Critical care clinics
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Critical care clinics · Jul 1995
ReviewNutritional management and the multisystem organ failure/systemic inflammatory response syndrome in critically ill preterm neonates.
Current information and concepts regarding unique features and practical aspects of metabolism and the nutritional management of critically ill, very low birthweight neonates are reviewed in this article. The use of "gut priming" (early hypocaloric minimal enteral feeding) and parenteral nutrition and their application to the treatment of specific disease states is discussed. The concepts of critical oxygen delivery and multiorgan failure and their impact on nutritional management in adults show striking similarities to metabolic observations of progressively deteriorating, sick neonates.
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This article discusses the role of amino acids in nutritional support during critical illness. The basis for assessing the requirements for protein and amino acids is presented, and the case for enhanced requirement of particular amino acids is discussed. Specific requirements for branched-chain amino acids, glutamine, and arginine are evaluated.
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Although many of the measurements and techniques outlined in this article may be epidemiologically useful and correlate with morbidity and mortality, no single indicator is of consistent value in the nutritional assessment of critically ill patients. Measurements such as anthropometrics, total body fat estimation, or delayed hypersensitivity skin testing either are liable to non-nutritional influences or lack accuracy and precision in individual patients. Plasma concentrations of hepatic proteins are affected significantly by the patient's underlying disease state and therapeutic interventions and therefore lack specificity. ⋯ The biochemical measurement of levels of vitamins, minerals, and trace elements is invaluable in demonstrating specific deficiencies associated with disease and assessing whether long-term nutritional support is adequate. Such measurements rarely are necessary to make the initial clinical decision to give nutritional support, however. The most widely used measures of nutritional state are nitrogen balance and secretory protein concentrations, and these indices improve when sick patients recover.(ABSTRACT TRUNCATED AT 400 WORDS)
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Maintenance of the patient-ventilator system is the primary role of the respiratory care practitioner in the intensive care unit. Patient-ventilator system checks should include monitoring the patient's response to ventilation, evaluating function of the ventilator, maintaining ventilator settings according to physician orders, setting appropriate alarms, maintaining the integrity of the ventilator circuit and humidifier, and documenting all of the above. The concept of ventilator checks should be expanded and thus, the name changed to patient-ventilator system check to emphasize the importance of evaluating the patient. This article reviews the rationale for performing patient-ventilator system checks and measurements.
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Emphasis is on the mechanical properties of the spontaneously breathing patient. The occasional reference to mechanically ventilated patients is used to clarify and provide additional insight to the topic of spontaneously breathing individuals. Reference to the basic principles of mechanics are to establish the foundation for an integrated description of lung mechanics. Finally, a brief review of the "state of the art" respiratory monitoring parameters shown to have direct clinical applications.