Critical care : the official journal of the Critical Care Forum
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Both quantitative and qualitative aspects of muscle status significantly impact clinical outcomes in critically ill patients. Comprehensive monitoring of baseline muscle status and its changes is crucial for risk stratification and management optimization. However, repeatable and accessible indicators are lacking. We hypothesized that creatinine production rate (CPR) could serve as an integrative indicator of skeletal muscle status. ⋯ CPR represents an integrative indicator of skeletal muscle status in critically ill patients, reflecting both quantitative and qualitative aspects. Monitoring CPR in the ICU may facilitate risk stratification and optimization of patient care.
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Conflicts between ICU staff and patient/relatives are common and are a source of additional stress in an already tense environment. These conflicts vary from disagreements to serious controversies, which may lead to legal process or even violence. ⋯ Both conflict prevention and conflict management/resolution rely on understanding and addressing the main reasons behind it. Using a case-example, we propose a 'mentalisation-based' approach to family meetings may improve communication and decrease conflict.
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Randomized Controlled Trial
A phase 2 randomized, placebo-controlled trial of inulin for the prevention of gut pathogen colonization and infection among patients admitted to the intensive care unit for sepsis.
Patients admitted to the intensive care unit (ICU) often have gut colonization with pathogenic bacteria and such colonization is associated with increased risk for death and infection. We conducted a trial to determine whether a prebiotic would improve the gut microbiome to decrease gut pathogen colonization and decrease downstream risk for infection among newly admitted medical ICU patients with sepsis. ⋯ Prebiotic fiber had minimal impact on the gut microbiome in the ICU and did not improve clinical outcomes.
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The oxygen reactivity index (ORx) reflects the correlation between focal brain tissue oxygen (pbtO2) and the cerebral perfusion pressure (CPP). Previous, small cohort studies were conflicting on whether ORx conveys cerebral autoregulatory information and if it is related to outcome in traumatic brain injury (TBI). Thus, we aimed to investigate these issues in a larger TBI cohort. ⋯ ORx seemed to be sensitive to the lower, but not the upper, limit of autoregulation, in contrast to PRx which was sensitive to both. The combination of high values for both ORx and PRx was particularly associated with worse outcome and, thus, ORx may provide a complementary value to the global index PRx. ORx could also be useful to determine the safe and dangerous perfusion target intervals.