Current opinion in critical care
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This is a literature review over a time period of the past 2 years concerning glutamine in clinical nutrition. Emphasis is put upon studies of glutamine in clinical settings, but a brief overview of the large range of literature over the role of glutamine in various experimental settings is also included. The most interesting concept for the past 2 years is the suggestion to use plasma glutamine concentration at admission to the intensive care unit as a prognostic marker and as a possible indicator for indication of glutamine supplementation.
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Metabolic acidosis is characterized by a decrease of the blood pH associated with a decrease in the bicarbonate concentration. This may be secondary to a decrease in the strong ion difference or to an increase in the weak acids concentration, mainly the inorganic phosphorus. From a conceptual point of view, two types of nontoxic metabolic acidosis must be differentiated: the mineral metabolic acidosis that reveals the presence of an excess of nonmetabolizable anions, and the organic metabolic acidosis that reveals an excess of metabolizable anions. ⋯ No reliable argument exists to prove that this acidosis is harmful under these conditions in humans. Experimental data even show that hypoxic cells are able to survive only if the medium is kept acidic. The management of an acute organic metabolic acidosis is therefore primarily based on the cause of the acidosis, and no scientific argument exists to justify the correction of the acid-base imbalance in this context.
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This review intends to summarize the recent findings regarding the presence of increased oxidative stress in critically ill patients and its potential pathophysiologic role, as well as the results of recent clinical trials of antioxidant therapies. ⋯ Patients at risk of organ failure could benefit from the early adjunction of antioxidant treatment, including vitamins and glutamine.
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The demand for high-quality care is increasing. A variety of therapies have been shown to improve patient outcomes in critical care. Nevertheless, relatively little research has focused on identifying how to deliver those therapies effectively and efficiently. As a result, the most cost-effective opportunity to improve patient outcomes will likely come not from discovering new therapies but from discovering how to deliver therapies that are known to be effective. ⋯ Because quality is a multidimensional construct, it is unlikely that a single approach will be effective. ICU physicians and hospital leaders must assume a leadership role, implementing a combination of different approaches and developing appropriate systems for patient care.