Showing papers by "Lena M. Napolitano published in 2009"

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

Abstract: A.S.P.E.N. and SCCM are both nonprofit organizations composed of multidisciplinary healthcare professionals. The mission of A.S.P.E.N. is to improve patient care by advancing the science and practice of clinical nutrition and metabolism. The mission of SCCM is to secure the highest quality care for all critically ill and injured patients. Guideline Limitations: These A.S.P.E.N.−SCCM Clinical Guidelines are based on general conclusions of health professionals who, in developing such guidelines, have balanced potential benefits to be derived from a particular mode of medical therapy against certain risks inherent with such therapy. However, practice guidelines are not intended as absolute requirements. The use of these practice guidelines does not in any way project or guarantee any specific benefit in outcome or survival. The judgment of the healthcare professional based on individual circumstances of the patient must always take precedence over the recommendations in these guidelines. The guidelines offer basic recommendations that are supported by review and analysis of the current literature, other national and international guidelines, and a blend of expert opinion and clinical practicality. The population of critically ill patients in an intensive care unit (ICU) is not homogeneous. Many of the studies on which the guidelines are based are limited by sample size, patient heterogeneity, variability in disease severity, lack of baseline nutritional status, and insufficient statistical power for analysis. Periodic Guideline Review and Update: This particular report is an update and expansion of guidelines published by A.S.P.E.N. and SCCM in 2009 (1). Governing bodies of both A.S.P.E.N. and SCCM have mandated that these guidelines be updated every three to five years. The database of randomized controlled trials (RCTs) that served as the platform for the analysis of the literature was assembled in a joint “harmonization process” with the Canadian Clinical Guidelines group. Once completed, each group operated separately in their interpretation of the studies and derivation of guideline recommendations (2). The current A.S.P.E.N. and SCCM guidelines included in this paper were derived from data obtained via literature searches by the authors through December 31, 2013. Although the committee was aware of landmark studies published after this date, these data were not included in this manuscript. The process by which the literature was evaluated necessitated a common end date for the search review. Adding a last-minute landmark trial would have introduced bias unless a formalized literature search was re-conducted for all sections of the manuscript. Target Patient Population for Guideline: The target of these guidelines is intended to be the adult (≥ 18 years) critically ill patient expected to require a length of stay (LOS) greater than 2 or 3 days in a medical ICU (MICU) or surgical ICU (SICU). The current guidelines were expanded to include a number of additional subsets of patients who met the above criteria, but were not included in the previous 2009 guidelines. Specific patient populations addressed by these expanded and updated guidelines include organ failure (pulmonary, renal, and liver), acute pancreatitis, surgical subsets (trauma, traumatic brain injury [TBI], open abdomen [OA], and burns), sepsis, postoperative major surgery, chronic critically ill, and critically ill obese. These guidelines are directed toward generalized patient populations but, like any other management strategy in the ICU, nutrition therapy should be tailored to the individual patient. Target Audience: The intended use of these guidelines is for all healthcare providers involved in nutrition therapy of the critically ill, primarily physicians, nurses, dietitians, and pharmacists. Methodology: The authors compiled clinical questions reflecting key management issues in nutrition therapy. A committee of multidisciplinary experts in clinical nutrition composed of physicians, nurses, pharmacists, and dietitians was jointly convened by the two societies.

Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care

Abstract: proved by the EAST Board of Directors, the Board of Regents of the ACCM and the Council of SCCM. Results: Key recommendations are listed by category, including (A) Indications for RBC transfusion in the general critically ill patient; (B) RBC transfusion in sepsis; (C) RBC transfusion in patients at risk for or with acute lung injury and acute respiratory distress syndrome; (D) RBC transfusion in patients with neurologic injury and diseases; (E) RBC transfusion risks; (F) Alternatives to RBC transfusion; and (G) Strategies to reduce RBC transfusion. Conclusions: Evidence-based recommendations regarding the use of RBC transfusion in adult trauma and critical care will provide important information to critical care practitioners. (Crit Care Med 2009; 37:3124‐3157)

Intensive-care patients with severe novel influenza A (H1N1) virus infection - Michigan, June 2009.

Abstract: In April 2009, CDC reported the first two cases in the United States of human infection with a novel influenza A (H1N1) virus. As of July 6, a total of 122 countries had reported 94,512 cases of novel influenza A (H1N1) virus infection, 429 of which were fatal; in the United States, a total of 33,902 cases were reported, 170 of which were fatal. Cases of novel influenza A (H1N1) virus infection have included rapidly progressive lower respiratory tract disease resulting in respiratory failure, development of acute respiratory distress syndrome (ARDS), and prolonged intensive care unit (ICU) admission. Since April 26, communitywide transmission of novel influenza A (H1N1) virus has occurred in Michigan, with 655 probable and confirmed cases reported as of June 18 (Michigan Department of Community Health [MDCH], unpublished data, 2009). This report summarizes the clinical characteristics of a series of 10 patients with novel influenza A (H1N1) virus infection and ARDS at a tertiary-care ICU in Michigan. Of the 10 patients, nine were obese (body mass index [BMI] >or=30), including seven who were extremely obese (BMI =40); five had pulmonary emboli; and nine had multiorgan dysfunction syndrome (MODS). Three patients died. Clinicians should be aware of the potential for severe complications of novel influenza A (H1N1) virus infection, particularly in extremely obese patients.

Bundles to prevent ventilator-associated pneumonia: how valuable are they?

Abstract: Purpose of reviewTo review the value of care bundles to prevent ventilator-associated pneumonia (VAP).Recent findingsThe Ventilator Bundle contains four components, elevation of the head of the bed to 30–45°, daily ‘sedation vacation’ and daily assessment of readiness to extubate, peptic ulcer disea

Clinical practice guideline: red blood cell transfusion in adult trauma and critical care.

Abstract: STATEMENT OF THE PROBLEMRed blood cell (RBC) transfusion is common in critically ill and injured patients. Many studies1–6 have documented the widespread use of RBC transfusion in critically ill patients and the data from these studies from diverse locations in Western Europe, Canada, the United Kin

Primary Aortoenteric Fistula and Endovascular Repair

Abstract: Primary aortoenteric fistulae are difficult conditions to diagnose and manage. A 35-year-old male developed massive upper gastrointestinal hemorrhage due to a primary aortoduodenal fistula. Previous radiation therapy and retroperitoneal lymph node dissection for germ cell cancer with resultant dense retroperitoneal fibrosis made open aortic repair impossible. Endovascular balloon occlusion of the aorta and stent graft repair of the primary aortoduodenal fistula was performed. At 1-year follow-up, there is no clinical or radiographic evidence of stent-graft infection. Endovascular techniques and repair are important approaches to consider during the management of complicated primary aortoenteric fistulae when open surgical repair is not feasible.

Epoetin alfa in the critically ill: What dose? Which route?

Abstract: 1. Cittanova ML, Leblanc I, Legendre C, et al: Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet 1996; 348:1620–1622 2. Schortgen F, Lacherade JC, Bruneel F, et al: Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: A multicentre randomised study. Lancet 2001; 357:911–916 3. Brunkhorst FM, Engel C, Bloos F, et al: Intensive insulin therapy and pentastarch resuscitation in severe sepsis. The German Competence Network Sepsis (SepNet). N Engl J Med 2008; 358:125–139 4. Davidson IJ: Renal impact of fluid management with colloids: A comparative review. Eur J Anaesthesiol 2006; 23:721–738 5. Rioux J-P, Lessard M, De Bortoli B, et al: Pentastarch 10% (250 kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery. Crit Care Med 2009; 37:1293–1298 6. Briegel I, Dolch M, Rehm M, et al: Hydroxyethylstarch increases the risk for acute renal failure in patients with severe ARDS. Anesthesiology 2007; 107:A1514 7. Giral M, Bertola JP, Foucher Y, et al: Effect of brain-dead donor resuscitation on delayed graft function: Results of a monocentric analysis. Transplantation 2007; 83:1174–1181 8. Sakr Y, Payen D, Reinhart K, et al: Effects of hydroxyethyl starch administration on renal function in critically ill patients. Br J Anaesth 2007; 98:216–224 9. Blasco V, Leone M, Antonini F, et al: Comparison of the novel hydroxyethylstarch 130/ 0.4 and hydroxyethylstarch 200/0.6 in braindead donor resuscitation on renal function after transplantation. Br J Anaesth 2008; 100:504–508 10. Schortgen F, Girou E, Deye N, et al: The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med 2008; 34:2157–2168 11. Wilkes MM, Navickis RJ, Sibbald WJ: Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: A meta-analysis of postoperative bleeding. Ann Thorac Surg 2001; 72:527–533 12. Solanke TF: Clinical trial of 6 per cent hydroxyethyl starch (a new plasma expander). Br Med J 1968; 3:783–785 13. Dickenmann MJ, Filipovic M, Schneider MC, et al: Hydroxyethylstarch-associated transient acute renal failure after epidural anaesthesia for labour analgesia and Caesarean section. Nephrol Dial Transplant 1998; 13:2706 14. Jacob M, Chappell D, Conzen P, et al: Smallvolume resuscitation with hyperoncotic albumin: A systematic review of randomized clinical trials. Crit Care 2008; 12:R34 15. Wiedermann CJ: Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis. BMC Emerg Med 2008; 8:1–8

ARDS: Risk Factors, Prognostic Factors, Management and Outcomes. Incidence and Mortality of ARDS in Combat Casualty Care

Abstract: : The incidence and mortality of Acute Respiratory Distress Syndrome (ARDS) and utilization of resources for ARDS treatment in current combat casualty care was investigated through a query of the Joint Theater Trauma Registry. Development of ARDS was found to be significantly associated (p =.05) with higher military injury severity scale (ISS), low admission systolic blood pressure (SBP), and female gender. Blast injury was the most common mechanism of injury in ARDS patients but was not confirmed as an independent risk factor for ARDS development. Mortality among ARDS patients was independently associated with higher ISS, low SBP and lower Glasgow Coma Scale and was significantly increased in intubated patients when ARDS was present. Critical care resource utilization was significantly greater for ARDS patients. ARDS still accounts for death in 0.4% of hospitalized casualties in current military medical care. Further investigations of ARDS prevention and evaluation of resuscitation strategies as a risk factor is warranted. Long-term follow up of ARDS survivors in combat casualty is necessary.