Critical care clinics
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Critical care clinics · Jul 2002
ReviewEndocrine and metabolic issues in the management of the chronically critically ill patient.
The metabolic syndrome of chronic critical illness (CCI) consists of multisystem organ dysfunction resulting from the initial acute injury and chronic immune-neuroendocrine axis activation, adult kwashiorkor-like malnutrition, and prolonged immobilization with suppression of the PTH-vitamin D axis and hyper-resorptive metabolic bone disease. CCI patients can also present unique challenges in the management of diabetes mellitus, thyroid and adrenal diseases, electrolyte abnormalities and hypogonadism.
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CINMAs occur commonly in acutely critically ill inflamed patients, and can prolong respiratory failure, lead to ventilator dependency, and contribute to the development of chronic critical illness. The etiology of NMDs are diverse and overlap, and distinguishing different disease entities by clinical exam and electrophysiologic studies can be difficult. CIP, which has been the most widely studied CINMA, represents the peripheral nervous system manifestation of the MODS. ⋯ Although there are no definitive treatments, diagnosing a CINMA may provide helpful prognostic information. Future preventative measures may include immunoglobulin, nerve growth factors, or strict glycemic control, although in the CCI phase general supportive care is given, including prevention of iatrogenic complications, nutritional support, psychosocial support, and physical therapy. The early recognition of CINMAs and prevention of associated complications are important to enabling CCI patients with CINMAs to recover and return home with an acceptable functional level and quality of life.
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Critical care clinics · Jul 2002
Multidisciplinary care of the obese patient with chronic critical illness after surgery.
The surgical patient with prolonged critical illness usually has a higher severity of illness on ICU admission, and is destined for greater morbidity, debilitation, and poorer hospital and long-term survival. Care of those with obesity is particularly difficult. Only with meticulous attention to detail and refined, dedicated, multidisciplinary processes of care, preferably assisted by protocolization, can these patients sustain any hope of recovery to acceptable functionality.