Current opinion in critical care
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This review discusses the unique metabolic changes in critically ill obese patients and the challenges in estimating and providing them with nutritional support while in the intensive care unit. It provides some of the scientific data in support of and against hypocaloric, high-protein nutritional support in critically ill obese patients. ⋯ Nutritional support of the critically ill obese represents a unique challenge but early administration of protein followed by carbohydrates and finally lipids can result in net protein anabolism and better glycemic control.
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Curr Opin Crit Care · Aug 2005
ReviewOrganizational characteristics and the quality of surgical care.
Public recognition of wide variations in surgical outcomes has prompted numerous efforts aimed at measuring and improving quality. Given that many of the most prominent efforts focus on organizational factors, this paper reviews the growing body of evidence underlying these initiatives. ⋯ Several organizational characteristics are strongly related outcomes for critically ill surgical patients. Increasing the number of surgical patients receiving care in hospitals adhering to these organizational practices would save many lives each year.
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Curr Opin Crit Care · Aug 2005
ReviewPotential mechanisms and markers of critical illness-associated cognitive dysfunction.
To review the current understanding of the potential mechanisms of critical illness-associated cognitive dysfunction and to provide insight into markers that could be used to evaluate the influence of specific mechanisms in individual patients. ⋯ Although recent advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed to provide a better understanding of the relative contribution of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Until relatively recently critical care practitioners have focused on survival of their patients and not long-term outcomes. An increasing body of research has examined patient outcomes beyond discharge from the intensive care unit and hospital. One area of focus is neurobehavioral outcomes including neurocognitive sequelae and neuropsychiatric disorders such as depression and anxiety. Cognitive functions are brain-based or mental activities that involve acquiring, storing, retrieving, and using information and include domains such as memory, attention, executive function, mental processing speed, spatial abilities, and general intelligence. It is known from other medical specialties that impaired cognitive function can have a broad, substantial, and long-lasting impact on a patient's life. This paper examines the current evidence for neurocognitive impairments in survivors of critical illness. ⋯ Among the potential consequences of critical illness are now included neurocognitive impairments. Future research should include the search for strategies for the early identification of neurocognitive impairments, mechanisms of brain injury, and therapeutic modalities designed to prevent or decrease neurocognitive morbidity.