ABC’s of Vitamin Supplementation in Critical Illness

2020 ◽  
pp. 089719002095823 ◽  
Author(s):  
Melissa Chudow ◽  
Beatrice Adams
Keyword(s):  
Oxidative Stress ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Phase Reactant ◽  
Organ Damage ◽  
Vitamin Supplementation ◽  
Critically Ill Patient ◽  
Enhanced Production

Critical illness commonly presents as a systemic inflammatory process. Through this inflammation, there is an enhanced production of reactive oxygen and nitrogen species combined with marked reductions in protective plasma antioxidant concentrations. This imbalance is referred to as oxidative stress and is commonly encountered in numerous disease states in the critically ill including sepsis, trauma, acute respiratory distress syndrome, and burns. Oxidative stress can lead to cellular, tissue and organ damage as well as increased morbidity and mortality in critically ill patients. Supplementation with exogenous micronutrients to restore balance and antioxidant concentrations in critically ill patients has been considered for several decades. It is proposed that antioxidant vitamins, such as vitamins A and C, may minimize oxidative stress and improve clinical outcomes. Vitamin B formulations may play a role in curtailing lactic acidosis and are recently being evaluated as an acute phase reactant. However, few large, randomized trials specifically investigating the role of vitamin supplementation in the critically ill patient population are available. This article seeks to review recently published literature surrounding the role of supplementation of vitamins A, B and C in critically ill patients.

scholarly journals Role of Melatonin Supplementation on Inflammatory and Oxidative Stress Markers in Critically Ill Patients

2018 ◽  
Vol 5 (4) ◽  
pp. 143-145
Author(s):  
Naseh Pahlavani ◽  
Seyedeh Shabnam Mazloumi Kiapey ◽  
Safieh Firouzi ◽  
Mahsa Malekahmadi
Keyword(s):  
Oxidative Stress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oxidative Stress Markers ◽  
Stress Markers ◽  
And Oxidative Stress

scholarly journals Rectal Swabs from Critically Ill Patients Provide Discordant Representations of the Gut Microbiome Compared to Stool Samples

mSphere ◽  
2019 ◽  
Vol 4 (4) ◽  
Author(s):  
Katherine Fair ◽  
Daniel G. Dunlap ◽  
Adam Fitch ◽  
Tatiana Bogdanovich ◽  
Barbara Methé ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gut Microbiome ◽  
Rectal Swab ◽  
Time Points ◽  
Rectal Swabs ◽  
Stool Samples ◽  
Microbiome Profiling

ABSTRACT The role of the gut microbiome in critical illness is being actively investigated, but the optimal sampling methods for sequencing studies of gut microbiota remain unknown. Stool samples are generally considered the reference standard but are not practical to obtain in the intensive care unit (ICU), and thus, rectal swabs are often used. However, the reliability of rectal swabs for gut microbiome profiling has not been established in the ICU setting. In this study, we compared 16S rRNA gene sequencing results between rectal swab and stool samples collected at three time points from mechanically ventilated critically ill adults. Rectal swabs comprised 89% of the samples collected at the baseline time point, but stool samples became more extensively available at later time points. Significant differences in alpha-diversity and beta-diversity between rectal swabs and stool samples were observed, but these differences were primarily due to baseline samples. Higher relative abundances of members of the Actinobacteria phylum (typically skin microbes) were present in rectal swabs than in stool samples (P = 0.05), a difference that was attenuated over time. The progressively increasing similarity of rectal swabs and stool samples likely resulted from increasing levels of stool coating of the rectal vault and direct soiling of the rectal swabs taken at later time points. Therefore, inferences about the role of the gut microbiome in critical illness should be drawn cautiously and should take into account the type and timing of samples analyzed. IMPORTANCE Rectal swabs have been proposed as potential alternatives to stool samples for gut microbiome profiling in outpatients or healthy adults, but their reliability in assessment of critically ill patients has not been defined. Because stool sampling is not practical and often not feasible in the intensive care unit, we performed a detailed comparison of gut microbial sequencing profiles between rectal swabs and stool samples in a longitudinal cohort of critically ill patients. We identified systematic differences in gut microbial profiles between rectal swabs and stool samples and demonstrated that the timing of the rectal swab sampling had a significant impact on sequencing results. Our methodological findings should provide valuable information for the design and interpretation of future investigations of the role of the gut microbiome in critical illness.

scholarly journals Correlation of Redox Status with Procalcitonin and C-reactive Protein in Septic Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jasna Petrovic ◽  
Tamara Nikolic Turnic ◽  
Vladimir Zivkovic ◽  
Marijana Andjic ◽  
Nevena Draginic ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Redox Status ◽  
Prospective Clinical Study ◽  
C Reactive Protein ◽  
Reactive Protein

Based on the role of oxidative stress in the pathophysiological mechanisms of sepsis and the importance of PCT as a clinically applicable biomarker for early detection of inflammatory response initiation, we aimed this study at examining the correlation between PCT levels and oxidative stress parameters (prooxidants and antioxidants) in patients with sepsis. This study was designed as a case-series prospective clinical study which involved 103 critically ill patients and 17 healthy participants with diagnosis of sepsis/septic shock (over 18 years of age, both gender) admitted to the Intensive Care Unit (ICU) of Valjevo General Hospital in Serbia. All subjects were divided into patients who were operated on/underwent surgery before sampling and have sepsis (n=24), patients who were operated on/underwent surgery before sampling and have septic shock (n=25), patients who were not operated on/did not undergo surgery before sampling and have sepsis (n=26), patients who were not operated on/did not undergo surgery before sampling and have septic shock (n=28), and participants who are healthy (n=17). PCT has confirmed a positive correlation with prooxidants and type of critical illness, and performing surgical intervention diminished oxidative stress in patients with septic shock. Prognosis in critically ill patients was strongly associated with PCT levels but not with nonspecifically C-reactive protein.

scholarly journals A COMPREHENSIVE APPROACH TO THE MANAGEMENT OF CRITICALLY ILL

2019 ◽  
Vol 8 (2) ◽  
pp. 116-124
Author(s):  
E. V. Grigoryev ◽  
A. A. Mikhailova ◽  
D. L. Shukevich ◽  
G. P. Plotnikov ◽  
A. S. Radivilko ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cognitive Dysfunction ◽  
Critically Ill Patients ◽  
Critical Condition ◽  
Underlying Disease ◽  
Early Rehabilitation ◽  
Critically Ill Patient ◽  
Social Aspect ◽  
Long Term Treatment

The study of long-term treatment outcomes of patients in the intensive care unit (ICU) is necessary for the rapid recovery of a critically ill patient. Training of ICU staff in basic rehabilitation techniques for early rehabilitation and resocialization of patients allows promoting improvements in postresuscitation immunosuppression, polyneuropathy, polymyopathy, and cognitive dysfunction. The introduction of rehabilitation in the ICU enables avoiding the concept of syndrome-treatment of critically ill patients, solving the problem of “a chronic ICU patient”, reducing the number of complications of the underlying disease and chronic pathologies associated with the patient's critical condition. The algorithms for the recovery of critically ill patients are proposed to be introduced from the first day of the hospitalization, when the first pathophysiological recovery patterns begin to form. The role of resocialization in the framework of this approach to the rehabilitation of critically ill patients, the “open ICU” model and deontological aspects of the communication between medical staff and an ICU patient are put forward. The prevention of delirium after cardiac arrest contributes greatly to the further prevention of post-resuscitation cognitive dysfunction, decreases depression and prevents oversedation. A new phenotype of a chronic critically ill patient, the “patient after a critical condition,” is introduced with the discussion of the pathophysiological patterns involved in its formation. The relevance of this review is confirmed by the growing interest to the integration between ICU staff and patient`s family, thus emerging the role of social aspect of the rehabilitation in critically ill patients. The novelty of this research is imposed by advanced approaches to the early rehabilitation of ICU survivors which are currently neglected from the routine ICU practice.

scholarly journals Rectal swabs in critically-ill patients provide discordant representations of the gut microbiome compared to stool samples: a brief methodologic report

2019 ◽  
Author(s):  
Katherine Fair ◽  
Daniel G. Dunlap ◽  
Adam Fitch ◽  
Alison Morris ◽  
Bryan J. McVerry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gut Microbiome ◽  
Time Points ◽  
Rectal Swabs ◽  
Stool Samples ◽  
Microbiome Profiling

AbstractThe role of the gut microbiome in critical illness is being actively investigated, but the optimal sampling methods for sequencing studies of gut microbiota remain unknown. Stool samples are generally considered gold-standard but are not practical to obtain in the intensive care unit (ICU), and thus, rectal swabs are often used. However, the reliability of rectal swabs for gut microbiome profiling has not been established in this clinical setting. In this study, we compared 16S rRNA gene sequencing results between rectal swab and stool samples collected at three timepoints in mechanically-ventilated critically-ill adults. Rectal swabs comprised 89% of samples collected at the baseline timepoint, but stool samples became more available at later time-points. Significant differences in alpha and beta-diversity between rectal swabs and stool samples were observed (p<0.003), but these differences were primarily due to baseline samples. Higher relative abundance of Actinobacteria phyla (typically skin microbes) was present in rectal swabs compared to stool samples (p<0.02), a difference that was attenuated overtime. The progressive similarity of rectal swabs and stool samples likely results from increasing stool coating of the rectal vault and direct soiling of the rectal swabs taken at later time points. Therefore, inferences about the role of the gut microbiome in critical illness should be drawn cautiously and take into account the actual type and timing of samples analyzed.Statement of ImportanceRectal swabs are considered reliable alternatives to stool samples for gut microbiome profiling in outpatients or healthy adults, but their reliability in critically-ill patients has not been defined. Because stool sampling is not practical or often feasible in the intensive care unit, we performed a detailed comparison of gut microbial sequencing profiles between rectal swabs vs. stool samples in a longitudinal cohort of critically-ill patients. We identified systematic differences in gut microbial profiles between rectal swabs and stool samples, and highlighted that timing of rectal swabbing had a significant impact on sequencing results. Our methodological findings should inform future investigations of the role of the gut microbiome in critical illness.

Benzodiazepine Sedation in Critically Ill Patients

1991 ◽  
Vol 2 (4) ◽  
pp. 748-761 ◽  
Author(s):  
Margaret H. Doherty
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Assessment Tools ◽  
Critically Ill Patient ◽  
Treatment Intervention ◽  
Common Phenomenon ◽  
Sedation Scale ◽  
Motor Restlessness ◽  
Effective Assessment

Agitation is a common phenomenon in critically ill patients. This multidimensional challenge can prolong illness, interfere with treatment, and harm the patient. The nurse must assess the cause of the agitation and provide effective, timely intervention. Agitation is defined as motor restlessness secondary to possible physiologic, psychologic, environmental, and pharmacologic causes. The nurse has many effective assessment tools to systematically determine the cause of the agitation, including an agitation algorithm and sedation scale. With astute assessment and intervention, agitation can be prevented and treated to enhance recovery from critical illness. Benzodiazepines are an effective treatment intervention for agitation. With thorough knowledge of the actions and potential effects of these drugs, the nurse can provide the best pharmacologic intervention to treat agitation in the critically ill patient

scholarly journals Dysregulated host response in SARS-CoV-2 induced critical illness

2021 ◽  
Author(s):  
Shilpa Tiwari-Heckler ◽  
Conrad Rauber ◽  
Maria Serena Longhi ◽  
Inka Zörnig ◽  
Paul Schnitzler ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oxygen Therapy ◽  
T Cell Subsets ◽  
Low Flow ◽  
Critically Ill Patient ◽  
Myeloid Dendritic Cells ◽  
High Flow Oxygen

Abstract Background Impaired immune response has been described to be the cause of the development of COVID-19 related respiratory failure. Further studies are needed to understand the immunopathogenesis and to enable an improved stratification of patients that are at risk for critical illness. Methods 32 severely ill hospitalized COVID19 patients were recruited in our center at the University Hospital Heidelberg. We performed a comprehensive analysis of immune phenotype, cytokine and chemokine profiling and leukocyte transcripts in severe COVID-19 patients comparing critically ill patients requiring mechanical ventilation and high flow oxygen therapy and non-critically ill patient receiving low flow oxygen therapy. Results Critically ill patients exhibited low levels of CD8 T cells and myeloid dendritic cells. We noted a pronounced CCR6 + TH17 phenotype in CD4 central memory cells and elevated circulating levels of IL-17 in the critical group. Gene expression of leukocytes derived from critically ill patients was characterized by an upregulation of proinflammatory cytokines and reduction of IFN-responsive genes upon stimulation with toll-like receptor 7/8 agonist. When correlating clinical improvement and immune kinetics, we found that CD8 T cell subsets and myeloid dendritic cells significantly increased after disconnection from the ventilator. Conclusion Critical illness was characterized by a TH17-mediated response and dysfunctional IFN-associated response, indicating an impaired capacity to mount antiviral responses during SARS-CoV-2 severe infection.

Critical Care Implications of Adrenal Disease States

2020 ◽  
Author(s):  
Shaun Thompson ◽  
Erin Etoll
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Morbidity And Mortality ◽  
Critically Ill Patient ◽  
Disease States ◽  
Adrenal Disease ◽  
Corticosteroid Insufficiency

Adrenal disease in the critically ill patient can present many challenges for the intensivist. Besides primary, secondary, and tertiary adrenal insufficiency, a state known as critical care–related corticosteroid insufficiency (CIRCI) has been described. Adrenal insufficiency can pose many issues to the critically ill patient as it can decrease the patient’s ability to respond to the stress that critical illness presents to the human body. Proper recognition and diagnosis of adrenal insufficiency in the critically ill patient can be extremely important in the treatment of these patients and could be a lifesaving intervention if CIRCI is discovered. A less commonly encountered issue of adrenal disease lies in the area of adrenal hormone excess caused by a pheochromocytoma or extra-adrenal paragangliomas. These tumors can release large amounts of endogenous catecholamines that cause significant patient morbidity and mortality if not recognized early and treated appropriately. Although adrenal insufficiency and adrenal excess are less commonly encountered problems in critically ill patients, the recognition and treatment of these disease states can prevent the morbidity and mortality of critically ill patients that suffer from these disease states. This review contains 5 figures, 5 tables, and 89 references. Key words: adrenal insufficiency, hypothalamic-pituitary axis, critical illness–related corticosteroid insufficiency, pheochromocytoma, steroid replacement therapy

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

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