The Metabolic Management Of The Critically Ill

HOW DO I USE THIS BOOK? This book is organized to answer specific questions about the metabolic and nutritional problems of critically ill patients. Thc questions are listed under five chapter headings in the Contents. Each question is self-contained with its own charts, tables, and references, although, in some instances, you may be referred to another section of the book for additional information. A detailed subject outline appears on the first page of each chapter, and there is an index for cross-reference to specific subjects. A metabolic support plan and accompanying metabolic and nutritional worksheet are locatcd in the Appendix. This plan pro vides the best estimates available for predicting the metabolic requirements of patients, and outlines approaches to feeding the hospitalized patient which will satisfy these nutritional needs. Clin ical cases are presented in this section to help you get started using the support plan. This volume is a handbook organized for frequent use - place the appropriate tables and nomograms on the bulletin board of the intensive care unit or in your office for convenient reference. Use the metabolic and nutritional support plan and establish the habit of assessing the metabolic requirements of your patients. Refer to the references cited to explore in further detail specific questions or areas of interest. By applying our knowledge of the metabolic and nutritional alterations which occur following disease, we can improve our care of the critically ill.

The purpose of this book is to bring together the latest findings on metabolic disorders that are strongly implicated in various critically ill patients. Since the beginning of the 20th century, maintaining the "milieu intérieur" has been a major challenge for intensivists. In addition to considerable technological developments in intensive care units, important advances in our understanding of metabolic disorders observed in critically ill patients have been made during the 10 last years. Today, the intensivit can’t ignore these disorders when selecting the most appropriate treatment for an illness. Cellular metabolic abnormalities are responsible for systems and organ failures, so the modern approach of organ dysfunctions now includes prevention or treatment of such disorders. This book is a comprehensive tool, allowing the physician to understand, diagnose and treat these metabolic disorders. Water, electrolyte, acid-base, glycemic and endocrinologic problems, as well as metabolic abnormalities observed in renal, cerebral and hepatic failure are presented in different chapters. The last part of the book is devoted to modern nutritional concepts, the consequences of energy modifications, mitochondrial dysfunction, hypothermia, oxidative stress and ischemia reperfusion, which open the way for new therapies.​

The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes.

Nutritional support of critically ill patients is a major treatment modality which will enhance recovery and shorten convalescence. New knowledge has emphasized that much of the organ dysfunction associated with sepsis and altered blood flow is related to oxidative injury. Specific nutrients are highly effective in counteracting these effects and their early administration may attenuate cellular damage and multi-organ failure. Patient outcome may also be enhanced by the route of feeding, administration of newer nutrient combinations, utilization of evolving methods of monitoring and the use of growth factors. This new knowledge has evolved to a new area of metabolic support which is addressed for the first time by a group of international experts. The topics presented and general conclusions are of major importance to the practitioners in this field, for they show, for the first time, a departure from the more traditional approaches of nutritional support in patients with life-threatening diseases.

This book demonstrates how the latest insights into the physiopathology of the stress response can be integrated into clinical practice. The topic is particularly relevant since the metabolic changes triggered by acute stress, including adaptive responses such as resistance to anabolic signals, have recently been more precisely delineated. The underlying mechanisms of these changes are also now better understood. The authors analyse how these advances could result in better management and more effective prevention of the long-term clinical consequences of the alterations occurring during the acute phase. An international panel of respected experts discusses these topics and describes the management of some common clinical conditions.

Nutrition Support for the Critically Ill Patient: A Guide to Practice provides state-of-the-art practices and key principles of nutrition support through evidence-based medicine. Following a review of the metabolic alterations that occur during critical illness, this book discusses the nutrient requirements of critically ill patients as well

Now in paperback, the second edition of the Oxford Textbook of Critical Care is a comprehensive multi-disciplinary text covering all aspects of adult intensive care management. Uniquely this text takes a problem-orientated approach providing a key resource for daily clinical issues in the intensive care unit. The text is organized into short topics allowing readers to rapidly access authoritative information on specific clinical problems. Each topic refers to basic physiological principles and provides up-to-date treatment advice supported by references to the most vital literature. Where international differences exist in clinical practice, authors cover alternative views. Key messages summarise each topic in order to aid quick review and decision making. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Careprovides an up-to-date reference that is relevant for intensive care units and emergency departments globally. This volume is the definitive text for all health care providers, including physicians, nurses, respiratory therapists, and other allied health professionals who take care of critically ill patients.

This book offers a pragmatic approach to day-to-day metabolic and nutritional care based on physiological considerations. Due to the numerous controversial trials published in the last 15 years, there is no clear guidance for intensive care physicians regarding the metabolic and nutritional management of patients. This has resulted in a return to underfeeding and related complications in most ICUs worldwide as shown by the latest Nutrition Day data. Using a structured, logical approach, the book examines practical solutions for artificial feeding in complex areas of critical care (brain injuries, burns, cardiac failure, ECMO, intestinal failure, long term patient, renal failure, metabolic diseases, obesity, old patients) and discusses measurement of the results of metabolic interventions. It also includes dedicated chapters focusing on specific problems, in order to avoid complications. Critical Care Nutrition Therapy for Non-nutritionists is a valuable resource for all general ICUs and ICU subspecialties such as cardiovascular, neuro, gastrointestinal and burns ICUs.