scholarly journals Commercial vs. Natural Food-based Tube Feeding on Diarrhea Incidence in Critically Ill Cardiac Surgery Patients (P12-030-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Dario Gregori ◽  
Adam Fabiani ◽  
Gianfranco Sanson ◽  
Giulia Lorenzoni
Keyword(s):  
Cardiac Surgery ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tube Feeding ◽  
Primary Study ◽  
Natural Food ◽  
P Value ◽  
Negative Consequences ◽  
Gastrointestinal Complications ◽  
Diarrhea Incidence

Abstract Objectives Diarrhea has negative consequences on health outcomes of critically ill patients administered with enteral feeding. Diarrhea pathogenesis in these patients is associated with several factors, including the administration of commercial enteral formulas providing nutrients and food without the natural food matrix. However, the potential benefits of natural food-based tube feeding on gastrointestinal complications have not been well established yet. The present study aimed at examining the effect of natural-based tube feeding on diarrhea incidence in critically ill cardiac surgery patients. Methods Retrospective medical chart review of adult patients admitted postoperatively to a Cardiac Surgery Intensive Care Unit and administered with tube feeding. Two cohorts of patients were identified, one administered with blenderized natural food (BNF) and the other one with standard commercial formula (SCF). In the study setting, there was a switch from SCF to BNF starting from 01/01/2015. The two cohorts were identified according to such a time criterion. Time to the first event of diarrhea, defined as the presence of loose or watery stool - at least 3-time per day - according to the Bristol Stool Chart type, was the primary study outcome. A crude comparison of the time to the first event of diarrhea between SCF and BNF cohorts was carried out using Kaplan-Meier curves. Differences in survival rates between groups were assessed with the Log-Rank test. The adjusted comparison was performed by fitting a multivariable Cox Proportional-Hazards (PH) model. Results Two-hundred and ten patients were considered in the study (99 in the BNF cohort). No significant differences were identified in patients’ baseline characteristics. At crude analysis, the likelihood of diarrhea occurrence was significantly lower for subjects in the BNF compared to those in the SCF cohort (p-value 0.017). At adjusted analysis, BNF almost halved the risk of experiencing diarrhea (Hazard Ration of diarrhea in BNF patients compared to SCF ones of 0.554, 95% CI: 0.327–0.938, p-value 0.02). Conclusions In a population of postoperative cardiac surgery patients, a BNF diet was found to reduce the risk of diarrhea significantly. The present study provides new insights into the nutritional management of critically ill patients. Funding Sources Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.

scholarly journals Longitudinal Outcomes in Octogenarian Critically Ill Patients with a Focus on Frailty and Cardiac Surgery

2020 ◽  
Vol 10 (1) ◽  
pp. 12
Author(s):  
Aileen Hill ◽  
Daren K. Heyland ◽  
Rolf Rossaint ◽  
Rakesh C. Arora ◽  
Daniel T. Engelman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Elderly Patients ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
P Value ◽  
Clinical Frailty Scale ◽  
Icu Patients ◽  
Subdistribution Hazard ◽  
Discharge Home ◽  
Surgical Icu

Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, prospective observational cohort study of 610 elderly patients admitted to the ICU and followed for one year to document long-term outcomes. CSX-ICU-patients (n = 49) were compared to surgical ICU patients (n = 184) with regard to demographics, frailty, and outcomes. Of all surgical patients, 102 (43%) were considered vulnerable or frail. The subdistribution hazard ratio (SHR) of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.54 (95% confidence interval (CI), 0.34, 0.86, p = 0.007). The p-value for effect modification between surgery group (CSX vs. surgical ICU patients) and Clinical Frailty Scale (CFS) group was not significant (p = 0.37) suggesting that the observed difference in the CFS effect between the CSX and surgical ICU patients is consistent with random error. A further subgroup analysis shows that among surgical ICU patients, the SHR of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.49 (95% CI, 0.29, 0.83) while the corresponding SHR for CSX patients was 0.77 (0.32–1.88). In conclusion, preoperative frailty reduced the rate of discharge to home in both surgical and CSX patients, but a larger sample of CSX patients is needed to adequately address this question in this patient group.

scholarly journals ASSOCIATION OF ACID-BASE PARAMETERS WITH LACTATE LEVEL IN CRITICALLY ILL PATIENTS WITH METABOLIC ACIDOSIS

2018 ◽  
Vol 24 (2) ◽  
pp. 141
Author(s):  
Donaliazarti Donaliazarti ◽  
Rismawati Yaswir ◽  
Hanifah Maani ◽  
Efrida Efrida
Keyword(s):  
Metabolic Acidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Linear Regression Analysis ◽  
P Value ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Parameters ◽  
Base Balance

Metabolic acidosis is prevalent among critically ill patients and the common cause of metabolic acidosis in ICU is lactic acidosis. However, not all ICUs can provide lactate measurement. The traditional method that uses Henderson-Hasselbach equation (completed with BE and AG) and alternative method consisting of Stewart and its modification (BDEgap and SIG), are acid-base balance parameters commonly used by clinicians to determine metabolic acidosis in critically ill patients. The objective of this study was to discover the association between acid-base parameters (BE, AGobserved, AGcalculated, SIG, BDEgap) with lactate level in critically ill patients with metabolic acidosis. This was an analytical study with a cross-sectional design. Eighty-four critically ill patients hospitalized in the ICU department Dr. M. Djamil Padang Hospital were recruited in this study from January to September 2016. Blood gas analysis and lactate measurement were performed by potentiometric and amperometric method while electrolytes and albumin measurement were done by ISE and colorimetric method (BCG). Linear regression analysis was used to evaluate the association between acid-base parameters with lactate level based on p-value less than 0.05. Fourty five (54%) were females and thirty-nine (46%) were males with participant’s ages ranged from 18 to 81 years old. Postoperative was the most reason for ICU admission (88%). Linear regression analysis showed that p-value for BE, AGobserved, AGcalculated, SIG and BDEgap were 119; 0.967; 0.001; 0.001; 0.689, respectively. Acid-base balance parameters which were mostly associated with lactate level in critically ill patients with metabolic acidosis were AGcalculated and SIG. 

scholarly journals Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Prospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Alaa Alhubaishi ◽  
Ohoud Al Juhani ◽  
Khalid Eljaaly ◽  
Omar Al Harbi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Early Initiation ◽  
P Value ◽  
Icu Mortality ◽  
Icu Admission ◽  
Icu Length Of Stay ◽  
Beta Coefficient ◽  
Multicenter Prospective Cohort Study

Abstract Background: Corticosteroids, especially dexamethasone, showed a survival benefit in critically ill COVID 19 patients. However, it is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. The aim of this study is to evaluate the timing of dexamethasone initiation and 30-day ICU mortality in critically ill patients with COVID19. Methods: A multicenter, non-interventional, prospective study for all adult COVID19 admitted to intensive care units (ICUs) who received systemic dexamethasone between March 01 to December 31, 2020. Patients were divided into two groups based on the timing for dexamethasone initiation (early vs. late). Early use defined as the initiation of dexamethasone within three days of ICU admission. Multivariate logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: A total of 475 patients were included in the study; dexamethasone was initiated early within three days of ICU admission in 433 patients. Early initiation of dexamethasone was associated with lower 30-day ICU mortality (OR [95%CI]: 0.43 [0.23, 0.81], p-value = 0.01), and acute kidney injury during ICU stay, (OR [95%CI]: 0.45 [0.21, 0.94], p-value = 0.03). Additionally, among survivors, early initiation was associated with shorter MV duration (beta coefficient [95% CI]: -0.94 [-1.477, -0.395], p-value = 0.0001), ICU length of stay (LOS) (beta coefficient [95%CI]: -0.73 [-0.9971, -0.469], p-value = 0.0001), and hospital LOS (beta coefficient [95%CI]: -0.68 [-0.913, -0.452], p-value = 0.0001). Conclusion: Early initiation of dexamethasone within three days of ICU admission in COVID-19 critically ill patients was associated with a mortality benefit. Additionally, it was associated with shorter MV duration, hospital, and ICU LOS.

scholarly journals Effect of Permissive Underfeeding with Intensive Insulin Therapy on MCP-1, sICAM-1, and TF in Critically Ill Patients

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 987
Author(s):  
Ahmad Aljada ◽  
Ghada Fahad AlGwaiz ◽  
Demah AlAyadhi ◽  
Emad Masuadi ◽  
Mahmoud Zahra ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Inflammatory Mediators ◽  
Critically Ill Patients ◽  
Caloric Intake ◽  
Intercellular Adhesion Molecule ◽  
P Value ◽  
Permissive Underfeeding ◽  
Significant Difference

Purpose: This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients. Methodology: This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time. Results: Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01). Conclusions: Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.

scholarly journals Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Angelina Grest ◽  
Judith Kurmann ◽  
Markus Müller ◽  
Victor Jeger ◽  
Bernard Krüger ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Retrospective Study ◽  
Mean Arterial Pressure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Cost ◽  
Cardiovascular Safety ◽  
Drug Infusion ◽  
Saps Ii

Purpose. The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. Methods. 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). Results. Patients receiving clonidine (n = 193) were younger (66 (57–73) vs 70 (63–77) years, p=0.003) and had a lower SAPS II (35 (27–48) vs 41 (31–54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75–100) vs 90 (80–105) bpm, p=0.028), MAP (70 (65–80) vs 70 (65–75) mmHg, p=0.093), and norepinephrine (0.05 (0.00–0.11) vs 0.12 (0.03–0.19) mcg/kg/min, p<0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (−0.04–0.02) mcg/kg/min) and decreased in the dexmedetomidine group (−0.03 (−0.10–0.02) mcg/kg/min, p=0.007). Conclusions. Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

scholarly journals Use of argatroban: Experiences in continuous renal replacement therapy in critically ill patients after cardiac surgery

2014 ◽  
Vol 147 (6) ◽  
pp. 1918-1924 ◽  
Author(s):  
Matthias Klingele ◽  
Hagen Bomberg ◽  
Anne Lerner-Gräber ◽  
Danilo Fliser ◽  
Aaron Poppleton ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients

Crystalloids in critical illness

2016 ◽  
Author(s):  
Karthik Raghunathan ◽  
Andrew Shaw
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Endothelial Glycocalyx ◽  
Strong Ion Difference ◽  
Negative Consequences ◽  
Negative Effects ◽  
Randomized Controlled Studies ◽  
Preload Responsiveness ◽  
Saline Solutions

‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.

scholarly journals Copeptin and Arginine Vasopressin Concentrations in Critically Ill Patients

2006 ◽  
Vol 91 (11) ◽  
pp. 4381-4386 ◽  
Author(s):  
Stefan Jochberger ◽  
Nils G. Morgenthaler ◽  
Viktoria D. Mayr ◽  
Günter Luckner ◽  
Volker Wenzel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Healthy Volunteers ◽  
Critically Ill ◽  
Arginine Vasopressin ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
University Teaching ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients

Abstract Context: Determination of arginine vasopressin (AVP) concentrations may be helpful to guide therapy in critically ill patients. A new assay analyzing copeptin, a stable peptide derived from the AVP precursor, has been introduced. Objective: Our objective was to determine plasma copeptin concentrations. Design: We conducted a post hoc analysis of plasma samples and data from a prospective study. Setting: The setting was a 12-bed general and surgical intensive care unit (ICU) in a tertiary university teaching hospital. Patients: Our subjects were 70 healthy volunteers and 157 ICU patients with sepsis, with systemic inflammatory response syndrome (SIRS), and after cardiac surgery. Interventions: There were no interventions. Main Outcome Measures: Copeptin plasma concentrations, demographic data, AVP plasma concentrations, and a multiple organ dysfunction syndrome score were documented 24 h after ICU admission. Results: AVP (P &lt; 0.001) and copeptin (P &lt; 0.001) concentrations were significantly higher in ICU patients than in controls. Patients after cardiac surgery had higher AVP (P = 0.003) and copeptin (P = 0.003) concentrations than patients with sepsis or SIRS. Independent of critical illness, copeptin and AVP correlated highly significantly with each other. Critically ill patients with sepsis and SIRS exhibited a significantly higher ratio of copeptin/AVP plasma concentrations than patients after cardiac surgery (P = 0.012). The American Society of Anesthesiologists’ classification (P = 0.046) and C-reactive protein concentrations (P = 0.006) were significantly correlated with the copeptin/AVP ratio. Conclusions: Plasma concentrations of copeptin and AVP in healthy volunteers and critically ill patients correlate significantly with each other. The ratio of copeptin/AVP plasma concentrations is increased in patients with sepsis and SIRS, suggesting that copeptin may overestimate AVP plasma concentrations in these patients.

Hyperglycemia Management in Non-critically Ill Hospitalized Patients

2009 ◽  
Vol 22 (5) ◽  
pp. 467-477
Author(s):  
Lindsay M. Arnold ◽  
Darcie L. Keller ◽  
Toyin S. Tofade
Keyword(s):  
Health Care ◽  
Glycemic Control ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Hospitalized Patients ◽  
Negative Consequences ◽  
Care Providers ◽  
Specific Patient ◽  
Oral Agents

There is increasing evidence demonstrating negative consequences and poor clinical outcomes associated with untreated hyperglycemia in hospitalized patients. Data in specific patient populations, primarily critically ill patients, demonstrate improved patient outcomes with tight glycemic control. To date, no clear evidence exists to determine optimal glycemic targets in non-critically ill patients; however, experts agree that better glycemic control in hospitalized patients is warranted. Glycemic control is complicated by numerous factors in hospitalized patients including increased circulating stress hormones, changing nutritional status, and administration of medication therapies that contribute to hyperglycemia. In addition, fear of hypoglycemia among health care providers, a commonly cited barrier, contributes to the failure to adopt more intensive insulin regimens. Current practice trends have proven ineffective and major changes are needed. Some of those trends include the use of sliding scale insulin, continuation of oral agents or combination insulins upon admission, and provider reluctance to initiate insulin in patients not receiving insulin prior to admission. With proper education, safe and effective use of insulin can be used during hospitalization to improve glycemic control. The following article reviews the benefits of glycemic control, identifies barriers to achieving glycemic control, and describes strategies for health care providers and institutions to realize glycemic control in medically ill hospitalized patients.

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