scholarly journals Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study

2020 ◽  
Vol 13 ◽  
pp. 117863882090599
Author(s):  
Shinobu Yamamoto ◽  
Karen Allen ◽  
Kellie R Jones ◽  
Sarah S Cohen ◽  
Kemuel Reyes ◽  
...  
Keyword(s):  
Critically Ill ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Medical Intensive Care Unit ◽  
Mechanical Ventilator ◽  
Macronutrient Composition ◽  
Gastrointestinal Intolerance ◽  
Medical Intensive Care ◽  
Secondary Outcomes ◽  
Enteral Formula

Background: Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals. Design: This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes). Result: A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years with mean body mass index (BMI) of 27.9 ± 7.5 kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3 days. Overall, 75.0 ± 26.3% and 69.3 ± 26.7% of calorie and protein goals were achieved using the study formula. Conclusions: Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.

scholarly journals Not All Critically Ill Obese Patients Are the Same: The Influence of Prior Comorbidities

ISRN Obesity ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Adam Rahman ◽  
Renee D. Stapleton ◽  
Daren K. Heyland
Keyword(s):  
Critically Ill ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Admission Diagnosis ◽  
Apache Ii Score ◽  
Obese Patients ◽  
Icu Length Of Stay ◽  
Improved Outcomes ◽  
Severely Obese ◽  
Secondary Outcomes

Purpose. Data suggest that obesity in critical illness is associated with improved outcomes. We postulate that these findings may be influenced by preillness comorbidities. We sought to determine if critically ill obese patients without significant comorbidity had improved mortality compared to obese patients with multiple comorbidities. Materials and Methods. We analyzed data from a prospective observational study conducted in 3 tertiary ICUs. Severely obese (body mass index ≥30) adults in the ICU for ≥24 hours were identified and classified into limited comorbid illnesses (0-1) or multiple comorbidities (≥2). The primary outcome was the odds ratio (OR) of mortality at day 28. Important secondary outcomes were ICU length of stay and ICU free days in the first 28 days. Results. 598 patients were enrolled; 183 had BMI ≥30. Of these, 38 had limited comorbidities and 145 had multiple comorbidities. In unadjusted analyses, obese patients with multiple comorbidities were 4.70 times (95% CI 1.07–20.6) as likely to die by day 28 compared to patients with limited comorbidities (P=0.04). After stratifying by admission diagnosis and adjusting for APACHE II score, the influence of comorbidities remained large and trended toward significance (OR 4.28, 95% CI 0.92–20.02, P=0.06). In adjusted analyses, obese patients with multiple comorbidities tended to have longer ICU duration (3.06 days, SE 2.28, P=0.18) and had significantly fewer ICU free days in the first 28 days (−3.92 days, SE 1.83, P=0.03). Conclusions. Not all critically ill obese patients are the same. Those with less comorbidity may have better outcomes than those with multiple comorbidities. This may be important when considering prognosis and discussing care with patients and families.

Procalcitonin levels in sepsis and its association with clinical outcome in southern India

2017 ◽  
Vol 47 (4) ◽  
pp. 331-336
Author(s):  
Alex Rebello ◽  
Molly Mary Thabah ◽  
Tarun Kumar Dutta ◽  
Zachariah Bobby ◽  
BN Harish ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Antibiotic Administration ◽  
Mean Values ◽  
Good Marker ◽  
Significant Difference ◽  
Medical Intensive Care ◽  
Medical Wards

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

A survey of bedside methods used to detect pulmonary aspiration of enteral formula in intubated tube-fed patients

1999 ◽  
Vol 8 (3) ◽  
pp. 160-167 ◽  
Author(s):  
NA Metheny ◽  
MA Aud ◽  
RJ Wunderlich
Keyword(s):  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Pulmonary Aspiration ◽  
Care Facilities ◽  
Nursing Textbooks ◽  
Medical Intensive Care ◽  
Reagent Strips ◽  
Acute Care Facilities ◽  
Enteral Formula ◽  
Enteral Formulas

BACKGROUND: The most frequently recommended methods to assess for pulmonary aspiration of enteral formula in intubated, tube-fed patients are (1) adding dye to enteral formulas and observing for dye-stained tracheal secretions and (2) testing tracheal secretions with glucose oxidase reagent strips to detect the presence of glucose-rich formula. Reportedly, the glucose method is more sensitive than the dye method, and the dye method may have greater potential for harm. It is not known if this information has resulted in wider use of the glucose method in practice settings. OBJECTIVES: To describe the frequency with which nurses in intensive care units use the dye and glucose methods to detect pulmonary aspiration of enteral formula in tube-fed, intubated patients. METHODS: One registered nurse in the medical intensive care unit at 285 acute-care facilities was contacted by telephone and asked about the methods used to detect pulmonary aspiration of enteral formula in tube-fed, intubated adult patients. RESULTS: Responses were obtained from 281 facilities. More than 73% of the respondents reported using only the dye method; about 1% reported using only the glucose method. Approximately 13% used both methods; another 13% did not use either method. CONCLUSIONS: The dye method is used far more often than is the glucose method. Two probable reasons are that the dye method is easier to implement, and it is recommended in commonly used basic nursing textbooks.

Hemodynamic Instability Secondary to Vasopressin Withdrawal in Septic Shock

2017 ◽  
Vol 34 (9) ◽  
pp. 761-765 ◽  
Author(s):  
Brittany D. Bissell ◽  
Carolyn Magee ◽  
Peter Moran ◽  
Melissa L. Thompson Bastin ◽  
Alexander H. Flannery
Keyword(s):  
Septic Shock ◽  
Primary Outcome ◽  
Hemodynamic Instability ◽  
Bolus Administration ◽  
Optimal Sequence ◽  
Norepinephrine Infusion ◽  
Increased Risk ◽  
Medical Intensive Care ◽  
Baseline Characteristics ◽  
Secondary Outcomes

Rationale: Vasopressors such as norepinephrine are first line for support of mean arterial pressure (MAP) in the management of septic shock. Their use, however, is commonly associated with many adverse events. These detriments frequently trigger the use of alternative, noncatecholamine therapies, including vasopressin. Vasopressin deficiency is a known physiologic consequence of septic shock, and while guidelines recommend vasopressin in addition to norepinephrine, no consensus exists on the duration of deficiency or ideal time of cessation. Studies have suggested that vasopressin discontinuation prior to other vasopressors may lead to hypotension; however, data are limited. This study evaluates the optimal sequence for the discontinuation of vasopressin therapy in septic shock. Methods: This was a 1-year retrospective study of 152 patients admitted to the medical intensive care unit (ICU) with septic shock who received concurrent norepinephrine and vasopressin for vasoactive support. Patients were excluded if death occurred on vasopressors, within 24 hours after discontinuation of vasopressors, or within 48 hours of ICU admission. The primary outcome of hemodynamic instability included incidence of hypotension after vasopressor discontinuation (2 consecutive MAPs < 60 mm Hg), fluid bolus administration, greater than 0.05 μg/kg/min increase in norepinephrine requirements, or addition of an alternative vasopressor. Secondary outcomes included time to hypotension, total vasopressor duration, arrhythmias, mortality, and length of stay. Results: Ninety-one patients met exclusion criteria, resulting in 61 patients for evaluation. Vasopressin was the first vasoactive therapy to be discontinued in 19 patients and last in 42 patients. Baseline characteristics and the use of potentially confounding treatments known to effect MAP were similar between groups. Discontinuation of vasopressin first was associated with a significant increase in hemodynamic instability (74% vs 16.7%, P < .01), with a shorter time to hemodynamic instability (5 vs 15 hours, P < .01). Secondary outcomes were similar. Conclusion: Vasopressin discontinuation prior to cessation of norepinephrine infusion was associated with an increased risk of hemodynamic instability.

Critically Ill Surgical Patients Followed in a Medical Intensive Care Unit

2010 ◽  
Vol 1 (3) ◽  
pp. 60-62
Author(s):  
Mine Durusu Tanriover ◽  
Bilgin Sait ◽  
Begum Ergan Arsava ◽  
Kaya Yorganci ◽  
Arzu Topeli Iskit
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Intensive Care Unit ◽  
Surgical Patients ◽  
Medical Intensive Care ◽  
Critically Ill Surgical Patients

scholarly journals Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

2019 ◽  
Vol 30 (11) ◽  
pp. 2243-2251 ◽  
Author(s):  
Emily L. Joyce ◽  
Sandra L. Kane-Gill ◽  
Priyanka Priyanka ◽  
Dana Y. Fuhrman ◽  
John A. Kellum
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Lengths Of Stay ◽  
Medication Exposure ◽  
Secondary Outcomes

BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

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