Articles: critical-illness.
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AACN Clin Issues Crit Care Nurs · Nov 1994
ReviewThe role of total parenteral nutrition in critical illness: guidelines and recommendations.
Critically ill patients experience a multitude of metabolic derangements in response to sepsis, shock, and severe injury. The result of extreme stress is characterized by alterations in carbohydrate and fat metabolism and persistent catabolism of lean body mass. ⋯ In this article, the author identifies the patient at risk, defines the appropriate time to initiate parenteral nutrition, and outlines current recommendations for energy and protein prescription. The author also briefly reviews administration issues, discusses possible complications of therapy, and defines effective strategies to monitor the response to therapy.
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1. Intraperitoneal injections of zymosan were given to rats, according to a modified procedure, in order to create a pattern of illness with an acute critical phase for 36 h followed by a prolonged recovery phase lasting for at least 10 days. Changes in amino acid and protein metabolism were studied in both phases. 2. ⋯ Decreases in plasma glutamine and arginine on day 12 after zymosan indicated that the rats were still not fully recovered on this day. 4. We conclude that injection of a single dose of zymosan in rats leads to metabolic derangements both during the acute phase of critical illness and during the prolonged recovery phase. The model seems suited for investigating the biochemical mechanisms behind these metabolic derangements and for studying therapeutic and nutritional interventions during recovery from critical illness.
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The author reviews the newer nutritional substrates in use or under investigation for enteral and parenteral nutrition. Management of the critically ill patient remains a significant challenge to clinicians, and it is hoped that dietary manipulations, such as those outlined, may augment host barriers and immune function and improve survival. ⋯ Medium-chain fatty acids, branched-chain amino acids, and glutamine have been shown to be of clinical benefit and should be in common use in the near future. Short-chain fatty acids still are under investigation. Albumin, vitamins E and C, arginine, glutamine, and omega-3 fatty acids show great promise as pharmacologic agents to manipulate the stress response. Nucleotides remain investigational. CONTENTS SUMMARY: The application of some new nutritional substrates for use in critically ill patients, both as caloric sources and as pharmacologic agents, are reviewed.
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Intensive care medicine · Nov 1994
Randomized Controlled Trial Clinical TrialUse of antithrombin III in critical patients.
To evaluate the effect of the AT III concentrates upon the clinical evolution and hemostatic parameters. ⋯ The results suggest that the administration of AT III concentrates to critical patients with acquired low levels, but without manifest DIC, may not be justified; although further studies on a larger population are required to establish definite conclusions.
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Comparative Study Clinical Trial
Determination of cardiac output using acoustic quantification in critically ill patients.
The reliability of automated acoustic quantification (AQ) in yielding real-time left ventricular (LV) area, volume, and ejection fraction has been validated. The purpose of this study was to explore the potential of AQ in providing accurate immediate determination of cardiac output in critically ill patients. A total of 48 patients were studied. ⋯ There was a similar underestimation of cardiac output with manual analysis when compared with thermodilution. Given the absence of significant differences between AQ and manual analysis, this observation suggests that the bias is related to the echocardiographic determination of stroke volume, and not to errors from the automated border detection. It is concluded that AQ, besides providing information on LV volumes and ejection fraction, also can yield rapid measurements of cardiac output in most patients who are acutely ill.