scholarly journals Brain Crosstalk with Other Organs in ICU Patient

2019 ◽  
Vol 06 (03) ◽  
pp. 299-304
Author(s):  
Sai Saran ◽  
Mohan Gurjar

AbstractCrosstalk between various organs exists in the human body. This can be part of physiological reflexes such as cardiac reflexes that protect the organs during stressful stimuli or can be part of pathological conditions where an insult to an organ releases cytokines that cause distant effects on other organs. In critically ill patients, these crosstalks are independent of pre-existing common risk factors or the presence of new risk exposure during the treatment. Crosstalk can manifest in series or parallel. The human brain, being a control center of the human body, does crosstalk with almost every organ in the body. In this narrative review, crosstalk of the brain with various organs and systems such as the heart, lungs, liver, kidneys, gut, muscle, bone, skin, adipose tissue, and immune system is being discussed along with clinical manifestations and management. Future research might help to target these pathological processes in preventing progression of single-organ dysfunction to multi-organ failures in critically ill patients.

Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.


Author(s):  
Karan B. Shah ◽  
Sapna D. Gupta ◽  
Devang A. Rana ◽  
Supriya D. Malhotra ◽  
Pankaj R. Patel

Background: Electrolytes play an important role in various physiological functions of the body. Electrolyte disturbances are one of the most common problems encountered in critically ill patients. Drugs are also known to cause adverse electrolyte consequences. These drugs could be anti-hypertensive agents, hormones, antipsychotics or steroids. There is paucity of published literature on electrolyte disturbances caused by drugs. The purpose of our study was to evaluate the electrolyte disturbances caused by various drugs in critically ill patients.Methods: Following approval of the Institutional Ethics Committee, data collection was started. Adverse Drug Reactions (ADRs) presenting as an electrolyte disturbance in emergency medicine department or occurring in hospitalized patients in the Intensive care unit (ICU) of our hospital was be collected. ADRs resulting into electrolyte disturbances were identified and analysed in detail for demographic details, types of electrolyte disturbances, seriousness, severity, causality and preventability of ADRs. Fisher's exact test was done to find out the statistical difference between the electrolyte disturbances and different drugs.Results: Total 58 ADRs were reported as an electrolyte disturbance. Mean age of the patients affected was 52.48 years. Highest number of ADRs were observed in the age group of 61 to 70 years. Hypokalemia constituted 32 cases (55.2%) followed by hyponatremia (25.9%), hyperkalemia (6.9%), hypernatremia (6.9%), hypocalcemia (1.7%), hypomagnesemia (1.7%) and hypophosphatemia (1.7%). Insulin was associated with maximum cases of ADRs (27.6%).Conclusions: Electrolyte disturbances constitutes a major chunk of ADRs especially in critically ill patients. The physicians must be well-versed with the dynamics of fluid-electrolyte balance.


2019 ◽  
Vol 48 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Claudio Ronco ◽  
Zaccaria Ricci ◽  
Faeq Husain-Syed

Critically ill patients developing severe forms multiple organ dysfunction syndrome (MODS) may not be adequately supported by pharmacologic management. In these complex cases, a single form of extracorporeal organ support (ECOS) may be required, but multiple organ support therapy (MOST) is currently seen as a feasible approach. Severe renal dysfunction is a typical syndrome requiring renal replacement therapy (RRT) in the context of MODS. After more than a decade of RRT application in various intensive care settings, ECOS are not anymore seen as extraordinary or particularly aggressive techniques in MODS patients. Nowadays, a significant increase in the use of extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal is occurring. When renal and cardio-pulmonary ECOS are used together, a multidisciplinary approach is necessary to minimize negative interactions and unwanted adverse effects. In this editorial, we focus on the organ crosstalk between the native and artificial organs, including the advantages and disadvantages of organ support on multiorgan function. Much of current experience on MOST has been gained upon RRT connected to other organ support therapies. Overall, available literature has not definitely established the ideal timing of these interventions, and whether early implementation impacts organ recovery and optimizes resource utilization is still a matter of open debate: it is possible that future research will be devoted to identify patient groups that may benefit from short- and long-term multiple organ support. Video Journal Club “Cappuccino with Claudio Ronco” at  https://www.karger.com/Journal/ArticleNews/490694?sponsor=52


Planta Medica ◽  
2020 ◽  
Author(s):  
Maja Hitl ◽  
Nebojša Kladar ◽  
Neda Gavarić ◽  
Biljana Božin

AbstractRosmarinic acid is a phenolic compound commonly found in the Lamiaceae (Labiateae) plant species. It is considered responsible for a wide spectrum of biological and pharmacological activities of plants containing this compound. The aim of the current review is to present the fate of rosmarinic acid inside the human body, explained through pharmacokinetic steps and to briefly present the health benefits of RA. Pharmacokinetics was at first studied in animal models, but several studies were conducted in humans as well. This compound can be applied topically, pulmonary, intranasally, and via intravenous infusion. However, peroral application is the main route of entry into the human body. Presumably, it is mainly metabolized by the gut microflora, providing simple, more easily absorbed phenolic units. Inside the body, the rosmarinic acid molecule undergoes structural changes, as well as conjugation reactions. Renal excretion represents the main path of elimination. Previously conducted studies reported no serious adverse effects of herbal remedies containing RA, as well as their positive effects on human health. In addition to in vitro studies, clinical investigations suggested its benefits in dermatological, allergic, and osteoarthritic disorders, as well as for improving cognitive performance and in metabolic syndrome treatment. Future studies should investigate the kinetics during long-term application in patients who would have potential benefits from RA usage. Pharmaceutical formulations designed to prevent the fast metabolism of RA and allow its penetration into other compartments of the human body are also interesting topics for future research.


2006 ◽  
Vol 24 (24) ◽  
pp. 4003-4010 ◽  
Author(s):  
Márcio Soares ◽  
Jorge I.F. Salluh ◽  
Marilia S. Carvalho ◽  
Michael Darmon ◽  
José R. Rocco ◽  
...  

Purpose To evaluate the outcomes of critically ill patients with cancer and acute renal dysfunction. Patients and Methods Prospective cohort study conducted at a 10-bed oncologic medical-surgical intensive care unit (ICU) over a 56-month period. Results Of 975 patients, 309 (32%) had renal dysfunction and were studied. Their mean age was 60.9 ± 15.9 years; 233 patients (75%) had solid tumors and 76 (25%) had hematologic malignancies. During the ICU stay, 98 patients (32%) received dialysis. Renal dysfunction was multifactorial in 56% of the patients, and the main associated factors were shock/ischemia (72%) and sepsis (63%). Overall hospital and 6-month mortality rates were 64% and 73%, respectively. Among patients who required dialysis, mortality rates were lower in patients who received dialysis on the first day of ICU in comparison with those who required it thereafter. In a multivariable Cox model, age more than 60 years, uncontrolled cancer, impaired performance status, and more than two associated organ failures were associated with increased 6-month mortality. Renal function was completely re-established in 82% and partially re-established in 12%, and only 6% of survivors required chronic dialysis. Conclusion Acute renal dysfunction is frequent in critically ill patients with cancer. Although mortality rates are high, selected patients can benefit from ICU care and advanced organ support. When evaluating prognosis and the appropriateness of dialysis in these patients, older age, functional capacity, cancer status and the severity of associated organ failures are important variables to take into consideration.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257558
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Haiwang Sha ◽  
Fen He

Respiratory failure refers to pulmonary ventilation and ventilatory dysfunction caused by various reasons, which makes the patient unable to maintain the gas exchange required for stillness and causes a series of pathophysiological changes and corresponding clinical manifestations. In order to solve the problem of respiratory failure in critically ill patients, it is of great significance to analyze the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This article aims to study the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This paper presents the key technology based on the ARM11 processor. A breathing motion model is detected and established through a ventilator. The research objects are mainly divided into group A and group B. By comparing the two groups of emergency ventilator ventilation, it can effectively prevent the increase in respiratory muscle fatigue, reduce oxygen consumption, improve the patient's ventilation function and oxygen balance, quickly correct hypoxia and carbon dioxide storage, cooperate with drug treatment, and quickly take out the ventilator after relief. Good treatment results were achieved. The results show that the emergency ventilator controlled by a microcomputer is effective. The total effective rate of the control group was 71.11%, which was significantly lower than that of the observation group (86.67%).


2021 ◽  
Vol 17 (4) ◽  
pp. 13-22
Author(s):  
V.I. Trykhlib ◽  
A.P. Kazmirchuk ◽  
V.V. Grushkevych ◽  
T.V. Burakova

The article states that the new coronavirus disease (COVID-19) is characterized by a range of clinical manifestations, the development of various complications, inconsistency of clinical, laboratory and instrumental data of the patient’s state, which the authors have observed so far according to the results of our previous studies. A review of the literature is presented on the symptoms, laboratory blood tests of critically ill patients who recovered and those who died of a new COVID-19. Among the hospitalized seriously ill patients, there were mostly men, a signifi­cant number had comorbidities. According to the literature, hospitali­zed critically ill patients with confirmed new COVID-19 in most cases had cough, fever, chills, shortness of breath, lymphopenia. Other symptoms include sputum, headache, dizziness, rhinorrhea, anosmia, dysgeusia, sore throat, abdominal pain, ano­rexia and vomiting, diarrhea, nausea, and muscle pain. The study concluded that doctors, especially after 3 days of illness, when assessing the state of the patient, should pay attention to the following data or their severity, a combination of several symptoms that may suggest the need for hospitalization, particularly in the intensive care unit: the age of the patient; the pre­sence of concomitant pathology (cardiovascular, cerebral, chronic respiratory diseases, diabetes, obesity), especially in the stage of decompensation; the presence and extent of impaired consciousness (Glasgow Coma Scale); cyanosis, pallor of the skin, mucous membranes; acrocyanosis or central cyanosis; duration of fever (> 38 °C) more than 3 days, especially > 39 °C; manifestations of dyspnea (chest tightness, shortness of breath or tachypnea, shortness of breath during exercises), respiratory rate > 24 beats per minute or < 10; heart rate ≥ 125 beats per minute (measured when the patient is sitting); systolic blood pressure < 100 mmHg; SOFA score > 2; CURB-65 score > 2; the presence of signs of emergencies (acute respiratory distress syndrome, acute renal failure, bleedings and others); SpO2 < 93 %; leukocytosis > 10 • 109/l, lymphopenia, thrombocytopenia, serum C-reactive protein > 10 mg/l; an increase in prothrombin time (> 16), in the levels of D-dimer (> 1.5 ng/ml), ferritin (> 300), lactate dehydrogenase (above 360 U/l), procalcitonin (≥ 0.5 ng/ml), lactate (> 2 mmol/L), NT-proBNP (≥ 400 pg/ml), high-sensitivity cardiac troponin (> 5 pg/ml), changes on the electrocardiogram; lung damage more than 25 % according to computed tomography.


2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Seidu A. Richard ◽  
Sylvanus Kampo ◽  
Maite Esquijarosa Hechavarria ◽  
Marian Sackey ◽  
Alexis D. B. Buunaaim ◽  
...  

Chloroquine (CQ) and hydroxychloroquine (HCQ) are derivatives of 4-aminoquinoline compounds with over 60 years of safe clinical usage. CQ and HCQ are able to inhibit the production of cytokines such as interleukin- (IL-) 1, IL-2, IL-6, IL-17, and IL-22. Also, CQ and HCQ inhibit the production of interferon- (IFN-) α and IFN-γ and/or tumor necrotizing factor- (TNF-) α. Furthermore, CQ blocks the production of prostaglandins (PGs) in the intact cell by inhibiting substrate accessibility of arachidonic acid necessary for the production of PGs. Moreover, CQ affects the stability between T-helper cell (Th) 1 and Th2 cytokine secretion by augmenting IL-10 production in peripheral blood mononuclear cells (PBMCs). Additionally, CQ is capable of blocking lipopolysaccharide- (LPS-) triggered stimulation of extracellular signal-modulated extracellular signal-regulated kinases 1/2 in human PBMCs. HCQ at clinical levels effectively blocks CpG-triggered class-switched memory B-cells from differentiating into plasmablasts as well as producing IgG. Also, HCQ inhibits cytokine generation from all the B-cell subsets. IgM memory B-cells exhibits the utmost cytokine production. Nevertheless, CQ triggers the production of reactive oxygen species. A rare, but serious, side effect of CQ or HCQ in nondiabetic patients is hypoglycaemia. Thus, in critically ill patients, CQ and HCQ are most likely to deplete all the energy stores of the body leaving the patient very weak and sicker. We advocate that, during clinical usage of CQ and HCQ in critically ill patients, it is very essential to strengthen the CQ or HCQ with glucose infusion. CQ and HCQ are thus potential inhibitors of the COVID-19 cytokine storm.


2020 ◽  
Vol 40 (5) ◽  
pp. 26-37
Author(s):  
Hannah Nakashima ◽  
Cara Gallegos

Background Families experience high levels of stress during a loved one’s critical illness. Objective To provide an overview of current evidence on the use of journal writing as a coping mechanism for family members during a loved one’s critical illness in a neonatal, pediatric, or adult intensive care unit. Methods Five databases (MEDLINE, PsycINFO, CINAHL, APA PsycArticles, and Health Source: Nursing/Academic Edition) were searched to identify studies examining the benefits of journal writing for family members of critically ill patients. Eight eligible studies reported data from 426 relatives of critically ill patients. Results Regarding quality assessment, the quantitative studies met 73.1% of relevant quality criteria, whereas qualitative studies met 81.3%. Mixed-methods studies met 82.4% of quantitative and 55% of qualitative criteria. Various key themes were identified: communication and understanding, connection to the patient, emotional expression, creating something meaningful, and the importance of pictures and staff entries. Overall, writing in a diary seems to be beneficial for reducing psychological distress and posttraumatic stress disorder, but none of the studies found that it significantly decreased anxiety or depression. Conclusions The findings of this review suggest that having family members of critically ill patients write in a diary is a simple and cost-effective intervention that may improve their psychological outcomes. Critical care nurses are in a position to educate families about the potential benefits of writing in a diary. Future research would be valuable regarding the benefits of using a diary and an optimal approach for doing so in this population.


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