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Author: Yan Wang Publisher: ISBN: Category : Languages : en Pages : 27
Book Description
Worse clinical outcomes have been reported among critically ill COVID-19 patients who are admitted to an inpatient intensive care unit (ICU), especially those who require invasive mechanical ventilation (IMV). Patients on IMV do not receive any food or medication by mouth, during which their energy and protein needs are dependent on enteral nutrition (EN) and propofol lipid emulsion delivery (and parenteral nutrition if needed). Underfeeding throughout the ICU stay has been reported, while overfeeding due to propofol delivery is also a concern, which were both reported to be harmful to critically ill patients. However, there are limited data on the nutrition intake of COVID-19 patients during IMV and the association with in-hospital mortality. Objectives: In this study, we examined whether IMV is associated with higher mortality and longer ICU length of stay in critically ill ICU patients admitted with COVID-19. We calculated the energy and protein intake from EN and the lipid emulsion for propofol and also evaluated the associations with in-hospital mortality. We conducted a hospital-based retrospective study, using chart review of electronic medical records among COVID-19 patients admitted to an ICU at Harborview Medical Center (HMC) in Seattle, Washington, between March 5, 2020, through October 31, 2020. Multivariable logistic regression models were used to assess the associations between IMV and in-hospital mortality. Among those who survived to hospital discharge, multivariable linear regression was used to estimate the associations between IMV and ICU length of stay. Among those who received IMV during their hospital stay, we used multivariable logistic regression to estimate the associations between the nutrition intake during IMV and in-hospital mortality. Ninety-five patients were included in the chart review. The mean age was 60.9 [standard deviation (SD): 16.1] years and 78.9% were men. About half (50.5%) received IMV during hospitalization; 33.7% died prior to hospital discharge. After adjustment for demographics, the odds of in-hospital mortality was 3.28 (95% CI: 1.12, 9.59) times higher among patients who received IMV than those who did not (p = 0.03). The association was slightly attenuated after further adjustment for comorbidities [adjusted odds ratio (aOR) = 3.01 (95% CI: 0.97, 9.39), p = 0.06], prior medication use [aOR = 3.04 (95% CI: 0.96, 9.58), p = 0.06], and Sequential Organ Failure Assessment (SOFA) score [aOR = 2.92 (95% CI: 0.84, 10.15), p = 0.09]. Among the sixty-three patients who survived to hospital discharge, we found that patients receiving IMV were in the ICU 19.4 days longer (95% CI: 11.6, 27.3), than those who did not receive IMV after adjustment for demographics, comorbidities, prior medication use, and SOFA score (p
Author: Yan Wang Publisher: ISBN: Category : Languages : en Pages : 27
Book Description
Worse clinical outcomes have been reported among critically ill COVID-19 patients who are admitted to an inpatient intensive care unit (ICU), especially those who require invasive mechanical ventilation (IMV). Patients on IMV do not receive any food or medication by mouth, during which their energy and protein needs are dependent on enteral nutrition (EN) and propofol lipid emulsion delivery (and parenteral nutrition if needed). Underfeeding throughout the ICU stay has been reported, while overfeeding due to propofol delivery is also a concern, which were both reported to be harmful to critically ill patients. However, there are limited data on the nutrition intake of COVID-19 patients during IMV and the association with in-hospital mortality. Objectives: In this study, we examined whether IMV is associated with higher mortality and longer ICU length of stay in critically ill ICU patients admitted with COVID-19. We calculated the energy and protein intake from EN and the lipid emulsion for propofol and also evaluated the associations with in-hospital mortality. We conducted a hospital-based retrospective study, using chart review of electronic medical records among COVID-19 patients admitted to an ICU at Harborview Medical Center (HMC) in Seattle, Washington, between March 5, 2020, through October 31, 2020. Multivariable logistic regression models were used to assess the associations between IMV and in-hospital mortality. Among those who survived to hospital discharge, multivariable linear regression was used to estimate the associations between IMV and ICU length of stay. Among those who received IMV during their hospital stay, we used multivariable logistic regression to estimate the associations between the nutrition intake during IMV and in-hospital mortality. Ninety-five patients were included in the chart review. The mean age was 60.9 [standard deviation (SD): 16.1] years and 78.9% were men. About half (50.5%) received IMV during hospitalization; 33.7% died prior to hospital discharge. After adjustment for demographics, the odds of in-hospital mortality was 3.28 (95% CI: 1.12, 9.59) times higher among patients who received IMV than those who did not (p = 0.03). The association was slightly attenuated after further adjustment for comorbidities [adjusted odds ratio (aOR) = 3.01 (95% CI: 0.97, 9.39), p = 0.06], prior medication use [aOR = 3.04 (95% CI: 0.96, 9.58), p = 0.06], and Sequential Organ Failure Assessment (SOFA) score [aOR = 2.92 (95% CI: 0.84, 10.15), p = 0.09]. Among the sixty-three patients who survived to hospital discharge, we found that patients receiving IMV were in the ICU 19.4 days longer (95% CI: 11.6, 27.3), than those who did not receive IMV after adjustment for demographics, comorbidities, prior medication use, and SOFA score (p
Author: Xuejiao Wei Publisher: ISBN: Category : Languages : en Pages : 264
Book Description
Background: While the provision of adequate nutrition support in critically ill patients has been shown to have an impact on short-term clinical outcomes, relatively little is known about subsequent long-term outcomes. We aimed to examine the association between nutritional adequacy and long-term outcomes including survival and health-related quality of life (HRQoL) in critically ill patients requiring prolonged mechanical ventilation. Methods: The study was conducted as a retrospective cohort study on data collected prospectively in the context of a multicenter randomized controlled trial (RCT) in critically ill patients. Randomized patients who stayed in the intensive care unit (ICU) and were mechanically ventilated for >8 days were eligible for the study, but only six-month survivors were considered for the assessment of HRQoL. Nutritional adequacy was obtained from the average proportion of prescribed calories received during the first eight days of mechanical ventilation in the ICU. Survival status and HRQoL as assessed using Short-Form 36 Health Survey (SF-36) were obtained prospectively as part of the RCT protocol at three-months and six-months post ICU admission. Results: Of the 1223 patients enrolled in the randomized controlled trial, 475 met the inclusion criteria for this study. At six-month follow-up, 302 of the 475 patients were alive. Among critically ill patients with >8 days of mechanical ventilation in the ICU, survival time in those who received low nutritional adequacy was significantly shorter than for those who received high nutritional adequacy after adjusting for important covariates. Among six-month survivors, clinically meaningful and statistical significant associations between increase in scores of Physical Functioning (PF) and Role Physical domains (RP) of the SF-36 and 25% increase in nutritional adequacy were observed at three-months follow-up. No significant associations were observed at six-months. Conclusions: Our findings suggest that nutritional adequacy received as early as the first week in the ICU seems beneficial to longer survival time and faster physical recovery post ICU discharge in critically ill patients requiring prolonged mechanical ventilation in the ICU. Well-designed randomized controlled trials are needed to provide stronger assessment of the causal impact of nutrition therapy on long-term outcomes.
Author: P. Singer Publisher: Karger Medical and Scientific Publishers ISBN: 3318022284 Category : Medical Languages : en Pages : 206
Book Description
The care of ICU patients has seen many improvements over the years, both with regard to technical aspects and supportive measures. The first part of this book analyzes nutritional support at various levels, ranging from the cell level to the whole-body aspect; drawing on recent prospective randomized studies, the authors propose a new approach for oral, enteral and/or parenteral nutrition. The second part underlines the interference between nutrition and outcome to reach recovery, giving to this field an increased importance for better short and long term management: The best glucose control, individualized nutritional support and the avoidance of harmful interferences is extensively discussed. The final part deals with patients suffering from multi-organ failure and the need for a better understanding of the interactions between disease and nutrition. Identification of the metabolic condition of the patient, existence or not of evidence-based medicine, expert opinion, treatment opportunities and the case manager recognizing threats are all integrated to reach the appropriate decision. This last part will help the reader to untangle the complexity of the ICU patient of the 21st century and to propose a personalized nutritional support process.
Author: Michela Botta Publisher: ISBN: 9789464835496 Category : Languages : en Pages : 0
Book Description
"Critically ill patients with respiratory failure often require oxygen support and invasive or noninvasive mechanical ventilation in the intensive care unit (ICU). This thesis comprises a collection of studies on ventilator management and oxygen use in critically ill patients with coronavirus disease 2019 (COVID-19) and automated ventilation in critically ill patients in general. The first part of the thesis presents retrospective observational studies that were performed in critically ill COVID-19 patients. We described the ventilation practices and outcomes during the initial months of the COVID-19 pandemic in the Netherlands. Additionally, we investigated the prevalence of hyperoxemia and excessive oxygen use and their association with outcomes. In an international multicenter cohort of critically ill COVID-19 patients during the second wave of the outbreak, we described differences in oxygen use during high flow nasal oxygen (HFNO) therapy and mechanical ventilation. The second part of this thesis focuses on automated invasive mechanical ventilation in critically ill patients. We investigated effectiveness, safety and efficacy of a mode of automated ventilation named INTELLiVENT-ASV through a systematic review. Furthermore, we compared in an international multicenter cross-over trial conventional ventilation and automated mechanical ventilation by means of INTELLiVENT-ASV with regard to oxygenation settings, alarms and manual interventions related to oxygenation."--
Author: Qi Chen Publisher: CRC Press ISBN: 0429807813 Category : Medical Languages : en Pages : 269
Book Description
Vitamin C holds a unique place in scientific and cultural history. In this book, a group of leading scientific researchers describe new insights into the myriad ways vitamin C is employed during normal physiological functioning. In addition, the text provides an extensive overview of the following: the rationale for utilizing vitamin C in the clinic, updates on recent uses of vitamin C in cancer treatment through high-dose intravenous therapies, the role vitamin C plays in the treatment of sepsis and infectious disease, management of the ways vitamin C can improve stem cell differentiation, as well as vitamin C use in other important health situations. Features Includes chapters from a team of leading international scholars Reviews the history and recent research on the functions, benefits, and uses of vitamin C Focuses special attention on the way vitamin C can be used in the treatment of cancers Discusses how vitamin C can be employed against infectious disease
Author: Ginny Garcia-Alexander Publisher: Springer Nature ISBN: 3031109368 Category : Social Science Languages : en Pages : 343
Book Description
This handbook provides a demographic examination of global obesity trends by bringing together the range of research conducted in this field by demographers, sociologists, epidemiologists, and other quantitatively and demographically oriented social scientists. It utilizes a multidisciplinary demographic approach to provide insights into the global prevalence and mechanisms of obesity, as well as the population level impacts of rising obesity. Major sections include: global obesity trends and prevalence; obesity and demographic structures, processes, and characteristics; emerging areas of study; and obesity in LGBAT populations. This handbook provides readers with a broad understanding of population-based research on obesity and serves as a resource for scholars, students, policymakers, and researchers.
Author: Yan Wang
Author: Yan Wang
Author: Xuejiao Wei
Author: P. Singer
Author: Leila Itani
Author: Michela Botta
Author: Charles Morrison Mueller
Author: Deepak Govil
Author: Qi Chen
Author: Timotius Ivan Hariyanto
Author: Ginny Garcia-Alexander