Current opinion in critical care
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Curr Opin Crit Care · Aug 2008
ReviewIs there a role for growth hormone therapy in refractory critical illness?
Protein catabolism is common among critically ill patients, contributing to organ dysfunction, muscle weakness, prolonged mechanical ventilation and length of stay in the ICU, with adverse impact on patient prognosis and resource utilization. Neither adequate enteral nutrition nor parenteral nutrition stems this catabolism. Recombinant growth hormone supplementation in surgical trauma and burn injury patients has demonstrated nitrogen retention, increased insulin-like growth factor-1 levels, decreased length of stay and improved survival. As a result, growth hormone became widely used in the ICU, until two large randomized trials in 1999 noted increased mortality associated with infection and organ dysfunction. ⋯ Prior to proposing new prospective randomized clinical trials, case reports describing anecdotal experience with growth hormone in selected chronically critically ill patients may provide insight into redefining the ICU population most likely to benefit from growth hormone supplementation. Current guidelines continue to recommend against the use of growth hormone in critical illness.
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Curr Opin Crit Care · Aug 2008
ReviewThe pharmacology of oversedation in mechanically ventilated adults.
To review pharmacological-related factors that affect the incidence of oversedation in mechanically ventilated adults. ⋯ Recognition of these new advances will help liberate patients from mechanical ventilation sooner, without compromising patient comfort.
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Curr Opin Crit Care · Aug 2008
Review Comparative StudyEnteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred.
Current recommendations suggest starting enteral feeding as soon as possible whenever the gastrointestinal tract is functioning. The disadvantage of enteral support is that insufficient energy and protein coverage can occur. This review focuses on some recent findings regarding the nutritional support of critically ill patients and evaluates the data presented. ⋯ Early enteral nutrition is recommended for critically ill patients. Supplemental parenteral nutrition combined with enteral nutrition can be considered to cover the energy and protein targets when enteral nutrition alone fails to achieve the caloric goal. Whether such a combined nutritional support provides additional benefit on the overall outcome has to be proven in further studies on clinical outcome, including physical and cognitive functioning, quality of life, cost-effectiveness, and cost-utility.
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Curr Opin Crit Care · Aug 2008
ReviewHypoglycemia and strict glycemic control in critically ill patients.
In contrast to patients with diabetes mellitus, data on consequences of hypoglycemia in critically ill patients are sparse. The purpose of this review is to summarize available data on prevalence of hypoglycemia, risk factors, and possible consequences of hypoglycemia in critically ill patients. ⋯ Hypoglycemia should be avoided in critically ill patients, but not at the cost of less stringent glycemic control. Strict glycemic control with a low incidence of hypoglycemia can be achieved with a validated (computerized) algorithm and increased surveillance in patients with an increased risk for hypoglycemia.