Current opinion in critical care
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This clinical review focuses on the nutritional management of surgical patients with a severe postoperative complication. These patients having a succession of aggressions are at high risk of malnutrition. Our aim, following ICU patient studies, was to report the elements that could be applied for these patients. ⋯ In severe surgical complicated patients, special care must be taken vis-à-vis nutritional intake. Such patients are likely to have an energy deficit and are at high risk of malnutrition. Nutritional assistance is necessary and should be quickly implemented with the usual recommendations.
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This review summarizes recent updates in the prevention of infections in solid organ transplant patients using antimicrobial prophylaxis that are pertinent for the intensive care physician. ⋯ Some infectious risks with transplantation can be anticipated and preventive strategies can be instituted to improve the health and outcome of the transplant recipient.
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To provide the most recent and relevant clinical evidence regarding the use of prophylactic lung-protective mechanical ventilation in abdominal surgery. ⋯ The use of prophylactic lung-protective ventilation can help in improving the postoperative outcome.
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Fluid management is regarded as a cornerstone of successful perioperative care, but fluid prescription is not always treated that way. New insights and guidelines have become available very recently. ⋯ The combination of a careful prescription of maintenance fluids, additional replacement solutions tailored to the patient's eventual extra needs and a rational but nonaggressive goal-directed approach to resuscitation fluids seems to be the best practice to avoid fluid-related morbidity. Isotonic balanced crystalloids seem the best pragmatic choice for resuscitation purposes. In certain well defined conditions, colloids can still be used.
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The characteristics of an ideal intravenous fluid in the critically ill patient are discussed. ⋯ The ideal fluid currently does not exist. Of existing options, use of hydroxyethyl starches and high chloride-containing crystalloid solutions should be discouraged. There is a lack of direct evidence that a balanced crystalloid solution confers benefit, however, the trend of recent data would support future investigation into the advantage of balanced solution over 0.9% saline.