Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2019
ReviewReconsidering Nutritional Support in Critically Ill Patients.
Provision of nutrition is universally considered a key element of supportive care in the intensive care unit (ICU). Despite this, there is a relative dearth of high-quality data, and where available, results are often conflicting. ⋯ In the modern ICU era, where the goal of critical care has shifted from mere survival to surviving and living well, non-continuous modes of feeding may have advantages related to fewer feeding interruptions, ICU mobilization, optimizing protein synthesis and autophagy, as well as restoring gastrointestinal physiology and the circadian rhythm. More research is desperately required to provide a framework in order to guide best nutrition practices for clinicians at the bedside.
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Semin Respir Crit Care Med · Oct 2019
ReviewControversies Surrounding Renal Replacement Therapy in the Critically Ill Patient.
Acute kidney injury (AKI) commonly occurs in the intensive care unit and is associated with significant morbidity and mortality. Patients with AKI often require initiation of dialysis to control electrolytes, metabolic abnormalities, and volume status. This review will discuss controversies in renal replacement therapy (RRT), including timing of dialysis initiation, dialysis modality and dose, nonrenal indications for dialysis, and the patient population best suited for RRT therapy.
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Semin Respir Crit Care Med · Oct 2019
ReviewSleep in the Intensive Care Unit: Strategies for Improvement.
Sleep in the intensive care unit (ICU) is considered to be subjectively poor, highly fragmented, and sometimes referred to as "atypical." Although sleep is felt to be crucial for patient recovery, little is known about the association of sleep with physiologic function among critically ill patients, or those with clinically important outcomes in the ICU. Research involving ICU-based sleep disturbance is challenging due to the lack of objective, practical, reliable, and scalable methods to measure sleep and the multifactorial etiologies of its disruption. Despite these challenges, research into sleep-promoting techniques is growing and has demonstrated a variety of causes leading to ICU-related sleep loss, thereby motivating multifaceted intervention efforts. Through a focused review of (1) sleep measurement in the ICU; (2) outcomes related to poor sleep in the ICU; and (3) ICU-based sleep promotion efforts including environmental, nonpharmacological, and pharmacological interventions, this paper examines research regarding sleep in the ICU and highlights the need for future investigation into this complex and dynamic field.
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Semin Respir Crit Care Med · Oct 2019
ReviewTranslational Research in Intensive Care Unit: Novel Approaches for Drug Development and Personalized Medicine.
The major clinical presentations seen by critical care physicians are sepsis and acute respiratory distress syndrome (ARDS), both of which are heterogeneous clinical syndromes rather than specific diagnoses. The current diagnostic criteria provide little insight into the mechanisms underlying these heterogeneous syndromes and minimal progress has been made with regard to the development of therapies, despite many large randomized controlled trials being undertaken. This review outlines the advances made in improved characterization of critically-ill patients, using ARDS as an exemplar, and highlights the need for this improved patient characterization to be coupled with mechanistic science to develop therapies that target specific pathomechanisms.
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Semin Respir Crit Care Med · Oct 2019
ReviewPatient-Centered Outcomes in Critical Illness: Will My Patient Be Functionally and Cognitively Intact?
Survival in the intensive care unit (ICU) has steadily increased over the past several decades; millions of patients now survive a critical illness every year. ICU survivors are at a significantly increased risk of impairments in physical function, cognitive function, and mental health. ⋯ Landmark studies concerning treatment preferences have demonstrated that patients value functional and cognitive outcomes over mortality. In this chapter, we discuss the determinants of functional and cognitive outcomes post critical illness to address the question, "Will my ICU patient be functionally and cognitively intact?"