Crit Care Resusc
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To develop an outcome measure as a basis for prescribing and evaluating rehabilitation in the critically ill, and to measure its reliability and responsiveness to change. The study also aimed to assess the feasibility and safety of a pilot exercise training protocol in an intensive care unit. ⋯ The PFIT is a reliable and responsive outcome measure, and the pilot training protocol was safe and feasible. As exercise may attenuate weakness and functional impairment, the PFIT can be used to prescribe and evaluate exercise and mobilisation. Future research should aim to develop a PFIT score and investigate the ability of the PFIT to predict ICU readmission risk and functional outcome.
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Studies consistently show that nasogastric nutrition delivers only about 60% of nutritional goals in critically ill patients. The predominant reason is abnormal gastric motility, leading to delayed gastric emptying, which is evident clinically as large gastric residual volumes. Delayed gastric emptying occurs in about 50%-60% of critically ill patients who are fed enterally and can result in malnutrition. ⋯ Feed intolerance can be treated with prokinetic drugs and/or by the placement of postpyloric feeding catheters. The place of prokinetic agents in the treatment of feed intolerance is as yet unclear, but current evidence supports the administration of erythromycin combined with metoclopramide as first-line therapy. Other novel drugs, such as methylnaltrexone, mitemcinal, ghrelin agonists and dexloxiglumide, have potential advantages over these agents but require further investigation before widespread clinical use.
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To determine whether serum troponin I (TnI), measured 4 hours after surgery for congenital heart disease, is a predictor of myocardial dysfunction and low cardiac output syndrome (LCOS). ⋯ Measurement of early postoperative levels of TnI may aid in the early identification of children who will develop LCOS.