Volume 19 - Issue 3, 2019

The critically ill patient is often unable to feed by mouth. This condition, in some patients, can range from days to months. It is imperative that these patients receive macronutrients either through enteral or parenteral nutrition. If they don't, there is a risk of an energy deficit that could lead to loss of lean body mass and subsequently, other adverse outcomes. Muscle wasting and weakness due to lack...

ESPEN guidelines for nutrition in critical illness have shifted from optimistic anticipative nutritional pharmacotherapy towards cautious and balanced metabolic support. This important new orientation in ICU nutrition management is a consequence of recent strong RCT-based evidence. Recently, the new ESPEN guidelines for critically ill patients have been published. They are the result of two years of da...

The new trends in nutrition management included in the last guidelines are discussed, in particular the route and the dose of calories and proteins recommended. During the last decade, numerous paradigms and dogmas based on observational cohort studies were challenged by the publication of large multicentre prospective randomised controlled trials (RCT). Actually, until recently, the guidelines were suppo...

Prudent strategies to optimise nutrition for the critically ill child, improving long-term outcomes, and preserving quality of life. Optimal delivery of nutrients to the critically ill patient might prevent nutritional deterioration and expedite recovery. Prospective cohort studies have demonstrated the independent association between nutritional status and important clinical outcomes (de Souza Menezes e...

The role of nutrition in obese critically ill patients and an overview of the clinical guidelines for nutrition provision in this patient population. The World Health Organization defines obesity as an excess of abdominal fat that poses an increased risk to health. Characterised by a body mass index (BMI) ≥30 kg/m2, obesity rates have tripled since 1975, and in 2016, 650 million people worldwide were o...

Poor ICU nutrition delivery remains a challenge worldwide. Objective malnutrition diagnosis and personalisation of nutrition delivery may be one way of addressing this problem. Modern, and increasingly expensive ICU care now allows prolonged survival from illness and injury by providing life-sustaining support for extended periods of time, making previously nonsurvivable ICU insults, survivable. In fact,...

Speech and language therapists play an integral role in identifying dysphagia risk factors, facilitating oral intake, and improving clinical outcomes. Speech and Language Therapists (SLT) are recognised members of the multi-disciplinary team working in the Intensive Care Unit (ICU), with a focus on the rehabilitation of communication and swallowing difficulties (oropharyngeal dysphagia). Patients who are...

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Baxter launches a new parenteral nutrition formulation designed to meet the need for higher protein provision in Europe and signs a global partnership with COSMED to commercialise Q-NRG+, a metabolic monitoring device that utilises indirect calorimetry technology. Around 20 to 50% of hospital patients, including those in the ICU (trauma, surgery) are malnourished.1 Malnutrition is a clinical condition tha...

This symposium explores the different aspects of nutrition in the ICU and how nutritional requirements of the critically ill patient are met effectively. There is an overview of nutritional monitoring practices and how we could improve them for better nutritional delivery. There is also an overview of the DIVINE study which investigates the use of different nutritional formulas to facilitate blood glucose c...

Monitoring nutrition in the ICU is significantly different from monitoring other activities. For example, if we look at haemodynamics, it is pretty easy. We can monitor blood pressure, cardiac output etc. We can deliver a drug and look at its effect to see if it works or not, and, if it doesn’t, we can simply change the drug. These are simple activities that we do in the ICU every day. But is the same t...

The following is an overview of the DIVINE trial (Dietary Management of Glucose Variabilty in the ICU) as well as a quick summary of the role of glucose control and outcomes in critically ill patients. The DIVINE study was funded by Nestlé. Clinical studies show that goal nutrition may not result in the best outcomes. Available data suggest that protein may be more important than non-protein calories. Fi...

The Muscle UK Critical Care program was set up 10 years ago and focused on the association between muscle and skeletal muscle wasting to weakness to clinical outcome. There are a total of five pivotal trials, including Bernhard Jonghe et al.1 and Herridge M.2 that looked at skeletal muscle weakness and its impact on patients. In the Herridge study, all patients reported poor function and attributed this to...

Pathophysiology of Trauma and Revised European Trauma Guidelines Prof. Donat R. Spahn Coagulopathy During Cardiac Surgery: The Role of Factor Concentrates Marco Ranucci Treatment Options for Factor-Xa Inhibitor-Related Bleeding Jerrold Levy...

The fifth edition of the European Trauma Treatment Guidelines that have already been cited 1650 times and downloaded from the original home page nearly 600,000 times. The European trauma treatment guidelines have significantly changed the treatment modalities of trauma patients around the world. The guidelines have also been endorsed by major European professional societies including European Society of...

The EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. The EACTS/EACTA guidelines were published jointly by the Society of Cardiothoracic Anesthesia and Cardiac Surgery for patient blood management. In the bleeding patient with a low fibrinogen level (<1.5 g/L), fibrinogen substitution may be considered to reduce postoperative bleeding and transfusions. However, the prerequi...

Specific treatment options for factor Xa inhibitor-related bleeding, focusing on drugs like rivaroxaban, apixaban, and edoxaban. Non-vitamin K oral anticoagulants (NOACs/DOACs) are direct reversible inhibitors of factor Xa. These drugs are also reversible inhibitors versus warfarin or other vitamin K antagonist that are used in Europe. Anticoagulants decrease circulating levels of factor II, VII, IX and...

An overview of the practical uses of virtual reality in the ICU and the benefits it can provide. One way of defining virtual reality (VR) is as the set of techniques and systems required for human beings to enter computer-generated synthetic worlds. VR techniques are based on real-time interaction with an artificial immersive world using behavioural interfaces that enable both physical and emotional perce...

Human factors are significant contributors to drug error. To overcome some of these human factors, we propose standardisation and consolidation of agreed drugs and equipment into a compact pre-packed critical care drug pouch (CCP) for use in non-theatre environments. Emergency and sedation drugs availability and preparation represent a challenge in the setting of acute care or resuscitation outside the i...

An overview on sharing information, improving clinician skills, and transferring knowledge to ICU specialists about the care of immunocompromised patients. Studies have reported a volume-outcome relationship for cancer patients admitted to the ICU. In acute respiratory failure, mortality in ICUs managing more than 2 patients per week was 35%, whereas mortality is 70% in ICUs managing less than 1 patien...

Massimo Antonelli is a Professor of Intensive Care and Anesthesiology at the Università Cattolica del Sacro Cuore, Rome, Italy. He serves as the Director of the Dept. of Anesthesiology and Intensive Care and Emergency Medicine and of the General ICU, Postoperative ICU and Neurosurgical ICU of the Fondazione Policlinico Universitario A. Gemelli IRCCS. He is also the Director of the School of Specialty in...

10-12 8th Annual Johns Hopkins Critical Care Rehabilitation Conference Baltimore, USA 12-16 EUSEM 2019: 13th European Emergency Medicine Congress Prague, Czech Republic 14-18 World Congress of Intensive Care 2019 Melbourne, Australia 15-16 ESA Focus Meeting on Perioperative Medicine 2019: Mother and child Rome, Italy 19-23 ANESTHESIOLOGY® 2019 Orlando, USA 28-31 Qatar Critical Care Conference 201...