Intensive care medicine
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Intensive care medicine · Jan 1993
ReviewEnteral nutrition in the critically ill patient: a critical review of the evidence.
To examine the relationship between enteral nutrition (EN) and infection in the critically ill. ⋯ Evidence from experimental data in critically ill patients suggests that enteral nutrition may have a favourable impact on gastrointestinal immunological function and infectious morbidity.
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Sepsis and multiple organ failure are major problems in medical and surgical intensive care units. Critical illness polyneuropathy occurs in 70% of these patients. Difficulty in weaning from the ventilator is an early sign. ⋯ Other effects on muscle are cachectic myopathy and panfascicular muscle fibre necrosis. A variety of combinations of these conditions may affect the same patient. Only well-designed prospective studies will determine the true effect of these medications on the neuromuscular system in septic patients.
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Abnormalities in coagulation and fibrinolysis are frequently observed in septic shock. The most pronounced clinical manifestation is disseminated intravascular coagulation. ⋯ Also in patients with septic shock a dynamic process of coagulation and fibrinolysis is ongoing with evidence of impaired fibrinolysis. These abnormalities have prognostic significance; the extent of disturbances of coagulation and fibrinolysis is related to the development of multiple organ failure and death.
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Intensive care medicine · Jan 1993
Randomized Controlled Trial Clinical TrialParenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion.
The study investigated the use of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) in critically ill patients, and compared the effects with those of a conventional long chain triglyceride (LCT) preparation. ⋯ MCTs are rapidly hydrolysed and oxidised to fatty acids and ketones which can be readily utilised. This study indicates that intravenous lipid emulsion containing MCT are safe in critically ill patients and may have advantages over LCT. The number and range of patients studied was, however, small and larger studies are needed.
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Intensive care medicine · Jan 1993
Clinical TrialHemodynamic effects of sodium bicarbonate in critically ill neonates.
To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. ⋯ Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.