scholarly journals Understanding the mechanisms of glutamine action in critically ill patients

2010 ◽  
Vol 82 (2) ◽  
pp. 417-430 ◽  
Author(s):  
Gisele P. Oliveira ◽  
Cristina M. Dias ◽  
Paolo Pelosi ◽  
Patricia R.M. Rocco
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Cell Function ◽  
Immune Cell ◽  
Experimental Studies ◽  
High Dose ◽  
Neutrophil Accumulation ◽  
Metabolic Functions ◽  
Heat Shock Protein Expression ◽  
High Doses

Glutamine (Gln) is an important energy source and has been used as a supplementary energy substrate. Furthermore, Gln is an essential component for numerous metabolic functions, including acid-base homeostasis, gluconeogenesis, nitrogen transport and synthesis of proteins and nucleic acids. Therefore, glutamine plays a significant role in cell homeostasis and organ metabolism. This article aims to review the mechanisms of glutamine action during severe illnesses. In critically ill patients, the increase in mortality was associated with a decreased plasma Gln concentration. During catabolic stress, Gln consumption rate exceeds the supply, and both plasma and skeletal muscle pools of free Gln are severely reduced. The dose and route of Gln administration clearly influence its effectiveness: high-dose parenteral appears to be more beneficial than low-dose enteral administration. Experimental studies reported that Gln may protect cells, tissues, and whole organisms from stress and injury through the following mechanisms: attenuation of NF (nuclear factor)-kB activation, a balance between pro- and anti-inflammatory cytokines, reduction in neutrophil accumulation, improvement in intestinal integrity and immune cell function, and enhanced of heat shock protein expression. In conclusion, high-doses of parenteral Gln (>0.50 g/kg/day) demonstrate a greater potential to benefit in critically ill patients, although Gln pathophysiological mechanisms requires elucidation.

High-Dose Norepinephrine Treatment: Determinants of Mortality and Futility in Critically Ill Patients

2013 ◽  
Vol 22 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Donna Döpp-Zemel ◽  
AB Johan Groeneveld
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Significance ◽  
Circulatory Shock ◽  
Data Management System ◽  
High Dose ◽  
Rescue Treatment ◽  
High Doses

Background Critically ill patients with circulatory shock sometimes need rescue treatment with high doses of norepinephrine, a treatment that may be associated with a poor outcome because of excessive vasoconstriction. Objective To evaluate the outcome of treatment and its determinants in patients with circulatory shock who received high doses of norepinephrine in the intensive care unit and to identify indicators of futility for the treatment. Methods A retrospective study was done on 113 consecutive patients with circulatory shock who received 0.9 μg/kg per minute or greater of norepinephrine during at least 1 hour at any time in the intensive care unit. Data were extracted from the electronic patient data management system according to a predefined checklist. Results A total of 39 patients survived for 28 days after admission to the intensive care unit. The variables independently associated with 28-day mortality in multivariable models included low urine flow, high lactate levels, high organ failure score, high prothrombin time, and need for epinephrine cotreatment. The reason, dose, and duration of norepinephrine administration did not have prognostic significance. Scores greater than 40 on the Acute Physiology and Chronic Health Evaluation II, bicarbonate levels less than 9.0 mEq/L, or receipt of an epinephrine dose of 0.25 μg/kg per minute or greater were associated with 100% mortality. Conclusions Although the cause of shock and treatment with norepinephrine were not predictive of death when high doses of the drug were deemed necessary, rescue treatment with high-dose norepinephrine is futile in patients with severe disease and metabolic acidemia.

Comparison of the renal effects of low to high doses of dopamine and dobutamine in critically ill patients: A single-blind randomized study

2000 ◽  
Vol 28 (4) ◽  
pp. 921-928 ◽  
Author(s):  
Carole Ichai ◽  
Jérôme Soubielle ◽  
M. Carles ◽  
Carine Giunti ◽  
Dominique Grimaud
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Study ◽  
Renal Effects ◽  
High Doses ◽  
Single Blind

scholarly journals Impact of high dose prophylactic anticoagulation in critically ill patients with COVID-19 pneumonia

CHEST Journal ◽  
2021 ◽  
Author(s):  
Charles Tacquard ◽  
Alexandre Mansour ◽  
Alexandre Godon ◽  
Julien Godet ◽  
Julien Poissy ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
High Dose ◽  
Prophylactic Anticoagulation

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 effect of high-dose parenteral sodium selenite in critically ill patients following sepsis: A clinical and mechanistic study

2017 ◽  
Vol 21 (5) ◽  
pp. 287-293 ◽  
Author(s):  
Mohammad Abdollahi ◽  
Legese Chelkeba ◽  
Arezoo Ahmadi ◽  
Atabak Najafi ◽  
Mohammad Hosein Ghadimi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Sodium Selenite ◽  
Mechanistic Study ◽  
High Dose

High-dose selenium for critically ill patients with systemic inflammation: Pharmacokinetics and pharmacodynamics of selenious acid: A pilot study

Nutrition ◽  
2010 ◽  
Vol 26 (6) ◽  
pp. 634-640 ◽  
Author(s):  
William Manzanares ◽  
Alberto Biestro ◽  
Federico Galusso ◽  
María H. Torre ◽  
Nelly Mañáy ◽  
...  
Keyword(s):  
Pilot Study ◽  
Critically Ill ◽  
Systemic Inflammation ◽  
Critically Ill Patients ◽  
High Dose ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Selenious Acid

scholarly journals REducing Deaths due to OXidative Stress (The REDOXS© Study): rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients

2006 ◽  
Vol 65 (3) ◽  
pp. 250-263 ◽  
Author(s):  
Daren K. Heyland ◽  
Rupinder Dhaliwal ◽  
Andrew G. Day ◽  
John Muscedere ◽  
John Drover ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Randomized Trial ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Antioxidant Therapy ◽  
Favourable Effect ◽  
High Dose ◽  
Antioxidant Supplementation

Critically-ill patients experience an extent of hyperinflammation, cellular immune dysfunction, oxidative stress and mitochondrial dysfunction. Supplementation with key nutrients, such as glutamine and antioxidants, is most likely to have a favourable effect on these physiological derangements, leading to an improvement in clinical outcomes. The results of two meta-analyses suggest that glutamine and antioxidants may be associated with improved survival. The purpose of the present paper is to report the background rationale and study protocol for the evaluation of the effect of high-dose glutamine and antioxidant supplementation on mortality in a large-scale randomized trial in 1200 mechanically-ventilated, critically-ill patients. Patients admitted to an intensive care unit (ICU) with clinical evidence of severe organ dysfunction will be randomized to one of four treatments in a 2×2 factorial design: (1) glutamine; (2) antioxidant therapy; (3) glutamine and antioxidant therapy; (4) placebo. The primary outcome for this study is 28 d mortality. The secondary outcomes are duration of stay in ICU, adjudicated diagnosis of infection, multiple organ dysfunction, duration of mechanical ventilation, length of stay in hospital and health-related quality of life at 3 and 6 months. A novel design feature is the combined use of parenteral and enteral study nutrients dissociated from the nutrition support. The therapeutic strategies tested in the randomized trial may lead to less morbidity and improved survival in critically-ill patients. The trial will be conducted in approximately twenty tertiary-care ICU in Canada and the first results are expected in 2009.

scholarly journals Tigecycline Therapy for Nosocomial Pneumonia due to Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Who Received Inappropriate Initial Antibiotic Treatment: A Retrospective Case Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Xiaomai Wu ◽  
Yefei Zhu ◽  
Qiuying Chen ◽  
Liuyang Gong ◽  
Jian Lin ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Nosocomial Pneumonia ◽  
Critically Ill Patients ◽  
Standard Dose ◽  
High Dose ◽  
Gram Negative Bacteria ◽  
Loading Dose ◽  
Icu Mortality ◽  
Carbapenem Resistant

Background. Nosocomial pneumonia due to carbapenem-resistant Gram-negative bacteria (CRGNB) is a growing concern because treatment options are limited and the mortality rate is high. The effect of tigecycline (TGC) on nosocomial pneumonia due to CRGNB in patients who have received inappropriate initial empiric antibiotic treatment (IIAT) is unclear. Therefore, this study aimed to examine the effect of TGC on nosocomial pneumonia due to CRGNB in critically ill patients who had received IIAT. Methods. A retrospective study was conducted in an adult respiratory intensive care unit. Data were obtained and analyzed for all patients who were treated with TGC ≥ 3 days for microbiologically confirmed nosocomial pneumonia due to CRGNB and had experienced initial antibiotic failure. Clinical and microbiological outcomes were investigated. Results. Thirty-one patients with hospital-acquired pneumonia or ventilator-associated pneumonia were included in the study. The majority of the responsible organisms were carbapenem-resistant Acinetobacter baumannii (67.7%), followed by Klebsiella pneumoniae (16.1%) and Escherichia coli (9.7%). Twenty patients were treated with high-dose TGC therapy (100 mg every 12 h after a 200 mg loading dose), and the others received a standard-dose therapy (50 mg every 12 h after a 100 mg loading dose). The duration of TGC therapy was 14.3±2.8 days. The global clinical cure rate and the microbiological eradication rate were 48.4% and 61.3%, respectively. The overall ICU mortality rate was 45.2%. A higher score on the Acute Physiology and Chronic Health Evaluation II and a longer duration of IIAT were associated with clinical failure. High-dose TGC therapy had a higher clinical success rate [65.0% (13/20) versus 18.2% (2/11), P=0.023] and a lower ICU mortality rate [30.0% (6/20) versus 72.7% (8/11), P=0.031] than the standard-dose therapy. Conclusions. TGC, especially a high-dose regimen, might be a justifiable option for critically ill patients with nosocomial pneumonia due to CRGNB who have received IIAT when the options for these patients are limited.

Very-low-dose ketamine for the management of pain and sedation in the ICU

2018 ◽  
Vol 4 (1) ◽  
pp. 54 ◽  
Author(s):  
Mario De Pinto, MD ◽  
Jill Jelacic, MD ◽  
William T. Edwards, PhD, MD
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Respiratory Depression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Anesthetic Agent ◽  
Cardiovascular Instability ◽  
High Doses ◽  
Very High

Management of pain in critically ill patients can be very difficult. In the attempt to provide comfort with adequate levels of opioids and sedatives, respiratory depression and cardiovascular instability may become difficult to control in patients with labile hemodynamics and poor cardiopulmonary reserve. The use of medications like ketamine, an anesthetic agent that in subanesthetic doses has been reported to be effective in preventing opioidinduced tolerance and to have analgesic properties, may be of help, especially in patients who develop tolerance, leading to rapidly escalating doses of opioids and sedatives. The case report presented here shows how a very low dose of ketamine can be helpful for the management of pain and sedation in critically ill patients, especially when they are ready to be weaned from mechanical ventilation, and very high doses of opiods and sedatives do not permit it.

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