BACKGROUND Evidence suggests that the relation between plasma and red cell vitamin B-6 concentrations is perturbed as part of the systemic inflammatory response in critically ill patients. OBJECTIVE The aim was to examine the cross-sectional and longitudinal interrelations between pyridoxal (PL) and pyridoxal phosphate (PLP) concentrations in plasma and red and white cells in patients with cr...

Multiorgan failure frequently develops in critically ill patients. While therapeutic efforts in such patients are often focused on the lungs, on the cardiovascular system as well as on the kidneys, it is important to also consider the functional alterations in gut motility and hormone secretion. Given the central regulatory functions of many gut hormones, such as glucagon-like peptide 1, glucag...

Vitamins and trace elements are known as micronutrients. Vitamins are organic substances not synthesized by the body, and some are cofactors for various enzymes; therefore, they are required for normal metabolism. Trace elements are metals present in very small quantities in the body. Micronutrient deficiencies are often present in critically ill surgical patients and may occur as a result of t...

Mortality is a common primary endpoint in randomized controlled trials of patients with a high severity of illness, such as critically ill patients. However, researchers are increasingly evaluating functional outcomes, such as quality of life. Importantly, in such trials some patients may die before the assessment of a functional outcome, resulting in the functional outcome being “truncated due...

A recent observational study in a large cohort of critically ill patients confirms the association between hyperlactatemia and mortality. The mechanisms regulating the rates of lactate production and clearance in critical illness remain poorly understood. During exercise, hyperlactatemia clearly results from an imbalance between oxygen delivery and energy requirements. In critically ill patient...

This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, prospective randomized...

OBJECTIVE Report an unusual cause of thrombocytopenia in a burn patient and provide a brief review of causes of thrombocytopenia in critically ill patients. METHODS Case report format and selected review of PubMed search including the search terms thrombocytopenia, critical illness, and vancomycin. RESULTS Reports of vancomycin-induced thrombocytopenia are uncommon. CONCLUSION Drug-induce...

The usefulness of n-3 fatty acids, γ-linolenic acid and antioxidants in the critically ill is controversial. I propose that adverse outcome in the critically ill is due to excess production of proinflammatory cytokines and eicosanoids from polyunsaturated fatty acids (PUFAs), while generation of anti-inflammatory products of PUFAs may lead to a favorable outcome. Hence, I suggest that measureme...

Newly recognized hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease (CVD). Hyperglycemia has been linked to increased morbidity and mortality in critically ill patients, especially when it is newly recognized. Increased rates of reinfarction, rehospitalization, major cardiovascular events, and death in CVD patients have also been fo...

Critically ill patients demonstrate established or impending multi-organ failure which may be due an acute condition such as sepsis or trauma, a deterioration in a chronic condition, or failure to progress during the recovery process and is often in part due to intrinsic risk factors such as age and concomitant disease processes (Loftus and Royal College of Surgeons of England, 2010). Survivors...