Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients

Dąbrowski, Wojciech; Siwicka-Gieroba, Dorota; Gasinska-Blotniak, Malgorzata; Zaid, Sami; Jezierska, Maja; Pakulski, Cezary; Roberson, Shawniqua Williams; Ely, E. Wesley; Kotfis, Katarzyna

doi:10.3390/medicina56090469

Cited by 9 publications

(12 citation statements)

References 134 publications

(160 reference statements)

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“…In addition, an important intervention would be to work with a team of dieticians as gut microbiome imbalance or disruption of the gut-brain axis has been associated with the pathomechanism of delirium [ 71 , 72 ]. Both anesthetics used in general anesthesia and sedatives used in the ICU can change the composition of gut microbiome and contribute to neuroinflammation [ 73 ].…”

Section: The Importance Of Multidisciplinary Carementioning

confidence: 99%

“…Both anesthetics used in general anesthesia and sedatives used in the ICU can change the composition of gut microbiome and contribute to neuroinflammation [ 73 ]. The role of the dieticians is not only to provide balanced nutritional support for ICU patients, but also to use evidence-based structured dietary interventions to prevent delirium through intestinal interventions, enhancing the role of gut-brain axis [ 71 ] or modulating the tryptophan metabolism pathway proven important in acute brain disorders [ 74 ].…”

Section: The Importance Of Multidisciplinary Carementioning

confidence: 99%

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The future of intensive care: delirium should no longer be an issue

et al. 2022

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In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

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Section: The Importance Of Multidisciplinary Carementioning

confidence: 99%

Section: The Importance Of Multidisciplinary Carementioning

confidence: 99%

The future of intensive care: delirium should no longer be an issue

et al. 2022

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“…e reason is that after probiotics enter the intestine, they can not only effectively ensure the balance of intestinal microbes but also restore intestinal peristalsis, reduce intestinal mucosal epithelial cell apoptosis, protect the barrier function of intestinal mucosa, and inhibit local inflammation of intestinal mucosa. Enhance the immune function of patients [18,19]. e results of the study showed that after treatment, the levels of PT and APTTof the two groups were higher than those before treatment, and the levels of FIB and DD were lower than those before treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Bifidobacterium Triple Viable Enteric-Coated Capsules Combined with Enteral Nutrition on Patients with Chronic Critical Illness and Influence on Immune and Coagulation Function

Wang

Zhang²,

Huang

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the efficacy of enteric-coated Bifidobacterium triple viable capsules combined with enteral nutrition in the treatment of patients with chronic critical illness (CCI) and their effects on the immune and coagulation function of patients. Methods. 106 CCI patients admitted to the intensive care unit of our hospital from December 2018 to March 2020 were selected as the research objects, and they were randomly divided into the control group (n = 53) and the observation group (n = 53). The control group was given symptomatic treatment, etiological treatment, clinical nursing, enteral nutrition support, and other conventional treatment methods according to the patient’s condition. On this basis, the observation group was treated with enteric-coated Bifidobacterium triple viable capsules, and both groups were treated for 14 days. All patients were followed up for 3 months after treatment, and their death/cure prognosis was recorded. The acute physiological and chronic health (APACHE II) scoring system was used to evaluate the acute physiological and chronic health status of the two groups before and after treatment, and the organs of the patients were scored with sepsis-related organ failure assessment (SOFA) score. T lymphocyte subsets (CD3+, CD4+, CD8+, and CD4+/CD8+), prothrombin time (PT), activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (DD) were measured before and after treatment. Results. The cure rate of the observation group was slightly higher than that of the control group, and the mortality rate was slightly lower than that of the control group, but the difference was not statistically significant ( P < 0.05 ). After treatment, the APACHE II and SOFA scores of the two groups were lower than before treatment, and the APACHE II and SOFA scores of the observation group were lower than those of the control group, and the differences were both statistically significant ( P < 0.05 ). After treatment, the levels of CD3+, CD4+, and CD4+/CD8+ in the two groups were higher than those before treatment, and the levels of CD8+ were lower than before treatment. The CD3+, CD4+, and CD4+/CD8+ levels of the observation group were higher than those of the control group, and the CD8+ levels were lower than the control group, and the differences were both statistically significant ( P < 0.05 ). After treatment, the PT and APTT levels of the two groups of patients were higher than those before treatment, and the levels of FIB and DD were lower than those before treatment. The PT and APTT levels of the observation group were higher than those of the control group, and the FIB and DD levels were lower than those of the control group, and the differences were both statistically significant ( P < 0.05 ). Conclusion. The combination of enteric-coated Bifidobacterium triple viable capsules and enteral nutrition for CCI has high cure rate, which can not only improve the patients’ physiological health status and organ dysfunction but also effectively improve the patients’ immune and coagulation function, which is worthy of promotion.

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“…Increased kynurenine plasma levels thus precede the development and persistence of sepsis in critically ill patients (276,277), and is associated with lower survival in ICU patients (274). Moreover, elevated kynurenic acid (also a metabolite of kynurenine) is associated with myelin damage leading to neuronal and cognitive dysfunction in critical illness (278). Based on the therapeutic literature from other diseases (275,(279)(280)(281)(282), the critical illness researchers suggest inhibiting the IDO enzyme in order to curtail the production of neurotoxic kynurenine pathways metabolites.…”

Section: Addressing the Production Of Pro-inflammatory Cytokines And Inflammationmentioning

confidence: 99%

Theory: Treatments for Prolonged ICU Patients May Provide New Therapeutic Avenues for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

2021

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We here provide an overview of treatment trials for prolonged intensive care unit (ICU) patients and theorize about their relevance for potential treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Specifically, these treatment trials generally target: (a) the correction of suppressed endocrine axes, notably through a “reactivation” of the pituitary gland's pulsatile secretion of tropic hormones, or (b) the interruption of the “vicious circle” between inflammation, oxidative and nitrosative stress (O&NS), and low thyroid hormone function. There are significant parallels in the treatment trials for prolonged critical illness and ME/CFS; this is consistent with the hypothesis of an overlap in the mechanisms that prevent recovery in both conditions. Early successes in the simultaneous reactivation of pulsatile pituitary secretions in ICU patients—and the resulting positive metabolic effects—could indicate an avenue for treating ME/CFS. The therapeutic effects of thyroid hormones—including in mitigating O&NS and inflammation and in stimulating the adreno-cortical axis—also merit further studies. Collaborative research projects should further investigate the lessons from treatment trials for prolonged critical illness for solving ME/CFS.

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Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients

Cited by 9 publications

References 134 publications

The future of intensive care: delirium should no longer be an issue

The future of intensive care: delirium should no longer be an issue

Efficacy of Bifidobacterium Triple Viable Enteric-Coated Capsules Combined with Enteral Nutrition on Patients with Chronic Critical Illness and Influence on Immune and Coagulation Function

Theory: Treatments for Prolonged ICU Patients May Provide New Therapeutic Avenues for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

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