Articles: critical-illness.
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Critical care medicine · Apr 1993
Endocrine profiles for outcome prediction from the intensive care unit.
To evaluate the discriminating ability of various specific endocrine studies on patient outcome from the intensive care unit (ICU). ⋯ The basal cortisol and triiodothyronine concentrations obtained from blood samples collected within 48 hrs of ICU admission appear to be better discriminators of patient outcome than the APACHE II score.
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Critical care clinics · Apr 1993
ReviewMetabolic and nutritional support of the intensive care patient. Ascending the learning curve.
The learning curve of nutritional support in the critically ill began with the amelioration of the effects of starvation in patients with a disabled intestine. Next, there was an appreciation that feeding formulas could be tailored to support patients with specific organ insufficiencies. Then it was realized that feeding enterally has distinct advantages over feeding parenterally. ⋯ In the future, feeding formulae will be devised that continue to modify the patient's response to illness favorably. Another important consideration is to begin nutritional support as soon as possible--i.e., on the day of admission, if appropriate. The critical care specialist should be expert in these techniques, with the goal of eliminating malnutrition as a confounding variable in the clinical course of the intensive care unit patient.
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Critical care medicine · Mar 1993
Randomized Controlled Trial Clinical TrialImproved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure.
To determine whether continuous modes of renal replacement therapy result in improved cardiovascular stability compared with standard daily intermittent treatment in critically ill patients. ⋯ In critically ill patients, in whom DO2 is impaired, the use of continuous forms of renal replacement therapy is preferred for its improved cardiovascular tolerance compared with daily intermittent machine treatments.
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Crit Care Nurs Clin North Am · Mar 1993
The significance of enteral nutrition in the intensive care unit patient.
The gut and its nonimmunologic and immunologic barriers have an important role in the survival of critically ill patients. Burns, hemorrhagic shock, intestinal obstruction, protein-calorie malnutrition, and several therapies (e.g., parenteral nutrition, steroids), used in critically ill patients are known to promote the breakdown of the mucosal barrier and to permit translocation of intestinal pathogens. Enteral nutrition, in conjunction with the use of certain immunostimulatory nutrients, can now be used to prevent or minimize damage to the mucosal barrier and to enhance its immunologic function in critically ill patients.
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Hypoalbuminemia is a common finding in critically ill patients. It has been well documented that hypoalbuminemic patients have a higher morbidity and mortality rate when compared with patients with a normal serum albumin. ⋯ There is, however, very little evidence that this practice is of any benefit. In this article the physiology of albumin in health and disease is reviewed, and those clinical studies that have investigated the use of albumin in acutely ill hypoalbuminemic patients are evaluated.