactive oxygen and nitrogen species combined with marked reductions in protective plasma antioxidant concentrations. This imbalance is referred to as oxidative stress and is commonly encountered in numerous disease states in the critically ill including sepsis, trauma, acute respiratory distress syndrome, and burns. Oxidative stress can lead to cellular, tissue and organ damage as well as increased morbidity and mortality in critically ill patients. Supplementation with exogenous micronutrients to restore balance and antioxidant concentrations in critically ill patients has been considered for several decades. It is proposed that antioxidant vitamins, such as vitamins A and C, may minimize oxidative stress and improve clinical outcomes. Vitamin B formulations may play a role in curtailing lactic acidosis and are recently being evaluated as an acute phase reactant. However, few large, randomized trials specifically investigating the role of vitamin supplementation in the critically ill patient population are available. This article seeks to review recently published literature surrounding the role of supplementation of vitamins A, B and C in critically ill patients.

Ketamine for Analgosedation in the Intensive Care Unit: A Systematic Review

2015 ◽  
Vol 32 (6) ◽  
pp. 387-395 ◽  
Author(s):  
Asad E. Patanwala ◽  
Jennifer R. Martin ◽  
Brian L. Erstad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Reports ◽  
Search Terms ◽  
Randomized Controlled Studies ◽  
Potential Safety ◽  
The Mean

Objective: To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. Methods: MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients. Results: One trial evaluated opioid consumption as an outcome in postoperative critically ill patients who were randomized to ketamine or saline infusions. The mean cumulative morphine consumption at 48 hours was significantly lower in the ketamine group (58 ± 35 mg) compared to the morphine-only group (80 ± 37 mg; P < .05). Other trials showed the potential safety of ketamine in terms of cerebral hemodynamics in patients with traumatic brain injury, improved gastrointestinal motility, and decreased vasopressor requirements. The observational study and case reports suggest that ketamine is safe and effective and may have a role in patients who are refractory to other therapies. Conclusion: Ketamine use may decrease analgesic consumption in the intensive care unit. Additional trials are needed to further delineate the role of ketamine for analgosedation.

scholarly journals Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Bin Liu ◽  
Kun Xiao ◽  
Peng Yan ◽  
Tianyu Sun ◽  
Jiang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Cox Regression Analysis ◽  
Increased Risk

Background. Critical illness in the intensive care unit (ICU) has been a global health priority. Systemic nutritional status has turned out to be related to the prognosis of critically ill patients. The albumin-globulin ratio (AGR) has been reported to be a novel prognostic factor of many diseases. This study is aimed at investigating whether the AGR could predict the mortality risk in critically ill patients. Methods. We enrolled 582 adult patients admitted to the respiratory intensive care unit (RICU). We collected the clinical and laboratory data. X-tile software was used to determine the optimal cut-off values for the AGR. Patients were divided into three groups according to the AGR (low AGR group with AGR < 0.8 , medium AGR group with AGR ranging from 0.8 to 1.1, and high AGR group with AGR > 1.1 ). Kaplan-Meier analysis was used for survival analysis. A Cox proportional hazard model was applied to the univariate and multivariate analyses for the potential predictors associated with survival. Results. Our present study showed that the AGR was related to the 28-day survival of critically ill patients in the RICU. The rate of pneumonia in the low AGR group was significantly higher than that in the other groups. Patients with a lower AGR present an increased risk of 28-day mortality compared to patients with a higher AGR. Cox regression analysis showed that the AGR might be an independent predictor of prognosis to 28-day survival in critically ill patients in the RICU. Medium and high AGR values remained independently associated with better 28-day survival than low AGR values (HR: 0.484 (0.263-0.892) ( p = 0.02 ); HR: 0.332 (0.166-0.665) ( p = 0.002 )). Conclusion. The AGR might be an independent predictor of prognosis in critically ill patients.

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