Critical care clinics
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Critical illness predisposes individuals to highly variable metabolic and immune responses, leading to muscle mass loss, impaired healing, immobility, and susceptibility to infections and cognitive impairment. Recommendations for nutrition in critically ill patients are supported by observational studies, small randomized controlled trials, and mechanistic data. There is no standardization of nutritional therapy in critically ill patients and controversies in the type, quantity, and timing of nutrition support persist. This article reviews the physiologic basis for nutrition support, the concept of nutritional risk, and various controversies in critical care nutrition support.
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Critical care clinics · Apr 2016
Review Comparative StudyRole of the Open Abdomen in Critically Ill Patients.
An open abdomen is common used in critically ill patients to temporize permanent abdominal closure. The most common reason for leaving the abdomen open by reopening a laparotomy, not closing, or creating a fresh laparotomy is the abdominal compartment syndrome. ⋯ The open abdomen is associated with many early and late complications, including infections, gastrointestinal fistulas, and ventral hernias. Clinicians should be vigilant regarding the development of these complications.
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Acute pancreatitis results in nearly 250,000 admissions annually. Acute pancreatitis varies widely in its clinical presentation. ⋯ The extent of necrosis correlates well with the incidence of infected necrosis, multiorgan failure, need for pancreatic debridement, and morbidity and mortality. Having established the diagnosis of pancreatic necrosis, goals of appropriately aggressive resuscitation should be established and adhered to in a multidisciplinary approach involving both medical and surgical critical care.
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The abdominal compartment is separated from the thoracic compartment by the diaphragm. Under normal circumstances, a large portion of the venous return crosses the splanchnic and nonsplanchnic abdominal regions before entering the thorax and the right side of the heart. ⋯ It is important to understand the consequences of abdominal pressure changes on respiratory and circulatory physiology. This article elucidates important abdominal-respiratory-circulatory interactions and their clinical effects.
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Critical care clinics · Apr 2016
ReviewAbdominal Compartment Hypertension and Abdominal Compartment Syndrome.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare but potentially morbid diagnoses. Clinical index of suspicion for these disorders should be raised following massive resuscitation, abdominal wall reconstruction/injury, and in those with space-occupying disorders in the abdomen. ⋯ Decompressive laparotomy is definitive therapy but paracentesis can be equally therapeutic in properly selected patients. Left untreated, ACS can lead to multisystem organ failure and death.