Herbert D. Spapen, Elisabeth De Waele, Elisabeth De Waele, Sabrina Mattens, Marc Diltoer, Viola Van Gorp and Patrick M. Honoré
High energy deficits due to underfeeding are frequently observed during critical illness and are associated with significant morbidity and mortality. Adequate determination of energy requirements is imperative for optimizing nutrition. For this goal, indirect calorimetry is considered to be the gold standard but it is expensive, time-consuming, and not readily available in many hospitals. As an alternative, most ICU physicians use bedside formulas to predict calorie needs. Some equations are obtained during resting metabolism in healthy humans and “corrected” by adding stress or injury factors. Others are derived from regression analysis in patients whereby various static and dynamic variables are identified and eventually adjusted for type of patient and/or disease. Few studies have evaluated the accuracy of predictive equations in critically ill patients. The largest prospective study to date identified the Penn State equation, including a modified version for obesity, as being the most accurate. Whether the systematic use of (a) particular formula(s) for estimating calorie needs may influence morbidity or outcome in ICU patients remains to be determined.
Herbert Spapen, Johan van Laethem, Maya Hites, An Verdoodt, Marc Diltoer and Patrick M. Honoré
Background and Objectives
High-dose colistin (COL) ensures adequate treatment of pneumonia caused by multidrug resistant gram-negative bacteria (MDR-GNB) but must be weighed against a higher risk of nephrotoxicity. Continuous veno-venous hemofiltration (CVVH) clears COL by filtering and membrane adsorption that permits to avoid dose accumulation and excessively high peak concentrations. We evaluated clinical/microbiological efficacy of the high-dose COL treatment under CVVH in patients with newly diagnosed MDR-GNB ventilator-associated pneumonia (VAP).
Observational cohort study in critically ill adult patients with MDR-GNB VAP. Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 × 4.5 MIU daily. CVVH was performed over a highly adsorptive membrane. Clinical and microbiological efficacies were assessed at the end of therapy. In survivors, serum creatinine level was evaluated before and at the end of therapy.
Fourteen patients (8 male patients, aged 57 ± 14 years) were consecutively included. Isolated pathogens were Pseudomonas aeruginosa in 7, Klebsiella pneumoniae in 5, and other Enterobacteriaceae in 2 patients. A favorable clinical response was observed in 9 patients (64%). Full and presumed microbiological eradication was observed in 12 patients (86%). Two patients were diagnosed with Stage 1 acute kidney injury.
In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.
Patrick M. Honore, David De Bels, Thierry Preseau, Sebastien Redant and Herbert D. Spapen
In most of the case, regional citrate anticoagulation is using diluted citrate around 1% depending on the types used in clinical practice. Diluted citrate is much more safer when compared to highly concentrated citrate around 4% or even more. In clinical practice, trisodium citrate is used in high concentration (around 30%) as a bactericidal agent with anticoagulant properties for locking deep venous catheters used in hemodialysis (HD; close to 25–30% of citrate). In this review article, buffer and anticoagulant potential of citrate are discussed during renal replacement therapy in critically ill patients with particular focus on the practical approach at the bedside.
An Verdoodt, Patrick M. Honore, Rita Jacobs, Elisabeth De Waele, Viola Van Gorp, Jouke De Regt and Herbert D. Spapen
Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidney disease.