Nutrition is one of the foundations for supporting and treating critically ill patients.Nutritional support providescalories,protein,electrolytes,vitamins,and trace elements via the enteral or parenteral route.Acute k...Nutrition is one of the foundations for supporting and treating critically ill patients.Nutritional support providescalories,protein,electrolytes,vitamins,and trace elements via the enteral or parenteral route.Acute kidneyinjury(AKI)is a common and devastating problem in critically ill patients and has significant metabolic andnutritional consequences.Moreover,renal replacement therapy(RRT),whatever the modality used,also profoundly impacts metabolism.RRT and of the extracorporeal circuit impede‘effect the evaluation of a patient’senergy requirements by clinicians.Substrates added and removed within the extracorporeal treatment are notalways taken into consideration,making treatment even more challenging.Furthermore,evidence on nutritionalsupport during continuous renal replacement therapy(CRRT)is scarce,and there are no clinical guidelines fornutrition adaptations during CRRT in critically ill patients.Most recommendations are based on expert opinions.This review discusses the complex interaction between nutritional support and CRRT and presents somemilestones for nutritional support in critically ill patients on CRRT.展开更多
Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19(COVID-19)patients.The aim of this review is to describe these disturbances during the progression of the disea...Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19(COVID-19)patients.The aim of this review is to describe these disturbances during the progression of the disease,from the pre-intubation phase through the ventilated condition to the post extubation phase.The analysis of new data describing the prevalence of malnutrition,the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss.Rehabilitation may be extremely prolonged and therefore,nutrition is mandatory to decrease this recondition pe-riod.This review also comments on the European Society of Parenteral and Enteral Nutrition(ESPEN)nutritional statements.展开更多
In the dilemma of when to initiate feeding in the critically ill,how much to prescribe,and which feeding route to use,2 reviews in recent issues of Journal of Intensive Medicine have addressed very important points:is...In the dilemma of when to initiate feeding in the critically ill,how much to prescribe,and which feeding route to use,2 reviews in recent issues of Journal of Intensive Medicine have addressed very important points:is it safe to underfeed our patients,and is it safe to use parenteral nutrition(PN)?It is unanimously recognized that early enteral feeding is the preferred route,[1,2]but the use of this medical nutritional therapy is limited by many obstacles.First,interruptions related to procedures or to transportation to surgery or diagnostic examinations have been reported,and a reduction in the time of administration as well as the amounts of energy and protein administered may result.[3]Second,symptoms of enteral nutrition intolerance are frequent and include large gastric residual volume,an inability to reach the energy/protein target on day 3,severe diarrhea or constipation,and elevated intra-abdominal pressure.展开更多
Background:This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit(ICU).Methods:This is a prospective observational cohort study...Background:This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit(ICU).Methods:This is a prospective observational cohort study conducted in a general ICU in which 8 of 18 rooms are equipped with a videoart system.Competent patients who spent at least 48 h in the ICU were asked to complete an Impact of Events Scale(IES)questionnaire during hospitalization and at least 1 year after discharge.Patients were recruited from April 2017 until June 2020,and follow-up phone calls were made from June to August 2021.The primary outcome was an IES score indicative of significant stress symptoms during hospitalization.Secondary outcomes were IES scores indicative of significant stress symptoms after discharge and clinical parameters during hospital stay.The cut-off value for high-risk stress symptoms was 26.However,because there is uncertainty in the literature regarding the desired cut-off value,two other values were also analyzed.Outcomes that were found statistically significant were further examined using a logistic regression model for the control of confounders.Results:Eighty-one patients completed the questionnaire during hospital stay and 24 patients after discharge.At home,patients who were exposed to videoart had a marginally lower mean IES score(median=6[interquartile range:0-18]vs.median=32[interquartile range:10-45],P=0.054)and a significantly lower rate of high-risk stress symptoms using the primary cut-off value(11.8%vs.57.1%,P=0.038;odds ratio=10.0095%CI:1.22 to 81.80,P=0.03).However,statistical significance was lost after adjustment for confounders(odds ratio=12.00,95%CI:0.67 to 222.00,P=0.09).There was no difference in the mean IES score,significant stress symptoms rate,or in any of the other endpoints examined during the hospital stay.Conclusions:There is a trend toward the beneficial effect of videoart for the alleviation of stress symptoms among ICU patients.However,further study is needed to examine the role of this technology.展开更多
Background The Sequential Organ Failure Assessment(SOFA)score,originally designed to reflect disease severity,is now recognized as a prognostic tool for critically ill patients.Recently,calls have emerged to update th...Background The Sequential Organ Failure Assessment(SOFA)score,originally designed to reflect disease severity,is now recognized as a prognostic tool for critically ill patients.Recently,calls have emerged to update the score to better align it with contemporary clinical practice.Methods This single-center,prospective,observational study was conducted in a general intensive care unit(ICU)of a university-affiliated tertiary hospital from September 10,2023,to January 7,2025.Urinary creatinine clearance(CrCl)was calculated daily using 6-h urine collection(CrCl6h)obtained during the first five nights after admission.Based on CrCl and Kidney Disease:ImprovingGlobal Outcomes(KDIGO)chronic kidney disease criteria,patients were categorized into five groups(0−4),with subsequent calculation of a modified SOFA score according to this grouping.The predictive ability of serum creatinine(Scr),urine output,CrCl6h,the original SOFA score,and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic(AUROC)values.Results A total of 200 patients were included in the study.The ICU mortality for these patients was 12.0%while the 90-day mortality reached 29.5%.Compared with Scr,CrCl6h displayed significantly higher AUROC values for mortality prediction on almost all days examined.For example,on day 3,the AUROC values were 0.821 vs.0.730(P=0.003)for ICU mortality,and 0.760 vs.0.662(P=0.002)for 90-day mortality.Similarly,the modified SOFA score showed significantly greater predictive performance on most days assessed.On day 3,the AUROC values were 0.791 vs.0.706(P=0.046)for ICU mortality,and 0.741 vs.0.655(P=0.007)for 90-day mortality.Conclusion The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality.展开更多
文摘Nutrition is one of the foundations for supporting and treating critically ill patients.Nutritional support providescalories,protein,electrolytes,vitamins,and trace elements via the enteral or parenteral route.Acute kidneyinjury(AKI)is a common and devastating problem in critically ill patients and has significant metabolic andnutritional consequences.Moreover,renal replacement therapy(RRT),whatever the modality used,also profoundly impacts metabolism.RRT and of the extracorporeal circuit impede‘effect the evaluation of a patient’senergy requirements by clinicians.Substrates added and removed within the extracorporeal treatment are notalways taken into consideration,making treatment even more challenging.Furthermore,evidence on nutritionalsupport during continuous renal replacement therapy(CRRT)is scarce,and there are no clinical guidelines fornutrition adaptations during CRRT in critically ill patients.Most recommendations are based on expert opinions.This review discusses the complex interaction between nutritional support and CRRT and presents somemilestones for nutritional support in critically ill patients on CRRT.
文摘Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19(COVID-19)patients.The aim of this review is to describe these disturbances during the progression of the disease,from the pre-intubation phase through the ventilated condition to the post extubation phase.The analysis of new data describing the prevalence of malnutrition,the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss.Rehabilitation may be extremely prolonged and therefore,nutrition is mandatory to decrease this recondition pe-riod.This review also comments on the European Society of Parenteral and Enteral Nutrition(ESPEN)nutritional statements.
文摘In the dilemma of when to initiate feeding in the critically ill,how much to prescribe,and which feeding route to use,2 reviews in recent issues of Journal of Intensive Medicine have addressed very important points:is it safe to underfeed our patients,and is it safe to use parenteral nutrition(PN)?It is unanimously recognized that early enteral feeding is the preferred route,[1,2]but the use of this medical nutritional therapy is limited by many obstacles.First,interruptions related to procedures or to transportation to surgery or diagnostic examinations have been reported,and a reduction in the time of administration as well as the amounts of energy and protein administered may result.[3]Second,symptoms of enteral nutrition intolerance are frequent and include large gastric residual volume,an inability to reach the energy/protein target on day 3,severe diarrhea or constipation,and elevated intra-abdominal pressure.
文摘Background:This study sought to evaluate the role of videoart in decreasing the risk of stress symptoms in patients hospitalized in the intensive care unit(ICU).Methods:This is a prospective observational cohort study conducted in a general ICU in which 8 of 18 rooms are equipped with a videoart system.Competent patients who spent at least 48 h in the ICU were asked to complete an Impact of Events Scale(IES)questionnaire during hospitalization and at least 1 year after discharge.Patients were recruited from April 2017 until June 2020,and follow-up phone calls were made from June to August 2021.The primary outcome was an IES score indicative of significant stress symptoms during hospitalization.Secondary outcomes were IES scores indicative of significant stress symptoms after discharge and clinical parameters during hospital stay.The cut-off value for high-risk stress symptoms was 26.However,because there is uncertainty in the literature regarding the desired cut-off value,two other values were also analyzed.Outcomes that were found statistically significant were further examined using a logistic regression model for the control of confounders.Results:Eighty-one patients completed the questionnaire during hospital stay and 24 patients after discharge.At home,patients who were exposed to videoart had a marginally lower mean IES score(median=6[interquartile range:0-18]vs.median=32[interquartile range:10-45],P=0.054)and a significantly lower rate of high-risk stress symptoms using the primary cut-off value(11.8%vs.57.1%,P=0.038;odds ratio=10.0095%CI:1.22 to 81.80,P=0.03).However,statistical significance was lost after adjustment for confounders(odds ratio=12.00,95%CI:0.67 to 222.00,P=0.09).There was no difference in the mean IES score,significant stress symptoms rate,or in any of the other endpoints examined during the hospital stay.Conclusions:There is a trend toward the beneficial effect of videoart for the alleviation of stress symptoms among ICU patients.However,further study is needed to examine the role of this technology.
文摘Background The Sequential Organ Failure Assessment(SOFA)score,originally designed to reflect disease severity,is now recognized as a prognostic tool for critically ill patients.Recently,calls have emerged to update the score to better align it with contemporary clinical practice.Methods This single-center,prospective,observational study was conducted in a general intensive care unit(ICU)of a university-affiliated tertiary hospital from September 10,2023,to January 7,2025.Urinary creatinine clearance(CrCl)was calculated daily using 6-h urine collection(CrCl6h)obtained during the first five nights after admission.Based on CrCl and Kidney Disease:ImprovingGlobal Outcomes(KDIGO)chronic kidney disease criteria,patients were categorized into five groups(0−4),with subsequent calculation of a modified SOFA score according to this grouping.The predictive ability of serum creatinine(Scr),urine output,CrCl6h,the original SOFA score,and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic(AUROC)values.Results A total of 200 patients were included in the study.The ICU mortality for these patients was 12.0%while the 90-day mortality reached 29.5%.Compared with Scr,CrCl6h displayed significantly higher AUROC values for mortality prediction on almost all days examined.For example,on day 3,the AUROC values were 0.821 vs.0.730(P=0.003)for ICU mortality,and 0.760 vs.0.662(P=0.002)for 90-day mortality.Similarly,the modified SOFA score showed significantly greater predictive performance on most days assessed.On day 3,the AUROC values were 0.791 vs.0.706(P=0.046)for ICU mortality,and 0.741 vs.0.655(P=0.007)for 90-day mortality.Conclusion The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality.
