Adrenal function/dysfunction in critically ill patients: a concise narrative review of recent novel insights

Introduction: Combating the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as Coronavirus Disease 2019 (COVID-19), in all countries of the world has been a challenge. Most patients can be treated in home isolation, however elderly patients and/or with associated comorbidities have been demonstrating more severe conditions of the disease, requiring hospitalization, or even nutritional therapy and mechanical ventilation. Objective: To review the current evidence to establish better nutritional recommendations for critically ill patients with COVID-19.Material and methods:This is a narrative review on nutritional therapy in critical patient with COVID-19. The scientific articles were searched in the databases U.S. National Library of Medicine (PubMed), as well as their respective terms in Portuguese and Spanish, and 40 articles were chosen, excluding the guidelines that were used to help better compose this article.Results: The main findings were that age and non-communicable diseases are considered risk factors for mortality, with systemic arterial hypertension and diabetes mellitus being the main ones. These patients need special care, as well as constant assessment of nutritional status, since malnourished and obese patients have shown a high association with mortality and the use of mechanical ventilation. Nutritional therapy in the affected patients can improve clinical outcome and should be considered as first-line treatment and be more valued in the hospital setting. Although there is no recommendation for supplementation of vitamin C and D and the mineral zinc, these may bring benefits to the immune system of these patients and help in a better prognosis of COVID-19, however more studies are still needed to substantiate the dosage.Conclusions: Further studies are needed, but it is important to bring these themes already exposed by some authors to stimulate discussions that might lead to improvements in the standardization of nutritional approaches.

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Role of Glutamine Supplementation in Critically ill patients: A Narrative Review

Research Journal of Pharmacy and Technology ◽

10.5958/0974-360x.2017.00496.6 ◽

2017 ◽

Vol 10 (8) ◽

pp. 2801

Author(s):

M Vijey Aanandhi ◽

Meha Rachel John

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Narrative Review ◽

Glutamine Supplementation

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The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

Critical Care ◽

10.1186/s13054-017-1810-2 ◽

2017 ◽

Vol 21 (1) ◽

Cited By ~ 38

Author(s):

Danielle E. Bear ◽

◽

Liesl Wandrag ◽

Judith L. Merriweather ◽

Bronwen Connolly ◽

...

Keyword(s):

Critically Ill ◽

Functional Recovery ◽

Critically Ill Patients ◽

Nutritional Support ◽

Narrative Review

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Critically ill patients with cancer: chances and limitations of intensive care medicine—a narrative review

ESMO Open ◽

10.1136/esmoopen-2015-000018 ◽

2016 ◽

Vol 1 (5) ◽

pp. e000018 ◽

Cited By ~ 46

Author(s):

Peter Schellongowski ◽

Wolfgang R Sperr ◽

Philipp Wohlfarth ◽

Paul Knoebl ◽

Werner Rabitsch ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Medicine ◽

Critically Ill ◽

Critically Ill Patients ◽

Narrative Review ◽

Patients With Cancer

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Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Journal of Fungi ◽

10.3390/jof7110921 ◽

2021 ◽

Vol 7 (11) ◽

pp. 921

Author(s):

Giacomo Casalini ◽

Andrea Giacomelli ◽

Annalisa Ridolfo ◽

Cristina Gervasoni ◽

Spinello Antinori

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Observational Studies ◽

Pulmonary Infection ◽

Fungal Infections ◽

Case Reports ◽

Mortality Rates ◽

Invasive Fungal Infections ◽

Narrative Review ◽

Crude Mortality

Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

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