scholarly journals The Importance of the Microbiome in Critically Ill Patients: Role of Nutrition

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 3002 ◽  
Author(s):  
Rocio Moron ◽  
Julio Galvez ◽  
Manuel Colmenero ◽  
Per Anderson ◽  
José Cabeza ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Practice ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Safety And Efficacy ◽  
Beneficial Effects ◽  
Nutritional Strategies

Critically ill patients have an alteration in the microbiome in which it becomes a disease-promoting pathobiome. It is characterized by lower bacterial diversity, loss of commensal phyla, like Firmicutes and Bacteroidetes, and a domination of pathogens belonging to the Proteobacteria phylum. Although these alterations are multicausal, many of the treatments administered to these patients, like antibiotics, play a significant role. Critically ill patients also have a hyperpermeable gut barrier and dysregulation of the inflammatory response that favor the development of the pathobiome, translocation of pathogens, and facilitate the emergence of sepsis. In order to restore the homeostasis of the microbiome, several nutritional strategies have been evaluated with the aim to improve the management of critically ill patients. Importantly, enteral nutrition has proven to be more efficient in promoting the homeostasis of the gut microbiome compared to parenteral nutrition. Several nutritional therapies, including prebiotics, probiotics, synbiotics, and fecal microbiota transplantation, are currently being used, showing variable results, possibly due to the unevenness of clinical trial conditions and the fact that the beneficial effects of probiotics are specific to particular species or even strains. Thus, it is of great importance to better understand the mechanisms by which nutrition and supplement therapies can heal the microbiome in critically ill patients in order to finally implement them in clinical practice with optimal safety and efficacy.

scholarly journals Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wolfgang Lösche ◽  
Janina Boettel ◽  
Björn Kabisch ◽  
Johannes Winning ◽  
Ralf A. Claus ◽  
...  
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Bleeding Risk ◽  
Antiplatelet Drugs ◽  
Beneficial Effects ◽  
Prospective Trials ◽  
High Bleeding Risk

Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

scholarly journals PROCALCITONIN FOR IMPROVED ASSESSMENT AND AN ANSWER TO SEPSIS DILEMMA IN CRITICALLY ILL - A MYTH, A HYPE, OR A REALITY ?

2014 ◽  
Vol 04 (01) ◽  
pp. 057-065
Author(s):  
Raghava Sharma ◽  
Maniyar Vijayakumar
Keyword(s):  
Septic Shock ◽  
Clinical Practice ◽  
Material Culture ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Specific Marker ◽  
Suspected Sepsis ◽  
Number Of Patients

Abstract: Background and objectives: “Sepsis is a major cause for mortality in critically ill patients all over the world. The number of patients presenting with sepsis, septic shock is gradually increasing in daily clinical practice. Mortality in sepsis is mainly due to a delay in diagnosis and initiation of specific therapy(antibiotics).This is in turn mainly attributed to the difficulty in differentiating infectious trigger(sepsis) from non infectious triggers as both present with similar clinical features. Lack of specific marker adds to this dilemma of differentiating infectious and non infectious factors in critically ill patients.Recently there are some reports from European countries on role of Procalcitonin (PCT) in critically ill patients. Draw backs of these studies are galore mainly due to the difficulties in interpretation of results, as varying definitions for sepsis are used. But also there is paucity of data on Procalcitonin from Indian sub continent. Hence in the present single centre prospective observational study conducted at tertiary care medical college hospital , A total of 50 adult patients with sepsis fulfilling ACCP/SCCM guidelines were included, out of which 23 were in SIRS/Sepsis, 14 in severe sepsis and 13 in septic shock. Procalcitonin was evaluated in the first 24 hours after admission and before initiation of any antibiotic therapy. The role of procalcitonin was analyzed in relation to confirming sepsis, assessing the severity of sepsis and assessing the prognosis(possible out come) of sepsis. Combined role of procalcitonin with other indicators especially ESR, SOFA Score, Blood/relevant material culture was explored. Results: Our study confirmed the importance of procalcitonin in critically ill patients particularly in improving the predictive power while solving the sepsis dilemma. Conclusions: From our study, we conclude that Procalcitonin is not a myth nor a hype but it is a hard reality and is an answer to sepsis dilemma. It is therefore preferable to add Procalcitonin into the standard workup of critically ill patients with suspected sepsis in every day clinical practice.

scholarly journals Fecal Microbial Transplantation in Critically Ill Patients—Structured Review and Perspectives

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1459
Author(s):  
Ivana Cibulková ◽  
Veronika Řehořová ◽  
Jan Hajer ◽  
František Duška
Keyword(s):  
Gut Microbiota ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fecal Microbiota Transplantation ◽  
Multiorgan Failure ◽  
Case Series ◽  
Underlying Disease ◽  
Fecal Microbiota ◽  
Host Susceptibility ◽  
Disease Case

The human gut microbiota consists of bacteria, archaea, fungi, and viruses. It is a dynamic ecosystem shaped by several factors that play an essential role in both healthy and diseased states of humans. A disturbance of the gut microbiota, also termed “dysbiosis”, is associated with increased host susceptibility to a range of diseases. Because of splanchnic ischemia, exposure to antibiotics, and/or the underlying disease, critically ill patients loose 90% of the commensal organisms in their gut within hours after the insult. This is followed by a rapid overgrowth of potentially pathogenic and pro-inflammatory bacteria that alter metabolic, immune, and even neurocognitive functions and that turn the gut into the driver of systemic inflammation and multiorgan failure. Indeed, restoring healthy microbiota by means of fecal microbiota transplantation (FMT) in the critically ill is an attractive and plausible concept in intensive care. Nonetheless, available data from controlled studies are limited to probiotics and FMT for severe C. difficile infection or severe inflammatory bowel disease. Case series and observational trials have generated hypotheses that FMT might be feasible and safe in immunocompromised patients, refractory sepsis, or severe antibiotic-associated diarrhea in ICU. There is a burning need to test these hypotheses in randomized controlled trials powered for the determination of patient-centered outcomes.

scholarly journals Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Min Dai ◽  
Yafei Liu ◽  
Wei Chen ◽  
Heena Buch ◽  
Yi Shan ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Potential Benefit ◽  
Fecal Microbiota Transplantation ◽  
Case Series ◽  
Fecal Microbiota ◽  
Abdominal Symptoms ◽  
Antibiotic Associated Diarrhea

Abstract Background Antibiotic-associated diarrhea (AAD) is a risk factor for exacerbating the outcome of critically ill patients. Dysbiosis induced by the exposure to antibiotics reveals the potential therapeutic role of fecal microbiota transplantation (FMT) in these patients. Herein, we aimed to evaluate the safety and potential benefit of rescue FMT for AAD in critically ill patients. Methods A series of critically ill patients with AAD received rescue FMT from Chinese fmtBank, from September 2015 to February 2019. Adverse events (AEs) and rescue FMT success which focused on the improvement of abdominal symptoms and post-ICU survival rate during a minimum of 12 weeks follow-up were assessed. Results Twenty critically ill patients with AAD underwent rescue FMT, and 18 of them were included for analysis. The mean of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at intensive care unit (ICU) admission was 21.7 ± 8.3 (range 11–37). Thirteen patients received FMT through nasojejunal tube, four through gastroscopy, and one through enema. Patients were treated with four (4.2 ± 2.1, range 2–9) types of antibiotics before and during the onset of AAD. 38.9% (7/18) of patients had FMT-related AEs during follow-up, including increased diarrhea frequency, abdominal pain, increased serum amylase, and fever. Eight deaths unrelated to FMT occurred during follow-up. One hundred percent (2/2) of abdominal pain, 86.7% (13/15) of diarrhea, 69.2% (9/13) of abdominal distention, and 50% (1/2) of hematochezia were improved after FMT. 44.4% (8/18) of patients recovered from abdominal symptoms without recurrence and survived for a minimum of 12 weeks after being discharged from ICU. Conclusion In this case series studying the use of FMT in critically ill patients with AAD, good clinical outcomes without infectious complications were observed. These findings could potentially encourage researchers to set up new clinical trials that will provide more insight into the potential benefit and safety of the procedure in the ICU. Trial registration ClinicalTrials.gov, Number NCT03895593. Registered 29 March 2019 (retrospectively registered).

scholarly journals The role of the microbiota in the management of intensive care patients

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Piotr Szychowiak ◽  
Khanh Villageois-Tran ◽  
Juliette Patrier ◽  
Jean-François Timsit ◽  
Étienne Ruppé
Keyword(s):  
Intensive Care ◽  
Gut Microbiota ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fecal Microbiota Transplantation ◽  
Anaerobic Bacteria ◽  
Fecal Microbiota ◽  
Resistant Bacteria ◽  
Shotgun Metagenomics ◽  
Increased Risk

AbstractThe composition of the gut microbiota is highly dynamic and changes according to various conditions. The gut microbiota mainly includes difficult-to-cultivate anaerobic bacteria, hence knowledge about its composition has significantly arisen from culture-independent methods based on next-generation sequencing (NGS) such as 16S profiling and shotgun metagenomics. The gut microbiota of patients hospitalized in intensive care units (ICU) undergoes many alterations because of critical illness, antibiotics, and other ICU-specific medications. It is then characterized by lower richness and diversity, and dominated by opportunistic pathogens such as Clostridioides difficile and multidrug-resistant bacteria. These alterations are associated with an increased risk of infectious complications or death. Specifically, at the time of writing, it appears possible to identify distinct microbiota patterns associated with severity or infectivity in COVID-19 patients, paving the way for the potential use of dysbiosis markers to predict patient outcomes. Correcting the microbiota disturbances to avoid their consequences is now possible. Fecal microbiota transplantation is recommended in recurrent C. difficile infections and microbiota-protecting treatments such as antibiotic inactivators are currently being developed. The growing interest in the microbiota and microbiota-associated therapies suggests that the control of the dysbiosis could be a key factor in the management of critically ill patients. The present narrative review aims to provide a synthetic overview of microbiota, from healthy individuals to critically ill patients. After an introduction to the different techniques used for studying the microbiota, we review the determinants involved in the alteration of the microbiota in ICU patients and the latter’s consequences. Last, we assess the means to prevent or correct microbiota alteration.

scholarly journals Interpretation of C-Reactive Protein Concentrations in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Christophe Lelubre ◽  
Sophie Anselin ◽  
Karim Zouaoui Boudjeltia ◽  
Patrick Biston ◽  
Michaël Piagnerelli
Keyword(s):  
Clinical Practice ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Process ◽  
Early Recognition ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Pathophysiological Role ◽  
Inflammatory Processes

Infection is often difficult to recognize in critically ill patients because of the marked coexisting inflammatory process. Lack of early recognition prevents timely resuscitation and effective antimicrobial therapy, resulting in increased morbidity and mortality. Measurement of a biomarker, such as C-reactive protein (CRP) concentration, in addition to history and physical signs, could facilitate diagnosis. Although frequently measured in clinical practice, few studies have reported on the pathophysiological role of this biomarker and its predictive value in critically ill patients. In this review, we discuss the pathophysiological role of CRP and its potential interpretation in the inflammatory processes observed in critically ill patients.

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