Current opinion in critical care
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Curr Opin Crit Care · Aug 2020
ReviewBone metabolism and fracture risk during and after critical illness.
There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies. ⋯ A history of critical illness should be considered as a strong risk factor for osteopenia and osteoporosis. ICU-related bone loss should be part of the postintensive care syndrome, and should be targeted by prevention and treatment strategies. Optimized and individualized protein and micronutrient provision (with specific attention to calcium, vitamin D and selenium), associated with physiotherapy and muscle training, should be implemented early after ICU admission and continued after ICU discharge. Antiresorptive agents such as biphosphonates should be considered on an individualized basis.
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Cardiogenic shock is a severe complication with mortality rates of ∼50% that requires a rapid and complex management to aid and identify the highest and lowest risk patients. To that end, novel cardiogenic shock biomarkers are needed to improve risk stratification and to personalize therapy. ⋯ A new wave of research focused on novel proteomic and molecular techniques, is providing new candidates that promise to aid clinical decision-making and patient stratification in cardiogenic shock. The CS4P score is emerging as the most robust, yet it requires prospective validation in cardiogenic shock patients managed with circulatory and ventricular assist devices.
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Curr Opin Crit Care · Aug 2020
ReviewThe best recipe: fat-based, protein-based, single amino acids?
Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients. ⋯ The nutritional therapy should take into account the fact that lipids are more oxidized. Intravenous lipid emulsions containing olive and fish oil are preferred, improving morbidity significantly in a recent meta-analysis. Enteral protein should be selected carefully according to protein source, origin and amount. Hydrolyzed whey protein improves nitrogen balance. The ultimate goal is to preserve muscle mass and muscle function. β-Hydroxy-β-methylbutyrate may improve muscle strength.
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Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. ⋯ Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.
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Curr Opin Crit Care · Aug 2020
ReviewMetabolic support in sepsis: corticosteroids and vitamins: the why, the when, the how.
Sepsis is a global health issue, and there is a need for effective, low-cost adjunct metabolic treatments. Corticosteroids have been investigated in many trials for decades, and recently the administration of vitamin C, thiamine (vitamin B1), and vitamin D have been proposed as novel therapies in patients with sepsis. ⋯ Evidence from high-quality research is still insufficient to support the use of vitamin C, thiamine, and vitamin D as metabolic support in sepsis treatment.