scholarly journals Cytomegalovirus infection in non-immunosuppressed critically ill patients

2011 ◽  
Vol 5 (08) ◽  
pp. 571-579 ◽  
Author(s):  
Manisha Jain ◽  
Shalini Duggal ◽  
Tulsi Das Chugh
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Population ◽  
Severe Trauma ◽  
Transplant Recipients ◽  
Hematological Disease ◽  
Mortality And Morbidity ◽  
Multiple Organs ◽  
System A ◽  
Immunosuppressed Patients

Cytomegalovirus (CMV) is an important and common cause of mortality and morbidity in immunocompromised patients such as those with HIV/AIDS, transplant recipients on immunosuppressive therapy, and malignant hematological disease. After primary infection with CMV the virus becomes latent in multiple organs and can later be reactivated during severe dysregulation of the immune system. A large population carry dormant virus and are thus at risk for reactivation. However, reactivation of CMV has been reported in "non-immunosuppressed patients" such as severe trauma, sepsis, shock, burns, cirrhosis and other critically ill patients lying in the intensive care units. Therefore, the intensivists are increasingly facing a dilemma of identifying such patients to treat and there is a debate if there is a scientific justification for prophylaxis in such immunocompetent patients.

Coronavirus disease 2019 in critically ill patients: can we re-program the immune system? A primer for Intensivists

2020 ◽  
Vol 86 (11) ◽  
Author(s):  
Fiorenza Ferrari ◽  
Federico Visconti ◽  
Mara De Amici ◽  
Angelo Guglielmi ◽  
Costanza N. Colombo ◽  
...  
Keyword(s):  
Immune System ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
System A

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Znacaj profilakse akutne mukozne lezije kod pacijenata u jedinici intenzivnog lecenja

2007 ◽  
Vol 54 (1) ◽  
pp. 47-50 ◽  
Author(s):  
N.M. Popovic
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Direct Consequence ◽  
Severe Trauma ◽  
Mucosal Lesion ◽  
Critically Ill Patient ◽  
Multiple Risk Factors ◽  
Massive Gastrointestinal Bleeding ◽  
Mucosal Lesions ◽  
Clinically Significant

At least three-quarters of critically ill patients develop mucosal lesion as a direct consequence of stress within the first 24 hours following the admission to intensive care unit. These mucosal lesions occur as superficial or deep mucosal lesions which can lead to massive gastrointestinal bleeding and it can put at risk the life of critically ill patient. There are multiple risk factors for the occurence of mucosal lesion such as: respiratory failure requiring mechanical ventilation, sepsis, hypotension, burns, severe trauma, neurotrauma, ileus, coagulopathy, renal and hepatic failure, myocardial infarction etc. The incidence of silent (ocult) bleeding in critically ill patients is almost 100%, but only about 5% of patients have clinically apparent (overt) hemorrhage and 1-2% have clinically significant bleeding which requires blood transfusions. In patients who are at the greatest risk of developing mucosal lesion, prophylactic treatment ought to be started immediately in order to achieve pH4 with adequate perfusion and coagulation. Today several groups of medications are used for the prevention of mucosal gastrointestinal lesion and they include: antacids, sucralfate, hisamine-2 receptor antagonists and proton pump inhibitors.

Noncandidal Fungal Infections

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Ventricular Assist Devices ◽  
Surgical Patient ◽  
Transplant Recipients ◽  
Biopsy Material ◽  
Ventricular Assist ◽  
The Past ◽  
Progressive Disseminated Histoplasmosis

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious fungal infections, including the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. This review outlines an approach to the workup and management of the nonneutropenic surgical patient with a suspected noncandidal infection (aspergillosis and zygomycosis). Figures show biopsy samples from an elderly man with chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis on biopsy material. This review contains 2 figures and 47 references Key words: aspergillosis, aspergillosis prophylaxis, blastomycosis, Cryptococcus, histoplasmosis, noncandidal fungal infections  

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

Candidiasis

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Diagnostic Methods ◽  
Ventricular Assist Devices ◽  
Transplant Recipients ◽  
Ventricular Assist ◽  
Disseminated Candidiasis ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious Candida infections. This review covers the definition and classification, epidemiology and risk factors, and clinical evaluation of candidiasis, as well as management of candidemia, acute disseminated candidiasis, nonhematogenous candidiasis, and peritonitis and intra-abdominal abscess. Figures show Candida endophthalmitis in patients with persistent fungemia and superficial candidiasis in the gastrointestinal tract. Tables list clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candidal infections, and the latest guidelines for candidiasis. This review contains 2 figures, 3 tables and 131 references Key words: acute disseminated candidiasis, candidemia, candidiasis, candiduria, nonhematogenous candidiasis  

scholarly journals Muscle wasting in the critically ill patient: how to minimise subsequent disability

2020 ◽  
Vol 81 (4) ◽  
pp. 1-9
Author(s):  
Luke Flower ◽  
Zudin Puthucheary
Keyword(s):  
Critically Ill ◽  
Psychological Health ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Critically Ill Patient ◽  
Muscle Loss ◽  
Post Discharge ◽  
Mortality And Morbidity ◽  
Muscle Breakdown ◽  
Physical And Psychological Health

Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2–3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.

CONTINUOUS CARDIAC OUTPUT/ MIXED VENOUS O2 MONITORING SYSTEM???A COMPARATIVE EVALUATION IN CRITICALLY ILL PATIENTS

1994 ◽  
Vol 22 (1) ◽  
pp. A191 ◽  
Author(s):  
William R. Auger ◽  
David B. Hoyt ◽  
F. Wayne Johnson ◽  
Diane Lewis ◽  
Joan Garcia ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Monitoring System ◽  
Critically Ill Patients ◽  
Comparative Evaluation ◽  
Continuous Cardiac Output ◽  
System A ◽  
Mixed Venous

Insulin and oral anti-hyperglycaemic agents in critical illness

2016 ◽  
Author(s):  
Roosmarijn T. M. van Hooijdonk ◽  
Marcus J. Schultz
Keyword(s):  
Blood Glucose ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Venous Catheter ◽  
Glycaemic Variability ◽  
Mortality And Morbidity ◽  
Glucose Levels ◽  
Measuring Devices

Dysglycaemia is frequently seen in the intensive care unit (ICU). Hyperglycaemia, hypoglycaemia and glycaemic variability are all independently associated with mortality and morbidity in critically-ill patients. It is common practice to treat hypergycaemia in these patients, while at the same time preventing hypoglycaemia and glycaemic variability. Insulin infusion is preferred over oral anti–hyperglycaemic agents for glucose control in the ICU because of the highly unpredictable biological availability of oral anti-hyperglycaemic agents during critical illness. Many oral anti–hyperglycaemic agents are relatively contraindicated in critically-ill patients. Intravenously-administered insulin has a predictable effect on blood glucose levels, in particular because of its short half-life. Notably, effective and safe insulin titration requires frequent blood glucose measurements, a dedicated lumen of a central venous catheter for infusion of insulin, an accurate syringe pump, and trained nurses for delicate adoptions of the infusion rate. Insulin infusion increases the risk of hypoglycaemia, which should be prevented at all times. In addition, precautions should be taken against overcorrection of hypoglycaemia, using only small amounts of glucose. Whether glycaemic variability can be kept minimal is uncertain. Use of continuous glucose measuring devices has the potential to improve glycaemic control in critically-ill patients.

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