stress-related mucosal damage (srmd) is a significant cause of morbidity and mortality in critically ill patients due to the gastrointestinal blood loss. prophylaxis of srmd with proton pump inhibitors or histamine-2 blockers has gained widespread use in intensive care units. both demonstrated to be effective in reducing clinically significant bleedings, while ppis has shown to exert some anti ...

The metabolic support of critically ill patients is a relatively new topic of active research and discussion, and surprisingly little is known about the effects of critical illness on metabolic physiology and activity. The metabolic changes seen in critical illness are highly complex, and how and when to treat them are only just beginning to be determined. Studies have demonstrated that the acu...

PURPOSE This article describes epidemiologic evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders. ...

BACKGROUND AND OBJECTIVES Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown. METHODS We con...

While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algori...

By definition, critical illness is any condition requiring support for failing vital functions, either with mechanical aids or with pharmacological agents (1). Concept of the modern critical care firstly appeared during the poliomyelitis epidemic of 1952 in Denmark. The increasing hospital admissions of patients with respiratory failure brought about the need for a distinct medical staff and de...

Introduction Critical illness is characterized by a dramatic loss of skeletal muscle mass which comprises to about 10% per week. This loss is mostly driven by an increased muscle protein breakdown, whereas synthesis rates are on average not changed [1]. However, this result limits to total muscle protein and does not elucidate whether different proteins behave differently. We have previously sh...

This Personal View (BMJ 2017;359:j5007, doi:10.1136/bmj. j5007) states that the World Health Organisation has recently taken antiviral neuraminidase inhibitors off its Model List of Essential Medicines. It should say that “The World Health Organization has recently downgraded its recommendations in its Model List of Essential Medicines for the limited indication of severe illness due to confirm...

There is growing interest in nutrition therapies that deliver a generous amount of protein, but not a toxic amount of energy, to protein-catabolic critically ill patients. Parenteral amino acids can achieve this goal. This article summarizes the biochemical and nutritional principles that guide parenteral amino acid therapy, explains how parenteral amino acid solutions are formulated, and compa...

We report on the clinical characteristics, antimicrobial therapy, and outcomes of 20 critically ill patients with severe OXA-48like infections. Carbapenem-based therapy demonstrated improved survival (odds ratio = 5.0) as compared with non-carbapenem therapy. Risk factors for mortality included Acute Physiology and Chronic Health Evaluation III score and length of stay, highlighting the signifi...