Muscle loss in critically ill patients may be related to nutrition. We study the association between modified NUTrition RIsk in the Critically ill (mNUTRIC) score obtained at admission to intensive care unit (ICU) and subsequent muscle loss. We measured rectus femoris cross-sectional area (RFCSA) by ultrasound on days 1, 3, 7, and 10 of ICU admission. We used linear mixed effects model following natural logarithmic transformation of the data. Forty-eight patients (median (IQR) age 66 (55-72.5) years, 71% male, APACHE II score 31 (25-34), BMI 24.2 (21.5-27.1) kg/m 2) were analyzed. The high mNUTRIC score (>5) cohort (n = 35) lost significantly more muscle as compared to the low (≤5) group (n = 13); the adjusted ratio (high versus low group) of the geometric mean RFCSA were (0.58, 95% CI 0.46-0.75) for right and (0.61, 95% CI 0.49-0.77) for left, both p < 0.001. mNUTRIC score obtained at admission to ICU can identify patients at risk of subsequent muscle loss.

Sedative and analgesic practices in intensive care units (ICUs) are frequently based on anesthesia regimes but do not take account of the important patient related factors. Pharmacologic properties of sedatives and analgesics change when used as continuous infusions in ICU compared to bolus or short-term infusions during anesthesia. In a prospective observational cohort study, we investigated the association between patient related factors and sedatives/analgesics doses in patients on mechanical ventilation (MV) and their association with cessation of sedation/analgesia. We included patients expected to receive MV for at least 24 hours and excluded those with difficulty in assessing the depth of sedation. We collected data for the first 72 hours or until extubation, whichever occurred first. Multivariate analysis of variance, multivariate regression as well as logistic regression were used. The final cohort (N = 576) was predominantly male (64%) with mean (SD) age 61.7 (15.6) years, weight 63.4 (18.2) Kg, Acute Physiology and Chronic Health Evaluation II score 28.2 (8) and 30% hospital mortality. Increasing age was associated with reduced propofol and fentanyl doses requirements, adjusted to the weight (p<0.001). Factors associated with higher propofol and fentanyl doses were vasopressor use (Relative mean difference (RMD) propofol 1.56 (95% confidence interval (CI) 1.28–1.90); fentanyl 1.48 (1.25–1.76) and central venous line placement (CVL, RMD propofol 1.64 (1.15–2.33); fentanyl 1.41 (1.03–1.91). Male gender was also associated with higher propofol dose (RMD 1.27 (1.06–1.49). Sedation cessation was less likely to occur in restrained patients (Odds Ratio, OR 0.48 (CI 0.30–0.78) or those receiving higher sedative/analgesic doses (OR propofol 0.98 (CI 0.97–0.99); fentanyl 0.99 (CI 0.98–0.997), independent of depth of sedation. In conclusion, increasing age is associated with the use of lower doses of sedative/analgesic in ICU, whereas CVL and vasopressor use were associated with higher doses.

Acute kidney injury (AKI) is a major complication of critical illness. More than 70% of patients with oliguric AKI and marked azotemia receive renal replacement therapy (RRT). 1 Continuous renal replacement therapy (CRRT) is the preferred option worldwide in critical care, accounting for 80% of all modalities used. 2 However, prolonged extracorporeal circulation is associated with higher risk of filter clotting, which is worsened by the inflammatory and pro-coagulant state in critical illness. 3 Premature circuit terminations compromise the treatment efficacy of CRRT, 4 contribute to blood loss and transfusions in patients, 5 and increase nursing workload required for circuit priming. Critically ill patients also have higher bleeding risk, in whom systemic anticoagulation

Background: Differential effects of energy and protein inadequacies of intensive care unit (ICU) patients in first 72 hours are unknown. Methods: We included all adult patients receiving mechanical ventilation (MV) > 72 hours between August 2012 and December 2014. Energy and protein doses were 25 kcal/kg/day and 1.5 g/kg/day, respectively. We used multivariable Cox regression analysis for 28-day mortality and competing risks regression analysis for post-ICU length of stay (LOS) in hospital survivors. Results: In 421 patients (male 63.4%, mean age 62 ± 15.1 years) the energy and protein adequacies at 72 hours were 70% and 56%, respectively. Non-survivors by day 28 were started on feeding significantly later (median, 14.13 (5.48-33.78) versus 9.25 (5.45-16.58) hours, P = .003) and received lower energy (mean, 0.57 ± 0.36 versus 0.76 ± 0.29, P < 0.001) and protein (median, 0.51 (0.13-0.74) versus 0.61 (0.40-0.84), P < 0.001) adequacies at day 7 (same effect seen at 72 hours, P < 0.001). Higher energy adequacy at 72 hours was associated with lower mortality (hazard ratio [HR], 0.39 (95% CI 0.20-0.75), P = 0.004); the lowest mortality was seen between 61% and 70% energy adequacies. No such association was seen with protein adequacy. In 280 hospital survivors, higher energy adequacy at 72 hours (subdistribution HR 1.63; 95% CI, 1.06-2.50, P = 0.025) was significantly associated with shorter post-ICU LOS. No such effect was seen with protein adequacy. Conclusion: Higher energy but not protein adequacy at 72 hours of MV was associated with improved patient-centric outcomes.

reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. carbon dioxide 30 [27][28][29][30][31][32][33][34][35] mmHg and median temperature 37.1 [36.8-37.3]°C. After removal of artefacts, the mean monitoring time was 22 h08 (8 h54). All patients had impaired cerebral autoregulation during their monitoring time. The mean IAR index was 17 (9.5) %. During H 0 H 6 and H 18 H 24 , the majority of our patients; respectively 53 and 71 % had an IAR index > 10 %. Conclusion According to our data, patients with septic shock had impaired cerebral autoregulation within the first 24 hours of their admission in the ICU. In our patients, we described a variability of distribution of impaired autoregulation according to time. ReferencesSchramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium. Crit Care 2012; 16: R181. Aries MJH, Czosnyka M, Budohoski KP, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit. Care Med. 2012.

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