Critical care : the official journal of the Critical Care Forum
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Acute kidney injury (AKI) develops mostly in the context of critical illness and multiple organ failure, characterized by alterations in substrate use, insulin resistance, and hypercatabolism. Optimal nutritional support of intensive care unit patients remains a matter of debate, mainly because of a lack of adequately designed clinical trials. Most guidelines are based on expert opinion rather than on solid evidence and are not fundamentally different for critically ill patients with or without AKI. ⋯ Nutritional support during CRRT should take into account the extracorporeal losses of glucose, amino acids, and micronutrients. Immunonutrients are the subject of intensive investigation but have not been evaluated specifically in patients with AKI. We suggest a protocolized nutritional strategy delivering enteral nutrition whenever possible and providing at least the daily requirements of trace elements and vitamins.
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International guidelines concerning the management of patients with sepsis, septic shock and multiple organ failure make no reference to the nature of the infecting organism. Indeed, most clinical signs of sepsis are nonspecific. In contrast, in vitro data suggest that there are mechanistic differences between bacterial, viral and fungal sepsis, and imply that pathogenetic differences may exist between subclasses such as Gram-negative and Gram-positive bacteria. ⋯ Data from some clinical trials conducted in severe sepsis support this hypothesis. It is likely that potential new therapies targeting, for example, Toll-like receptor pathways will require knowledge of the infecting organism. The advent of new technologies that accelerate the identification of infectious agents and their antimicrobial sensitivities may allow better tailored anti-mediator therapies and administration of antibiotics with narrow spectra and known efficacy.
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Comparative Study
Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients.
Gelsolin is an actin-binding plasma protein that is part of an 'actin-scavenging' system. Studies suggest that plasma gelsolin may play a crucial role in the pathophysiology of sepsis. Little is known about the course of plasma gelsolin levels over time in patients with severe sepsis. The aim of the study was to investigate plasma gelsolin levels in severe septic patients and to determine whether these levels predict the severity or clinical outcome of severe sepsis. ⋯ Plasma gelsolin may be a valuable marker for severe sepsis. Recovery of depleted plasma gelsolin levels correlated with clinical improvement. The prognostic role of plasma gelsolin in critical illness requires further investigation in a large cohort.
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Multicenter Study Comparative Study
Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics.
This prospective observational study was conducted to describe the nature of the intensive care population across Ireland, identify adherence to international benchmarks of practice, and describe patient outcomes in critically ill patients. ⋯ Intensive care medicine in Ireland serves a patient population with high requirement for mechanical ventilation and support of the function of multiple organs. The overall mortality compares favourably with international benchmarks.
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Multicenter Study
Mild hypothermia during advanced life support: a preliminary study in out-of-hospital cardiac arrest.
Induction of mild hypothermia after cardiac arrest may confer neuroprotection. We assessed the feasibility, safety and effectiveness of therapeutic infusion of 2 l of normal saline at 4 degrees C before return of spontaneous circulation during cardiopulmonary resuscitation after out of hospital cardiac arrest. ⋯ We concluded that prehospital induction of therapeutic hypothermia using infusion of 2 l of 4 degrees C normal saline during advanced life support was feasible, effective and safe. Larger studies are required to assess the impact that this early cooling has on neurological outcomes after cardiac arrest.