1/39. anorexia nervosa with severe liver dysfunction and subsequent critical complications.A twenty-year-old woman with anorexia nervosa (body mass index=11) suffered from severe liver dysfunction (aspartate aminotransferase 5,000 IU/l, alanine aminotransferase 3,980 IU/l, prothrombin time 32%), hypoglycemia (serum glucose 27 mg/dl), and pancreatic dysfunction (amylase 820 IU/l, lipase 558 IU/l). She fell into a depressive state with irritability, which was not improved by intravenous glucose. Despite treatment with plasmapheresis for the liver dysfunction, she subsequently developed pulmonary edema, acute renal failure, gastrointestinal bleeding, and disseminated intravascular coagulation. Hemodialysis, mechanical ventilation and drug therapy including prednisolone, prostaglandin E1, and branched-chain amino acid, improved her critical condition. In this case, malnutrition may have been the cause for the liver dysfunction and subsequent complications.- - - - - - - - - - ranking = 1keywords = nutrition, index (Clic here for more details about this article) |
2/39. delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring.A pilot prospective cohort study was conducted to determine delirium frequency and outcome in cancer patients consecutively hospitalized for terminal care (median stay: 12 days). Screening for delirium symptoms was performed daily, using the confusion Rating Scale. patients positive on screening had a diagnostic assessment within 24 hours using the confusion Assessment Method. Monitoring of symptoms was continued until death. Eighteen (20%) of the 89 study patients were positive on screening at admission. Among the 71 patients free of delirium at admission, the incidence of confirmed delirium was 32. 8% (95% CI, 21.3-44.3%). patients positive on screening received a higher mean equivalent parenteral daily dose of morphine than other patients (72 mg vs. 41 mg, p = 0.08). Significant symptom improvement occurred in 16 (50%) of the 32 delirious cases. delirium is a serious and frequent complication in terminal cancer whose outcome may not be as poor as previously considered.- - - - - - - - - - ranking = 0.017854361999459keywords = assessment (Clic here for more details about this article) |
3/39. Perforated duodenal ulcer associated with ovarian hyperstimulation syndrome: Case Report.ovarian hyperstimulation syndrome (OHSS) remains the most serious medical complication of controlled ovarian stimulation. An unusual case of perforated duodenal ulcer following critical OHSS is presented. A 29 year old nulligravid woman with polycystic ovarian syndrome underwent her first attempt at in-vitro fertilization. She was admitted to the hospital with critical OHSS and subsequently found to have a perforated posterior duodenal ulcer. She underwent exploratory laparotomy, antrectomy and gastrojejunostomy. Pathological analysis of her gastric antrum confirmed chronic gastritis and helicobacter pylori. She required prolonged assisted ventilation, vasopressor support, multiple i.v. antibiotics, blood product replacement and nutritional support. The patient was hospitalized for a total of 47 days and then transferred to a rehabilitation facility for an additional 30 days before being discharged to home. In this critically ill patient with OHSS, severe stress associated with invasive monitoring and multiple medical therapies in the intensive care unit as well as H. pylori infection appear to be the most probable causative factors of her perforated viscus. Prompt recognition of potential complications and proper medical intervention are essential in the management of patients with OHSS. Avoidance strategies are still needed.- - - - - - - - - - ranking = 0.99557358011282keywords = nutrition (Clic here for more details about this article) |
4/39. A method for the measurement of glucose oxidation using the constant infusion of stable isotope.We developed a method to measure the oxidation of glucose using the primed constant infusion of [U-13C] glucose in critically ill patients fed by total parenteral nutrition. The results obtained from the isotopic method were compared to those from indirect calorimetry in the critically ill patients. A patient with esophageal carcinoma was used for the preliminary study. The study was performed on the third postoperative day, assuming severely stressed state. Priming doses of NaH13CO3 at a dosage of 0.32 mg/kg and D-[U-13C] glucose at a dosage of 0.32 mg/kg were injected. D-[U-13C] glucose was then infused at an infusion rate of 0.004 mg/kg/min. It was revealed that the time required for an isotopic plateau was approximately 45 min in plasma glucose and 120 min in an expired air in highly stressed state. Isotopic measurement and indirect calorimetry were performed simultaneously pre- and postoperatively on three patients who underwent surgery for esophageal carcinoma. Increased fat oxidation was obtained by the isotopic method, whereas indirect calorimetry indicated nonprotein RQ above 1.0. Isotopic measurement offered a useful information that cannot be obtained from indirect calorimetry concerning the energy metabolism in the critical illness. Thus our method for the measurement of glucose oxidation is both simple and useful in investigating the energy metabolism in critically ill patients.- - - - - - - - - - ranking = 0.99557358011282keywords = nutrition (Clic here for more details about this article) |
5/39. critical illness neuromuscular disease: clinical, electrophysiological, and prognostic aspects.BACKGROUND: critical illness neuromuscular disease, which has been recognised as a distinct clinical entity in adults, remains poorly described in children. AIMS: To assess retrospectively the clinical, electrophysiological, and prognostic features of the disease. methods: Retrospective study in a children's university hospital. RESULTS: Five critically ill patients presented with generalised paralysis, associated with long lasting failure to breathe in three. The cause of the generalised paralysis was critical illness neuropathy in two, acute myopathy in two, and mixed neuromyopathy in one. CONCLUSIONS: Neuromuscular disease should be suspected in critically ill children with muscle weakness. Because corticosteroids and muscle relaxants appear to trigger some types of intensive care unit neuromuscular disease in children, their use should be restricted or administered at the lowest doses possible.- - - - - - - - - - ranking = 0.26921745887704keywords = prognostic (Clic here for more details about this article) |
6/39. Special feature: exploring the benefits and myths of enteral feeding in the critically ill.patients in the intensive care unit setting have been nutritionally deprived for various reasons. Many patients who are critically ill cannot absorb nourishment by traditional routes. Enteral feeding should be considered for all patients who cannot meet caloric needs. There are many benefits to enteral feeding such as decreased infection, rapid wound healing, and decreased length of stay and mortality. Many critical care nurses subscribe to myths for not feeding their patients. The myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. There is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.- - - - - - - - - - ranking = 2.9867207403384keywords = nutrition (Clic here for more details about this article) |
7/39. Open-label, multicentre, emergency-use study of clinafloxacin (CI-960) in the treatment of patients with serious life-threatening infections.In an open-label emergency-use study, 23 patients with bacterial infections caused by multiply drug resistant pathogens were treated with clinafloxacin. Efficacy and safety were evaluated by tabulating investigators' assessments at the end of treatment, treatment discontinuations and adverse event data. Most of the patients were seriously ill and had multi-organ infections, primarily respiratory tract infections such as nosocomial pneumonia and gastrointestinal infections. Eleven patients were successfully treated, two had treatment failure and 10 were not evaluable because the patients died of their underlying disease. Considering that most of the patients had several infections caused by multiply resistant pathogens, clinafloxacin may be useful for the treatment of such life-threatening episodes.- - - - - - - - - - ranking = 0.017854361999459keywords = assessment (Clic here for more details about this article) |
8/39. Saturday night fever: finding and controlling the source of sepsis in critical illness.fever is a daily concern in the intensive care unit. Although about half of all febrile cases are due to non-infectious causes, fear of sepsis frequently leads to diagnostic tests and escalation of therapy, including broadening antibiotic therapy. Using a case to illustrate this dilemma, we discuss the commonest non-infectious and infectious causes of fever, and suggests approaches to their management. Any unexplained fever in intensive care unit patients warrants investigation, which includes complete clinical assessment and blood cultures. When the source of fever is not immediately apparent, non-infectious and infectious causes should be considered. If stable, non-neutropenic patients should be monitored before further tests or empiric antibiotics are started. In an era of rapid emergence and spread of antimicrobial-resistant pathogens and intense scrutiny of resources, optimal diagnosis and management of patients with suspected infection entails much more than the escalation of antimicrobial therapy.- - - - - - - - - - ranking = 0.017854361999459keywords = assessment (Clic here for more details about this article) |
9/39. Pressure care in the paediatric intensive care unit.nursing staff in paediatric intensive care units (PICUs) regularly face a complex combination of nursing problems when admitting critically ill children. The assessment of skin integrity might not always be a priority during the initial period following admission. This article outlines some of the difficulties facing nurses involved in the care of critically ill children and reviews the literature on pressure ulcer assessment, highlighting the lack of a universal tool for risk assessment in this area. It also shows how a simple audit changed practice and reduced the incidence of pressure ulcer development in the PICU of the Royal Belfast Hospital for Sick Children over a two-year period.- - - - - - - - - - ranking = 0.053563085998378keywords = assessment (Clic here for more details about this article) |
10/39. End of life issues in a palliative care framework for a critically ill adult African American with cystic fibrosis: a case study.The purpose of this investigation, using case study methodology, was to explore the end of life issues and to give meaning to the biopsychosocial experiences of the study participant, an adult African American female patient diagnosed with cystic fibrosis. Two theoretical frameworks were used to guide the investigation of the study: Kubler-Ross Model of the Stages of Dying and the Conceptual Framework for palliative care Practice. Data analysis included review of medical records and patient journals, interviews, observations and clinical assessment. The findings indicated that end of life issues can be articulated within the context of a palliative care framework and that the biopsychosocial experiences of the dying person acquire meaning when situated within life history, ethical values and metaphysical belief systems.- - - - - - - - - - ranking = 0.017854361999459keywords = assessment (Clic here for more details about this article) |
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