scholarly journals Nutritional therapy of COVID-19 disease in Intensive care units

2021 ◽  
Vol 26 (83) ◽  
pp. 27-52
Author(s):  
Biljana Damnjanović ◽  
Đuro Šijan ◽  
Ivan Rović ◽  
Igor Lazić ◽  
Saša Knežević ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Impact ◽  
Current Knowledge ◽  
Virus Disease ◽  
Nutritional Therapy ◽  
Hospital Treatment ◽  
Omega 3 ◽  
Corona Virus ◽  
Number Of Patients

Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.

scholarly journals Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit

2020 ◽  
Vol 46 (5) ◽  
pp. 851-853 ◽  
Author(s):  
Jianlei Cao ◽  
Xiaorong Hu ◽  
Wenlin Cheng ◽  
Lei Yu ◽  
Wen-Jun Tu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Features ◽  
Virus Disease ◽  
Short Term ◽  
Corona Virus

scholarly journals Correction to: Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit

2020 ◽  
Vol 46 (6) ◽  
pp. 1298-1298 ◽  
Author(s):  
Jianlei Cao ◽  
Xiaorong Hu ◽  
Wenlin Cheng ◽  
Lei Yu ◽  
Wen-Jun Tu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Features ◽  
Virus Disease ◽  
Short Term ◽  
Corona Virus

scholarly journals Penggunaan Heparin Dosis Tinggi pada Pasien COVID-19 dengan ARDS dan Hipertensi di Unit Perawatan Intensif (ICU)

2020 ◽  
Vol 12 (3) ◽  
pp. 1-8
Author(s):  
Taufik Eko Nugroho ◽  
Mochamat Mochamat ◽  
Famila Famila
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19), pertama kali dilaporkan pada bulan Desember 2019 di Cina, merupakan penyakit yang disebabkan oleh virus SARS-CoV-2 yang menyebar lebih cepat pada populasi manusia dan dalam waktu singkat berkembang menjadi pandemi di seluruh dunia. Sebagian besar kasus yang berujung pada kematian dilaporkan terkomplikasi dengan koagulopati dan disseminated intravascular cogulation (DIC).Kasus: Seorang laki-laki terkonfirmasi positif COVID-19 berusia 50 tahun dengan sesak, batuk dan demam dan komorbiditas hipertensi dirujuk ke intensive care unit (ICU), selama di ICU pasien mendapat terapi heparin dengan dosis terapi dengan melihat kadar aPTT. Setelah perawatan intensif selama 14 hari, pasien mengalami perbaikan yang signifikan.Pembahasan: Pasien dengan infeksi COVID-19 yang progresif dan parah dengan acute respiratory distress syndrome (ARDS) seringkali ditemukan dengan kadar D-dimer dan fibrinogen yang sangat tinggi, yang berujung pada keadaan hiperkoagulasi. Penggunaan antikoagulan untuk pasien dengan COVID-19 yang parah telah. Banyak institusi telah menerapkan penggunaan antikoagulan dosis penuh secara empiris berdasarkan risiko venous thrombo embolism (VTE) dan insiden rendah perdarahan (3-5%).Kesimpulan: Penggunaan antikoagulan, khususnya unfractionatedheparin (UFH) dengan dosis lebih tinggi, direkomendasikan untuk pasien dengan COVID-19 yang parah, meskipun belum ada panduan yang mutlak. 

scholarly journals Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

2020 ◽  
Vol 12 (3) ◽  
pp. 17-33
Author(s):  
Rohmantuah Trada Purba ◽  
Mahendratama Purnama Adhi ◽  
Erna Kusumawardhani ◽  
Rapto Hardian ◽  
Andri Lumban Tobing
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Interleukin 6 ◽  
Virus Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

scholarly journals Nursing Interventions to Prevent Delirium in Critically Ill Patients in the Intensive Care Unit during the COVID19 Pandemic—Narrative Overview

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 578
Author(s):  
Dorota Ozga ◽  
Sabina Krupa ◽  
Paweł Witt ◽  
Wioletta Mędrzycka-Dąbrowska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill Patients ◽  
Current Knowledge ◽  
Personalised Medicine ◽  
Nursing Interventions ◽  
Evidence Based ◽  
Current State ◽  
Scientific Disciplines ◽  
Reliable Methods

It has become a standard measure in recent years to utilise evidence-based practice, which is associated with a greater need to implement and use advanced, reliable methods of summarising the achievements of various scientific disciplines, including such highly specialised approaches as personalised medicine. The aim of this paper was to discuss the current state of knowledge related to improvements in “nursing” involving management of delirium in intensive care units during the SARS-CoV-2 pandemic. This narrative review summarises the current knowledge concerning the challenges associated with assessment of delirium in patients with COVID-19 by ICU nurses, and the role and tasks in the personalised approach to patients with COVID-19.

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.

2020 ◽  
Author(s):  
Minghang Li ◽  
Mingyue Ding ◽  
Huanzhang Shao ◽  
Bingyu Qin ◽  
Xingwei Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Care Group ◽  
China National Knowledge Infrastructure ◽  
Number Of Patients ◽  
Icu Discharge

Abstract Background The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW. Methods We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc. Results The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) . Conclusions Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.

scholarly journals TARGET, PRESCRIPTION AND INFUSION OF ENTERAL NUTRITIONAL THERAPY OF CRITICAL PATIENTS IN INTENSIVE CARE UNIT

2018 ◽  
Vol 55 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Isabela Bernasconi JOSÉ ◽  
Vânia Aparecida LEANDRO-MERHI ◽  
José Luis Braga de AQUINO
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Critically Ill ◽  
Nutritional Therapy ◽  
Wilcoxon Test ◽  
Nutritional Risk ◽  
Albumin Ratio ◽  
Significant Difference ◽  
Prospective Longitudinal

ABSTRACT BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.

Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

2017 ◽  
Vol 13 (01) ◽  
pp. 057-062
Author(s):  
Dhruba Shrestha ◽  
Ganendra Raya ◽  
Amar Prajapati ◽  
Suruchi Dhaubhadel ◽  
Sushmita Puri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Intensive Care Unit Admission ◽  
Pneumococcal Vaccination ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Hospital Treatment ◽  
High Morbidity ◽  
Rural Nepal

Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal. Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation. Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission. Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.

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