scholarly journals The Type II Iodothyronine Deiodinase Is Up-Regulated in Skeletal Muscle during Prolonged Critical Illness

2007 ◽  
Vol 92 (8) ◽  
pp. 3330-3333 ◽  
Author(s):  
Liese Mebis ◽  
Lies Langouche ◽  
Theo J. Visser ◽  
Greet Van den Berghe
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Type Ii ◽  
Low T3 Syndrome ◽  
Low T3

Abstract Context: Critical illness is associated with the low T3 syndrome. It remains unclear whether altered type II deiodinase activity (D2) in skeletal muscle contributes to this syndrome. Objective: Our objective was to study D2 expression and activity in skeletal muscle of acute and prolonged critically ill patients. Design and Setting: We conducted a clinical observational study in acute and prolonged critical illness with comparison with healthy controls at a university hospital surgical intensive care unit. Patients: Subjects included 63 prolonged critically ill patients who died in the intensive care unit, 21 acutely ill patients, and 38 controls matched for age, gender, and body mass index. Results: Elevated expression of the D2 gene and D2 activity in skeletal muscle of prolonged, but not acute, critically ill patients were observed in the face of low circulating thyroid hormone levels. Conclusions: Reduced D2 activity does not appear to play a role in the pathogenesis of the low T3 syndrome of critical illness.

Myopathy and Neuropathy Acquired in the Intensive Care Unit

2019 ◽  
pp. 677-684
Author(s):  
Priya S. Dhawan ◽  
Jennifer A. Tracy
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Peripheral Neuropathy ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Illness Polyneuropathy ◽  
Muscle Disorder

Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

The need to know: experiences of critically ill patients

2000 ◽  
Vol 9 (3) ◽  
pp. 192-198 ◽  
Author(s):  
JE Hupcey ◽  
HE Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Second Phase ◽  
The Past ◽  
Intensive Care Unit Nurses ◽  
Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Bedside Videolaryngoscopic Assessment of Intubation Trauma

1989 ◽  
Vol 98 (8) ◽  
pp. 586-590 ◽  
Author(s):  
David M. Alessi ◽  
David G. Hanson ◽  
George Berci
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vocal Fold ◽  
Video Recording ◽  
Surgical Intensive Care Unit ◽  
Voice Rehabilitation ◽  
Surgical Intensive Care ◽  
Vocal Fold Paresis

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.

scholarly journals Efficacy of an 8-week Bedside Ultrasound Training Program for Surgical Residents in the Intensive Care Unit

2021 ◽  
Author(s):  
Kyoung Moo Im ◽  
Eun Young Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Training Program ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bedside Ultrasound ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Post Graduate ◽  
Surgical Residents

Abstract BackgroundBedside ultrasound has become one of the most important non-invasive and readily available diagnostic tools especially for critically ill patients. However, the current ultrasound training program is not standardized and is mostly unavailable to all surgical residents equally. The aim of this study was to assess and evaluate the effectiveness of our new training program in bedside ultrasound for surgical residents.MethodsPostgraduate residents (years 1 to 4) from the department of general surgery in a tertiary hospital attended the newly designed, 8-week training course in bedside ultrasound for critically ill patients at the surgical intensive care unit. Didactic and experimental lectures in basic ultrasound physics and machine usage were delivered, followed by daily hands-on ultrasound training to patients. Each participant prospectively documented their ultrasound findings and completed self-assessment of ultrasound skills using a Likert scale.Results44 residents were enrolled in the current study and only 36.4% of them were previously exposed to bedside ultrasound experience. Following the course completion, the proficiency levels and the objective structured assessment of ultrasound skill (OSAUS) scores showed significant improvement in all elements (P < 0.001). The mean differences in pre- and post-course score between post-graduate years were recorded, except for proficiency in peritoneal cavity (P = 0.163). Post-hoc analysis revealed that post-graduate year 2 residents showed a higher improvement in most elements. The training program showed improvement in post-course scores, whether or not residents had previous experience.ConclusionsOur results revealed that the knowledge and confidence of surgical residents in bedside ultrasound could be improved via short-term and impact training curriculum. The authors believe that such education should be encouraged for all surgical residents to enhance competency in performing bedside ultrasound evaluation of critically ill patients.

scholarly journals Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao-Ming Zhang ◽  
Denghong Chen ◽  
Xiao-Hua Xie ◽  
Jun-E Zhang ◽  
Yingchun Zeng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Muscle Area ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

scholarly journals Negative Drift of Sedation Depth In Critically Ill Patients Receiving Constant Minimum Alveolar Concentration of Isoflurane, Sevoflurane, or Desflurane: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Adrian Iustin Georgevici ◽  
Theodoros Kyprianou ◽  
Jennifer Herzog-Niescery ◽  
Livia Procopiuc ◽  
Sivakkanan Loganathan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Linear Models ◽  
Minimum Alveolar Concentration ◽  
T Test ◽  
Surgical Intensive Care Unit ◽  
Continuous Eeg ◽  
Negative Drift

Abstract Background: Intensive care unit (ICU) physicians have extended the minimum alveolar concentration (MAC) to deliver and monitor long-term volatile sedation in critically ill patients. There is limited evidence of MAC’s reliability in controlling sedation depth in this setting. We hypothesized that sedation depth, measured by the electroencephalography (EEG)-derived Narcotrend-Index (burst-suppression N_Index 0 – awake N_Index 100), might drift downward over time despite constant MAC values.Methods: This prospective single-centre randomized clinical study was conducted at a University Hospital Surgical Intensive Care Unit and included consecutive, postoperative ICU patients fulfilling the inclusion criteria. Patients were randomly assigned to receive uninterrupted inhalational sedation with isoflurane, sevoflurane, or desflurane. The end-expiratory concentration of the anaesthetics and the EEG-derived index were measured continuously in time-stamped pairs. Sedation depth was also monitored using Richmond-Agitation-Sedation-Scale (RASS). The paired t-test and linear models (bootstrapped or multilevel) have been employed to analyze MAC, N_Index and RASS across the three groups. Results: Thirty patients were recruited (female/male: 10/20, age 64±11, Simplified Acute Physiology Score II 30±10). In the first 24 hours, 21.208 pairs of data points (N_Index and MAC) were recorded. The median MAC of 0.58±0.06 remained stable over the sedation time in all three groups. The t-test indicated in the isoflurane and sevoflurane groups a significant drop in RASS and EEG-derived N_Index in the first versus last two sedation hours. We applied a multilevel linear model on the entire longitudinal data, nested per patient, which produced the formula N_Index=43−0.7·hours (R2=0.76), showing a strong negative correlation between sedation’s duration and the N_Index. Bootstrapped linear models applied for each sedation group produced: N_Index of 43–0.9, 45–0.8, and 43–0.4·hours for isoflurane, sevoflurane, and desflurane, respectively. The regression coefficient for desflurane was almost half of those for isoflurane and sevoflurane, indicating a less pronounced time-effect in this group.Conclusions: Maintaining constant MAC does not guarantee stable sedation depth. Thus, the patients necessitate frequent clinical assessments or, when unfeasible, continuous EEG monitoring. The differences across different volatile anaesthetics regarding their time-dependent negative drift requires further exploration.Trial registration: NCT03860129.

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