scholarly journals Nutrition in the Intensive Care Unit—A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2851
Author(s):  
Aileen Hill ◽  
Gunnar Elke ◽  
Arved Weimann
Keyword(s):  
Critically Ill ◽  
Feeding Strategy ◽  
Interdisciplinary Approach ◽  
Nutrition Therapy ◽  
Narrative Review ◽  
Optimal Timing ◽  
Special Focus ◽  
Prognostic Impact ◽  
Specific Patient ◽  
The Impact

Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

Immunoglobulin levels in systemic lupus erythematosus: A narrative review

Lupus ◽  
2021 ◽  
pp. 096120332110047
Author(s):  
Ibrahim Almaghlouth ◽  
Sindhu R Johnson ◽  
Eleanor Pullenayegum ◽  
Dafna Gladman ◽  
Murray Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Narrative Review ◽  
Special Focus ◽  
Immunoglobulin Level ◽  
Systemic Lupus ◽  
External Threats ◽  
Self Tolerance ◽  
Low Levels ◽  
The Impact

Immunoglobulins play a fundamental role in the protection of the human body against internal and external threats. They also contribute to the immune system homeostasis and maintenance of self-tolerance. Hypogammaglobulinemia is occasionally encountered in routine clinical practice by rheumatologists. Low levels of immunoglobulins can occur as primary or secondary issues and may predispose patients to various forms of infection. However, the impact of the low immunoglobulin level abnormality varies with the underlying condition. In this narrative review, we shed light on the overall types and functions of immunoglobulins for clinicians. We discuss important principles of immunoglobulin measurements. We then consider the primary and secondary causes of low immunoglobulins with a special focus on hypogammaglobulinemia in patients with systemic lupus erythematosus (SLE).

scholarly journals Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Djamel Mokart ◽  
◽  
Michael Darmon ◽  
Peter Schellongowski ◽  
Peter Pickkers ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Prognostic Impact ◽  
Immunocompromised Patients ◽  
Matched Cohort ◽  
Icu Admission ◽  
Neutropenic Patients ◽  
The Impact

Abstract Background The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia. Methods We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort. Results Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93–2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63–1.72). Conclusion Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.

scholarly journals The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review

Cells ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 475 ◽  
Author(s):  
Yuki Ishikawa ◽  
Chikashi Terao
Keyword(s):  
Rheumatoid Arthritis ◽  
Environmental Factors ◽  
Cigarette Smoking ◽  
Cyclic Peptide ◽  
Bone Destruction ◽  
Narrative Review ◽  
Special Focus ◽  
Main Role ◽  
Genetic And Environmental Factors ◽  
The Impact

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and subsequent proliferation of synovial tissues, which eventually leads to cartilage and bone destruction without effective treatments. Anti-citrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) are two main characteristic autoantibodies found in RA patients and are associated with unfavorable disease outcomes. Although etiologies and causes of the disease have not been fully clarified yet, it is likely that interactive contributions of genetic and environmental factors play a main role in RA pathology. Previous works have demonstrated several genetic and environmental factors as risks of RA development and/or autoantibody productions. Among these, cigarette smoking and HLA-DRB1 are the well-established environmental and genetic risks, respectively. In this narrative review, we provide a recent update on genetic contributions to RA and the environmental risks of RA with a special focus on cigarette smoking and its impacts on RA pathology. We also describe gene–environmental interaction in RA pathogenesis with an emphasis on cigarette smoking and HLA-DRB1.

scholarly journals Current Insights: The Impact of Gut Microbiota on Postoperative Complications in Visceral Surgery—A Narrative Review

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2099
Author(s):  
Ann-Kathrin Lederer ◽  
Sophia Chikhladze ◽  
Eva Kohnert ◽  
Roman Huber ◽  
Alexander Müller
Keyword(s):  
Postoperative Complications ◽  
Gut Microbiota ◽  
Anastomotic Leakage ◽  
Surgical Site Infections ◽  
Diagnostic Value ◽  
Narrative Review ◽  
Visceral Surgery ◽  
Special Focus ◽  
Microbial Profile ◽  
The Impact

Postoperative complications are a major problem occurring in up to 50% of patients undergoing major abdominal surgery. Occurrence of postoperative complications is associated with a significantly higher morbidity and mortality in affected patients. The most common postoperative complications are caused by an infectious genesis and include anastomotic leakage in case of gastrointestinal anastomosis and surgical site infections. Recent research highlighted the importance of gut microbiota in health and disease. It is plausible that the gut microbiota also plays a pivotal role in the development of postoperative complications. This narrative review critically summarizes results of recent research in this particular field. The review evaluates the role of gut microbiota alteration in postoperative complications, including postoperative ileus, anastomotic leakage, and surgical site infections in visceral surgery. We tried to put a special focus on a potential diagnostic value of pre- and post-operative gut microbiota sampling showing that recent data are inhomogeneous to identify a high-risk microbial profile for development of postoperative complications.

scholarly journals Energy availability in female athletes with disabilities: a narrative review

2018 ◽  
Vol 11 (1) ◽  
pp. 195
Author(s):  
Claudia Ridel Juzwiak ◽  
Daniel Paduan Joaquim ◽  
Ciro Winckler
Keyword(s):  
Bone Health ◽  
Female Athletes ◽  
Narrative Review ◽  
Screening Methods ◽  
Special Focus ◽  
Energy Availability ◽  
Menstrual Dysfunction ◽  
Athletes With Disabilities ◽  
And Performance ◽  
The Impact

Research on female athletes has increased, with the main focus on Low Energy Availability (LEA) and Female Athlete Triad (TRIAD), however there is a gap in knowledge about LEA and related conditions such as eating disorder, menstrual dysfunction and bone health in athletes with disabilities. The literature suggests that those athletes, depending on the type of disability, have a higher risk of developing LEA. In this way, the objective of this review is to describe the impact of LEA on health and performance of female athletes, with special focus on athletes with disabilities. A narrative review of the literature was conducted using as search terms LEA and TRIAD components - bone health and menstrual dysfunction - in female athletes. The narrative review yielded 24 studies on the subject, of those, 10 original studies, in which LEA was diagnosed in female athletes, only one referring to athletes with disabilities. Literature indicates the complexity in estimating EA, since the methods used to determine its components may present inaccuracies, especially for athletes with disabilities. Further researched is needed to assess EA in female athletes, especially with disabilities, as well as the improvement of EA's assessment and screening methods.

scholarly journals Effect of Hypocaloric Normoprotein Or Trophic Feeding versus Target Full Feeding on Patient Outcomes in Critically Ill Adults: A Systematic Review

2017 ◽  
Vol 45 (6) ◽  
pp. 663-675 ◽  
Author(s):  
K. A. Phan ◽  
C. M. Dux ◽  
E. J. Osland ◽  
M. C. Reade
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Feeding Strategy ◽  
Randomised Trial ◽  
Full Energy ◽  
The Impact ◽  
Duration Of Ventilation ◽  
Trophic Feeding

Uncertainty surrounds the optimal approach to feeding the critically ill, with increasing interest in the concept of intentional underfeeding to reduce metabolic stress while maintaining gut integrity. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates clinical outcomes reported in studies comparing hypocaloric normonitrogenous or trophic feeding (collectively ‘intentional underfeeding’) to target full energy feeding administered via enteral nutrition to adult critically ill patients. Electronic databases including PubMed, CINAHL, EMBASE and CENTRAL were searched up to September 2017 for trials evaluating intentional underfeeding versus targeted energy feeding interventions on clinical outcomes (mortality, length of stay, duration of ventilation, infective complications, feeding intolerance and glycaemic control) among critically ill adult patients. Bias of included studies was assessed using the Cochrane risk of bias tool. Of the 595 articles identified, seven studies (six randomised controlled trials, one non-randomised trial) met the inclusion criteria, representing 2,684 patients (hypocaloric normonitrogenous n=668; trophic n=681; full energy feeding n=1335). Across the studies, there was considerable heterogeneity in study methodology, population, feeding strategy and outcomes and their timepoints. We observed no evidence that intentional underfeeding, when compared to targeting full energy feeding, reduced mortality or duration of ventilation or length of stay. However, limited trial evidence is available on the impact of intentional underfeeding on post-discharge functional and quality of life outcomes.

Quality of Life and Mental Health of Infertile Women Affected by Endometriosis: A Narrative Review

2019 ◽  
Vol 15 (4) ◽  
pp. 238-244
Author(s):  
Cristina Zarbo ◽  
Agostino Brugnera ◽  
Rita Secomandi ◽  
Ilario Candeloro ◽  
Chiara Malandrino ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Narrative Review ◽  
Stress Perception ◽  
Infertile Women ◽  
Assisted Reproductive Treatment ◽  
General Quality ◽  
The Impact ◽  
Test Outcomes

Objective: Infertility has a severe impact on quality of life and mental health. This condition could be exacerbated by the existence of comorbid medical disease, like endometriosis. The aim of this critical narrative review is the examination of the state of the art about the quality of life and mental health in infertile women with endometriosis. Methods: We performed a rigorous and systematic search for studies on multiple electronic databases. A total of 6 papers were included in the review and were subjected to interpretative and critical narrative synthesis. Results and Discussion: Major findings are resumed in the following points: (a) infertile women with endometriosis when compared to infertile ones without endometriosis show higher depression, stress perception, and anxiety, and lower general quality of life; (b) quality of life specifically related to infertility is similar among women with and without endometriosis and seems to be related to personality and beliefs factors; (c) giving birth to a child is related to better mental quality of life; (d) during assisted reproductive treatment (ART) stimulation, infertile women with endometriosis have a decrease of dysmenorrhea and dyspareunia; (e) satisfaction of ART is related to the number of attempts, treatment accomplishment and pregnancy test outcomes. Clinical implications of these findings and suggestions for future researches were discussed. Conclusion: Concluding, it is crucial to assess the psychological factors related to endometriosis and infertility to reduce the impact of these diseases on quality of life and mental health, provide adequate support to these patients, improve their satisfaction and increase the change to get pregnant.

What Determines Fiscal Deficits in Europe? The Impact and Interaction of EMU Membership, Fiscal Rules, Fiscal Councils and Creative Accounting

2020 ◽  
Vol 71 (1) ◽  
pp. 15-41
Author(s):  
Dominik Maltritz ◽  
Sebastian Wüste
Keyword(s):  
Fiscal Rules ◽  
Special Focus ◽  
Annual Data ◽  
Budget Balance ◽  
Fiscal Deficits ◽  
Eu Countries ◽  
Creative Accounting ◽  
Stock Flow ◽  
The Impact

AbstractWe search for drivers of fiscal deficits in Europe using a data panel containing annual data of 27 EU countries in the years 1991–2012. Our special focus is on the influence of fiscal rules as well as on fiscal councils, i. e. institutions that may help to reduce deficits and enforce fiscal rules by advising governments. We distinguish between internal fiscal rules and external rules that result from EMU membership. In addition, we consider the impact of “creative accounting”, i. e. measures that help to circumvent fiscal rules, which we approximate by so called stock-flow-adjustments. We especially analyze the interactive influence of the mentioned variables on the budget balance.

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

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