Current opinion in critical care
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Curr Opin Crit Care · Aug 2016
ReviewBedside nutrition evaluation and physical assessment techniques in critical illness.
The purpose of this review is to highlight emerging techniques used to determine body composition early in ICU stay, their prediction of poor outcome, and what is required before they can be more widely used. ⋯ Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting have each been found to be better predictors of poor outcome than BMI in ICU patients.Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting may be able to identify patients who are most likely to benefit from enhanced nutrition support.We need further research incorporating the use of these simple measures to evaluate their ability to accurately identify patients most likely to benefit from enhanced nutritional support.
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After major progress in the 1980s of burn resuscitation resulting, the last years' research has focused on modulation of metabolic response and optimization of substrate utilization. The persisting variability of clinical practice is confirmed and results in difficult comparisons between burn centers. ⋯ Major burn patients differ from other critically ill patients by the magnitude and duration of their inflammatory and metabolic responses, their energy and substrate requirements. Pieces of the metabolic puzzle finally seem to fit together.
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Postoperative pulmonary complications (PPC) are a prominent determinant of postoperative morbidity, mortality, and increased use of healthcare resources. Several scores have been developed to identify patients at higher risk of PPC and have been proposed or validated as tools to predict postoperative respiratory disorders, stratify risk among patients requiring surgery, and to plan clinical studies. The aim of this review is to provide an update on the recent progresses in perioperative medicine concerning the risk assessment, prevention, and treatment of PPCs. ⋯ Several strategies can improve patients' outcome, including risk assessment, intraoperative protective ventilation and postoperative noninvasive ventilation.
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The purpose of the review is to identify the recently validated minimally invasive or noninvasive monitoring devices used to both monitor and guide resuscitation in the critically ill patients. ⋯ When coupled with a focused physical examination and functional hemodynamic monitoring analyses, these measures become even more specific at defining volume responsiveness and vasomotor tone and can be used to drive resuscitation strategies.
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Curr Opin Crit Care · Aug 2016
ReviewPostoperative complications of patients undergoing cardiac surgery.
Cardiac surgery is at high risk for the development of postoperative complications involving cardiovascular and respiratory system, as well as kidneys and central nervous system. The aim of this review is to provide an overview on the most recent findings concerning the type and incidence of different complications after cardiac surgery and to summarize the current recommendations. ⋯ Cardiac surgery is still at high risk for postoperative complications. The optimal type of anaesthesia, protective mechanical ventilation during and after surgery as well as haemodynamic management with vasoactive and inotropic drugs is still to be determined.