Challenges and advances in nutrition for the critically ill child
Purpose of review
Malnutrition remains prevalent in critically ill children and is associated with worse clinical outcomes. Conversely, nutrition provision has been associated with improved survival. Nutritional challenges must be addressed to guide best nutrition practices for the critically ill child. In this narrative review, we summarize findings from research published between July 2020 and January 2022 on nutrition in critically ill children. Findings from these articles build on previous work to guide next steps in both research and clinical practice in this cohort.
Recent findings
A comprehensive literat...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Nutrition before, during and after critical illness
Purpose of review
This review describes considerations preintensive care unit (ICU), within ICU and in the post-ICU period regarding nutrition management and the current state of the literature base informing clinical care.
Recent findings
Within ICU, studies have focussed on the first 5–7 days of illness in mechanically ventilated patients who are heterogeneous and with minimal consideration to premorbid nutrition state. Many evidence gaps in the period within ICU remain, with the major ones being the amount of protein to provide and the impact of longer-term nutrition interventions. Personalised nutrition ...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Update on glucose control during and after critical illness
Purpose of review
There is a complex bidirectional relationship between critical illness and disordered glucose metabolism. This review aims to provide a comprehensive summary of the recent evidence focused on the relationship between critical illness and disordered glucose metabolism through the distinct phases of prior to, during, and after an acute illness that requires admission to the intensive care unit (ICU).
Recent findings
Recent data suggest that preexisting glucose metabolism affects the optimal blood glucose target during critical illness, with preliminary data suggesting that glucose targets should ...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Intermittent feeding and circadian rhythm in critical illness
Purpose of review
Circadian rhythms, i.e., periodic oscillations in internal biological processes, modulate metabolic processes such as hormonal signalling, nutrient absorption, and xenobiotic detoxification. Meal timing is a strong entraining cue for peripheral clocks in various organs, and eating out of circadian phases can impair glucose, gastrointestinal, and muscle metabolism. Sleep/wake cycles and circadian rhythms are extremely disrupted during critical illness. Timing of nutritional support may help preserve circadian rhythms and improve post-Intensive Care Unit (ICU) recovery. This review summarises circadian ...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Update on vitamin C administration in critical illness
Purpose of review
Several studies have recently explored the effects of intravenous vitamin C in sepsis. We aimed to summarize their findings to provide perspectives for future research.
Recent findings
Sepsis trials examined 6 g/day of intravenous vitamin C with or without the thiamine and/or hydrocortisone compared with placebo or hydrocortisone. Network meta-analysis reported that intravenous vitamin C, thiamine, hydrocortisone, or combinations of these drugs was not proven to reduce long-term mortality. However, the component network meta-analysis suggested an association of high-dose (>6 g/day) and very...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Protein metabolism in critical illness
Purpose of review
Critically ill patients experience skeletal muscle wasting that may contribute to the profound functional deficits in those that survive the initial injury. Augmented protein delivery has the potential to attenuate muscle loss, yet the ability for dietary protein to improve patient outcomes is reliant on effective protein metabolism. This review will discuss the recent literature on protein delivery and digestion, amino acid absorption, and muscle protein synthesis (MPS) in critically ill adults.
Recent findings
Critically ill patients are prescribed protein doses similar to international recom...
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: METABOLIC SUPPORT: Edited by Marianne Chapman Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Critical Care)
Source: Current Opinion in Critical Care - July 23, 2022 Category: Nursing Tags: EDITORIAL INTRODUCTIONS Source Type: research
Monitoring of sedation in mechanically ventilated patients using remote technology
Purpose of review
Two years of coronavirus disease 2019 (COVID-19) pandemic highlighted that excessive sedation in the ICU leading to coma and other adverse outcomes remains pervasive. There is a need to improve monitoring and management of sedation in mechanically ventilated patients. Remote technologies that are based on automated analysis of electroencephalogram (EEG) could enhance standard care and alert clinicians real-time when severe EEG suppression or other abnormal brain states are detected.
Recent findings
High rates of drug-induced coma as well as delirium were found in several large cohorts of mechan...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
Monitoring during extracorporeal membrane oxygenation
Purpose of review
Extracorporeal membrane oxygenation (ECMO) offers advanced mechanical support to patients with severe acute respiratory and/or cardiac failure. Ensuring an adequate therapeutic approach as well as prevention of ECMO-associated complications, by means of timely liberation, forms an essential part of standard ECMO care and is only achievable through continuous monitoring and evaluation. This review focus on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy; as well as methods to assess readiness to wean and/or discontinue ECMO support.
Recent findi...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
Cardiac output monitoring – invasive and noninvasive
Purpose of review
The purpose of this article is to review various contemporary cardiac output (CO) measurement technologies available and their utility in critically ill patients.
Recent findings
CO measurement devices can be invasive, minimally invasive, or noninvasive depending upon their method of CO measurement. All devices have pros and cons, with pulmonary artery catheter (PAC) being the gold standard. The invasive techniques are more accurate; however, their invasiveness can cause more complications. The noninvasive devices predict CO via mathematical modeling with several assumptions and are thus prone ...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
New developments in the understanding of right ventricular function in acute care
Purpose of review
Right ventricular dysfunction has an important impact on the perioperative course of cardiac surgery patients. Recent advances in the detection and monitoring of perioperative right ventricular dysfunction will be reviewed here.
Recent findings
The incidence of right ventricular dysfunction in cardiac surgery has been associated with unfavorable outcomes. New evidence supports the use of a pulmonary artery catheter in cardiogenic shock. The possibility to directly measure right ventricular pressure by transducing the pacing port has expanded its use to track changes in right ventricular functio...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
The weaning from mechanical ventilation: a comprehensive ultrasound approach
Purpose of review
Due to heart, lung and diaphragm interactions during weaning from mechanical ventilation, an ultrasound integrated approach may be useful in the detection of dysfunctions potentially leading to weaning failure. In this review, we will summarize the most recent advances concerning the ultrasound applications relevant to the weaning from mechanical ventilation.
Recent findings
The role of ultrasonographic examination of heart, lung and diaphragm has been deeply investigated over the years. Most recent findings concern the ability of lung ultrasound in detecting weaning induced pulmonary edema dur...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
Artificial intelligence and clinical deterioration
Purpose of review
To provide an overview of the systems being used to identify and predict clinical deterioration in hospitalised patients, with focus on the current and future role of artificial intelligence (AI).
Recent findings
There are five leading AI driven systems in this field: the Advanced Alert Monitor (AAM), the electronic Cardiac Arrest Risk Triage (eCART) score, Hospital wide Alert Via Electronic Noticeboard, the Mayo Clinic Early Warning Score, and the Rothman Index (RI). Each uses Electronic Patient Record (EPR) data and machine learning to predict adverse events. Less mature but relevant evolutio...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
Remote monitoring in the use of extracorporeal membrane oxygenation and acute mechanical circulatory support
Purpose of review
To provide an overview of the role of remote monitoring tools in management of critically-ill patients requiring acute mechanical circulatory support (MCS).
Recent findings
Tele-critical care systems have received new interest during the COVID-19 pandemic, which has stretched the capacity of health systems everywhere. At the same time, utilization of MCS and extracorporeal membrane oxygenation (ECMO) technologies has increased during the pandemic. The opportunity for remote monitoring and clinical decision support for ECMO and acute MCS devices has been recognized by industry partners, with sev...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
Lung aeration, ventilation, and perfusion imaging
Purpose of review
Lung imaging is a cornerstone of the management of patients admitted to the intensive care unit (ICU), providing anatomical and functional information on the respiratory system function. The aim of this review is to provide an overview of mechanisms and applications of conventional and emerging lung imaging techniques in critically ill patients.
Recent findings
Chest radiographs provide information on lung structure and have several limitations in the ICU setting; however, scoring systems can be used to stratify patient severity and predict clinical outcomes. Computed tomography (CT) is the gol...
Source: Current Opinion in Critical Care - June 1, 2022 Category: Nursing Tags: CARDIOPULMONARY MONITORING: Edited by Jeanine P. Wiener-Kronish Source Type: research
