scholarly journals Immunonutrition in surgical and critically ill patients

2007 ◽  
Vol 98 (S1) ◽  
pp. S133-S139 ◽  
Author(s):  
Philip C. Calder
Keyword(s):  
Fatty Acids ◽  
Immune Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Experimental Studies ◽  
Good Evidence ◽  
Antioxidant Vitamins ◽  
Surgical Patients ◽  
Susceptibility To Infection ◽  
Long Chain

Surgery, trauma, burns and injury induce an inflammatory response that can become excessive and damaging in some patients. This hyperinflammation can be followed by an immunosuppressed state which increases susceptibility to infection. The resulting septic syndromes are associated with significant morbidity and mortality. A range of nutrients are able to modulate inflammation (and the associated oxidative stress) and to maintain or improve immune function. These include several amino acids, antioxidant vitamins and minerals, long-chain n-3 fatty acids and nucleotides. Experimental studies support a role for each of these nutrients in surgical, injured or critically ill patients. There is good evidence that glutamine influences immune function in such patients and that this is associated with clinical improvement. Evidence is also mounting for the use of long-chain n-3 fatty acids in surgical and septic patients, but more evidence of clinical efficacy is required. Mixtures of antioxidant vitamins and minerals are also clinically effective, especially if they include selenium. Their action appears not to involve improved immune function, although an anti-inflammatory mode of action has not been ruled out. Enteral immunonutrient mixtures, usually including arginine, nucleotides and long-chain n-3 fatty acids, have been used widely in surgical and critically ill patients. Evidence of efficacy is good in surgical patients. However whether these same mixtures are beneficial, or should even be used, in critically ill patients remains controversial, since some studies show increased mortality with such mixtures. There is a view that this is due to a high arginine content driving nitric oxide production.

Fish or Chips?

Physiology ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 50-54
Author(s):  
Axel R. Heller ◽  
Hermann J. Theilen ◽  
Thea Koch
Keyword(s):  
Fatty Acids ◽  
Fish Oil ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Extracellular Space ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
High Turnover ◽  
Omega 6 ◽  
Long Chain

Cell membranes are not simply barriers separating intracellular from extracellular space. Rather, they represent a dynamic high-turnover system that adapts to current demands. During inflammation, prostaglandins and leukotrienes are formed from membrane-derived phospholipids. Encouraging improvements in critically ill patients were observed after nutritional replacement of long-chain omega-6 fatty acids with long-chain omega-3-fatty acids, contained in fish oil.

scholarly journals Diagnostic biomarkers for adult haemophagocytic lymphohistiocytosis in critically ill patients (HEMICU): a prospective observational study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032695 ◽  
Author(s):  
Gunnar Lachmann ◽  
Cornelia Knaak ◽  
Clarissa von Haefen ◽  
Nadine Paeschke ◽  
Christian Meisel ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fatal Outcome ◽  
Experimental Studies ◽  
Ethics Committee ◽  
Adult Patients ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Diagnostic Biomarkers ◽  
Potential Biomarker

IntroductionHaemophagocytic lymphohistiocytosis (HLH) in adults is characterised by toxic immune activation and a sepsis-like syndrome, leading to high numbers of undiagnosed cases and mortality rates of up to 68%. Early diagnosis and specific immune suppressive treatment are mandatory to avoid fatal outcome, but the diagnostic criteria (HLH-2004) are adopted from paediatric HLH and have not been validated in adults. Experimental studies suggest biomarkers to sufficiently diagnose HLH. However, biomarkers for the diagnosis of adult HLH have not yet been investigated.Methods and analysisThe HEMICU (Diagnostic biomarkers for adult haemophagocytic lymphohistiocytosis in critically ill patients) study aims to estimate the incidence rate of adult HLH among suspected adult patients in intensive care units (ICUs). Screening for HLH will be performed in 16 ICUs of Charité – Universitätsmedizin Berlin. The inclusion criteria are bicytopaenia, hyperferritinaemia (≥500 µg/L), fever or when HLH is suspected by the clinician. Over a period of 2 years, we expect inclusion of about 100 patients with suspected HLH. HLH will be diagnosed if at least five of the HLH-2004 criteria are fulfilled, together with an expert review; all other included patients will serve as controls. Second, a panel of potential biomarker candidates will be explored. DNA, plasma and serum will be stored in a biobank. The primary endpoint of the study is the incidence rate of adult HLH among suspected adult patients during ICU stay. Out of a variety of measured biomarkers, this study furthermore aims to find highly potential biomarkers for the diagnosis of adult HLH in ICU. The results of this study will contribute to improved recognition and patient outcome of adult HLH in clinical routine.Ethics and disseminationThe institutional ethics committee approved this study on 1 August 2018 (Ethics Committee of Charité – Universitätsmedizin Berlin, EA4/006/18). The results of the study will be disseminated in an international peer-reviewed journal and presented at international conferences.Trial registration numberNCT03510650.

scholarly journals The association between culture positivity and long-term mortality in critically ill surgical patients

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yu-Cheng Wu ◽  
Li-Ting Wong ◽  
Chieh-Liang Wu ◽  
Wen-Cheng Chao
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Culture ◽  
Surgical Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Culture Positivity ◽  
Critically Ill Surgical Patients ◽  
Long Term Mortality

Abstract Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

scholarly journals Pulmonary Artery Catheterization was not Associated with Survival Benefits in Critically Ill Patients with Cardiac Disease: An Analysis of the MIMIC-IV Database

2021 ◽  
Author(s):  
Jie Wu ◽  
Shiyu Zhou ◽  
Hongbin Hu ◽  
Yuan Zhang ◽  
Sheng An ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Pulmonary Artery Catheterization

Abstract Background: It is not clear whether pulmonary artery catheter (PAC) placement is beneficial for critically ill patients with heart disease. This study aims to investigate the association of PAC use with 28-day mortality in that population.Methods: The MIMIC-IV database was employed to identify critically ill patients with cardiac disease with or without PAC insertion. The primary outcome was 28-day mortality. Multivariate regression was modeled to examine the association between PAC and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching (PSM) was conducted to validate our findings.Results: No improvement in 28-day mortality was observed among the PAC group compared to the non-PAC group (odds ratio=1.18, 95% CI=1.00-1.38, P=0.049). When stratified by cardiac surgeries, the results were consistent. Patients in the PAC group had fewer ventilation-free days and vasopressor-free days than those in the non-PAC group after surgery stratification. In surgical patients, PAC insertion was not associated with the occurrence of acute kidney injury (AKI), and was associated with a higher daily fluid input (mean difference=0.13, 95% CI=0.05-0.20, P=0.001). In non-surgical patients, the PAC group had a higher risk of AKI occurrence (odds ratio=1.94, 95% CI=1.32-2.84, P=0.001).Conclusion: PAC placement was not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical and non-surgical patients.

scholarly journals Stool Short-Chain Fatty Acids in Critically Ill Patients with Sepsis

2020 ◽  
Vol 39 (8) ◽  
pp. 706-712 ◽  
Author(s):  
Beatriz E. Valdés-Duque ◽  
Nubia A. Giraldo-Giraldo ◽  
Ana M. Jaillier-Ramírez ◽  
Adriana Giraldo-Villa ◽  
Irene Acevedo-Castaño ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Chain Fatty Acids ◽  
Short Chain ◽  
Chain Fatty Acids

scholarly journals Association of Serum Albumin Concentration and Mortality Risk in Critically Ill Patients

2002 ◽  
Vol 30 (2) ◽  
pp. 202-207 ◽  
Author(s):  
F. H. Y. Yap ◽  
G. M. Joynt ◽  
T. A. Buckley ◽  
E. L. Y. Wong
Keyword(s):  
Serum Albumin ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Roc Curves ◽  
Apache Ii ◽  
Surgical Patients ◽  
Apache Ii Score ◽  
Albumin Concentration ◽  
Serum Albumin Concentration

In this study we aimed to examine the association between serum albumin concentration and mortality risk in critically ill patients. We retrospectively studied 1003 patients admitted to our Intensive Care Unit (ICU) over an 18-month period. Serial albumin measurements over 72 hours were compared between survivors and non-survivors, and medical and surgical patients were also compared. Our results showed that serum albumin decreased after ICU admission, most rapidly in the first 24 hours, in both survivors and non-survivors. Serum albumin was lower in non-survivors than in survivors, but albumin concentrations poorly differentiated the two groups. Medical patients had higher admission albumin levels than surgical patients, but both subgroups showed a similar albumin profile over 72 hours. We evaluated the prognostic value of serum albumin using receiver operator characteristic (ROC) curves. We constructed ROC curves for APACHE II score, admission albumin, albumin at 24 and 48 hours. We also combined APACHE II with albumin values and constructed the corresponding ROC curves. Our data showed that serum albumin had low sensitivity and specificity for predicting hospital mortality. Combining APACHE II score with serum albumin concentrations did not improve the accuracy of outcome prediction over that of APACHE II alone.

Sign in / Sign up

Export Citation Format

Share Document