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Parenteral and Enteral Nutrition in Critical Illness
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
This chapter will start with an overview of critical care metabolism. We will explore the approaches to managing nutritional support through the phases of critical illness. We will discuss the concepts of hypocaloric enteral feeding, combined parenteral and enteral nutrition and address the challenges of managing nutritional support in an obese critically-ill patient.
Creating Value Today with AI
Published in Tom Lawry, Hacking Healthcare, 2022
In another use case, the University of Pennsylvania Health System and Brown University-affiliated hospitals made use of AI with chest X-rays to improve the ability to predict the risk of progression to critical illness in patients with COVID-19.
Care of the Critically Ill Pediatric Patient
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Katelyn Ariagno, Nilesh M. Mehta
Nutrition screening has been adopted in most centers in order to flag patients with risk factors for malnutrition (Chapter 3). This is followed by a more detailed initial nutrition assessment (within 48 hours of PICU admission) conducted by a trained dietitian. A variety of tools exist for nutrition screening and assessment of hospitalized children. However, there is a paucity of validated tools that can be applied specifically to critically ill children. Despite these shortcomings, institutional processes based on manual and electronic medical record review allow identification of patients who might be already malnourished or at risk of malnutrition during the illness course. The premise of screening and initial assessment is to direct clinical resources for timely intervention in these vulnerable patients who might potentially benefit from nutrition therapies. Critical illness often results in further nutrition deterioration during the illness course, probably due to the failure to offset the burden of metabolic stress. Children admitted to the PICU, including previously healthy children or children with obesity, can still present at increased nutrition risk if nutrition therapy is delayed or delivery is inadequate over prolonged periods throughout their hospitalization. Hence, serial assessments (at least weekly throughout PICU stay) should be considered.
Reliability and responsiveness of the Danish version of The Chelsea Critical Care Physical Assessment tool (CPAx)
Published in Physiotherapy Theory and Practice, 2023
Katrine Astrup, Evelyn Corner, Maurits Van Tulder, Lotte Sørensen
An increasing number of patients are surviving critical illness due to advances in medical care (Graf et al., 2005). However, both the critical illness itself and the iatrogenic effects of its management, such as enforced immobilization, sedation, mechanical ventilation, and physical inactivity, can result in severe and rapid peripheral and respiratory muscle wasting (Latronico and Bolton, 2011; Puthucheary et al., 2013). This is referred to as ‘Intensive Care Unit-Acquired Weakness’ (ICU-AW). ICU-AW affects around 43% (IQR 9–86%) of critically ill patients (Appleton, Kinsella, and Quasim, 2015; Vanhorebeek, Latronico, and Van den Berghe, 2020) and is linked to the presence of sepsis and multi-organ failure (Fan et al., 2014). The rapid and substantial loss of muscle mass and reduced muscle strength that occurs during the ICU stay can result in prolonged weaning from mechanical ventilation, physical disability, and impaired activities of daily living (ADL) (Herridge et al., 2011; Vanhorebeek, Latronico, and Van den Berghe, 2020; Visser et al., 2002). Early physiotherapy for patients in the ICU is essential to minimize the physical consequences of critical illness (Anekwe, Biswas, Bussières, and Spahija, 2020; Schaller et al., 2016; Schweickert et al., 2009) and improve long-term outcomes and survival (Iwashyna, Ely, Smith, and Langa, 2010; Needham et al., 2012).
Video-nystagmography test findings in post COVID-19 patients
Published in Hearing, Balance and Communication, 2021
Tayseer Taha Abdelrahman, Noha Ali Shafik
Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g. fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, loss of taste and smell) but who do not have shortness of breath, dyspnoea, or abnormal chest imaging.Moderate Illness: Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation (SpO2) ≥94% on room air at sea level.Severe Illness: Individuals who have SpO2 < 94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%.Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.
The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness
Published in Brain Injury, 2021
Laura E. Gonzalez-Lara, Sarah Munce, Jennifer Christian, Adrian M. Owen, Charles Weijer, Fiona Webster
In addition, caregivers often felt a sense of duty, leaving them no choice as to the extent of care they were called to provide, resulting in a sense of loss of control over their lives. Spouses in this study expressed they often experienced a sense of duty concurrently with a confusing sense of mourning similar to what has been previously reported by Hamama-Raz et al. (19). There are few resources available to support caregivers of patients who have survived critical illness, and in the case of patients with prolonged DoC, with considerable needs. Lack of resources and sense of control over life has been reported to be associated with poorer mental health outcomes (38). Caregiving has been previously described as a lonely experience (39) and hopelessness, in particular, has been associated with a higher burden (40). Regardless of the etiology, it has been recognized that providing care for a family member following a severe injury results in emotional, physical, social, and financial strain (19,41–43). In particular, anxiety and depression have a detrimental effect on the mental and physical health of caregivers of patients with VS or MCS (44).