Current opinion in critical care
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Numerous micronutrients are involved in antioxidant and immune defence, while their blood concentrations are frequently low in critically ill patients: this has fuelled many supplementation trials. Numerous observational, randomized studies have been published, which are presented herein. ⋯ The needs in critical illness are higher than those of healthy individuals and must be covered to support immunity. Monitoring selected micronutrients is justified in patients requiring more prolonged ICU therapy. Actual results point towards combinations of essential micronutrients at doses below upper tolerable levels. Finally, the time of high-dose micronutrient monotherapy is probably over.
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Curr Opin Crit Care · Aug 2023
ReviewIs there a role for ketones as alternative fuel in critical illness?
The evidence base advocating ketones as an alternative substrate for critically ill patients is expanding. We discuss the rationale for investigating alternatives to the traditional metabolic substrates (glucose, fatty acids and amino acids), consider evidence relating to ketone-based nutrition in a variety of contexts, and suggest the necessary future steps. ⋯ Whilst ketones provide an attractive nutritional option, further research is required to determine whether the proposed benefits are translatable to critically unwell patients.
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Curr Opin Crit Care · Jun 2023
ReviewWhich haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?
To discuss the suitable haemodynamic monitoring for critically ill patients with shock. ⋯ For monitoring critically ill patients with shock, minimally or noninvasive systems are not reliable or informative enough. In the most severe patients, a reasonable monitoring policy can combine continuous monitoring by transpulmonary thermodilution systems or the pulmonary arterial catheter, with an intermittent assessment with ultrasound and measurement of tissue oxygenation.