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
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.