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...

The adipocyte-derived cytokine leptin was implicated to link inflammation and metabolic alterations. We investigated the potential role of leptin components in critically ill patients, because systemic inflammation, insulin resistance, and hyperglycemia are common features of critical illness. Upon admission to Medical Intensive Care Unit (ICU), free leptin and soluble leptin-receptor serum con...

PATHOPHYSIOLOGY Critical care in obstetrics has many similarities in pathophysiology to the care of nonpregnant women. However, changes in the physiology of pregnant woman necessary to maintain homeostasis for both mother and fetus, especially during critical illness, result in complex pathophysiology. Understanding the normal physiologic changes during pregnancy, intrapartum, and postpartum is...

Levosimendan, the active enantiomer of simendan, is a calcium sensitizer developed for treatment of decompensated heart failure, exerts its effects independently of the beta adrenergic receptor and seems beneficial in cases of severe, intractable heart failure. Levosimendan is usually administered as 24-h infusion, with or without a loading dose, but dosing needs adjustment in patients with sev...

Delirium is a frequently occurring but often under-diagnosed and under-treated problem in the intensive care unit (ICU). It has been linked to adverse outcome, increased length of stay and higher mortality in critically ill patients. A study by Thomason and coworkers published in this issue of Critical Care deals with the issue of delirium and its consequences in less severely ill patients. Thi...

BACKGROUND Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. AIM To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. PATIENTS AND METHODS During a 3 months period, an observational prospecti...

The metabolic response to stress and infection is closely related to the corresponding requirements of energy and nutrients. On a general level, the response is driven by a complex endocrine network and related to the nature and severity of the insult. On an individual level, the effects of nutritional interventions are highly variable and a possible source of complications. This narrative revi...

Tani et al. recently found an association between hypochloraemia and worse clinical outcome in critically ill patients, albeit not as an independent risk factor [1]. The authors were unable to find any explanation for this association. From clinical experience we could invoke three possible causes: use of NaHCO3, use of loop diuretics, or renal compensation for acidosis, all of which might be m...

Nutrition support is an integral part of care among critically ill patients. However, critically ill patients are commonly underfed, leading to consequences such as increased length of hospital and intensive care unit stay, time on mechanical ventilation, infectious complications, and mortality. Nevertheless, the prevalence of underfeeding has not resolved since the first description of this pr...

It was reported that 30-50% of inpatients are in a malnutrition status. Measuring the prealbumin level is a sensitive and cost-effective method for assessing the severity of illness in critically or chronically ill patients. However it is uncertain whether or not the prealbumin level correlates with the level of nutrition support and outcomes in critically ill patients. The aim of this study wa...