Jpen Parenter Enter
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Jpen Parenter Enter · Jul 2014
ReviewERAS--enhanced recovery after surgery: moving evidence-based perioperative care to practice.
ERAS is the acronym for enhanced recovery after surgery, a term often used to describe perioperative care programs that have been shown to improve outcomes after major surgery. This article gives a brief history of the development from fast-track surgery to ERAS. Today, the full meaning of ERAS goes beyond just a protocol for perioperative care with the initiation of a novel multiprofessional, multidisciplinary medical society: the Enhanced Recovery After Surgery Society for Perioperative Care (www.erassociety.org). ⋯ While ERAS was initially developed for colonic resections, these principles are being used in a range of operations, and there is also a continuous update of care protocols as the fields develop. A key mechanism behind the effectiveness of ERAS is the dampening of the stress responses to the surgical insult combined with the use of treatments that support return of functions that delay recovery in traditional care. The article also gives some insights to why the protocols work and reports the effects of ERAS protocols.
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Jpen Parenter Enter · Jul 2014
Peripherally inserted central catheter (PICC) complications during pregnancy.
Peripherally inserted central catheters (PICCs) are routinely used in women with hyperemesis gravidarum. However, little is known about the consequences of PICC insertion in these patients. Our aim was to analyze PICC-related complication rates among pregnant women. ⋯ PICC insertion in pregnant women is associated with a high complication rate, which appears to be independent of the type of infusate and occurs in the majority of women. PICCs should be used judiciously and only when clearly necessary during pregnancy. Further studies are needed to determine how to reduce PICC-related complications in this population.
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Jpen Parenter Enter · Jul 2014
ReviewElderly persons with ICU-acquired weakness: the potential role for β-hydroxy-β-methylbutyrate (HMB) supplementation?
Intensive care unit (ICU)-acquired weakness is common and characterized by muscle loss, weakness, and paralysis. It is associated with poor short-term outcomes, including increased mortality, but the consequences of reduced long-term outcomes, including decreased physical function and quality of life, can be just as devastating. ICU-acquired weakness is particularly relevant to elderly patients who are increasingly consuming ICU resources and are at increased risk for ICU-acquired weakness and complications, including mortality. ⋯ Increasingly, intensivists and researchers are focusing on strategies and therapies aimed at improving long-term neuromuscular function. β-Hydroxy-β-methylbutyrate (HMB), an ergogenic supplement, has shown efficacy in elderly patients and certain clinical populations in counteracting muscle loss. The present review discusses ICU-acquired weakness, as well as the unique physiology of muscle loss and skeletal muscle function in elderly patients, and then summarizes the evidence for HMB in elderly patients and in clinical populations. We subsequently postulate on the potential role and strategies in studying HMB in elderly ICU patients to improve muscle mass and function.