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  • Author: Marc Diltoer x
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Calculating energy needs in critically ill patients: Sense or nonsense?

Abstract

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.

Open access
Treatment of ventilator-associated pneumonia with high-dose colistin under continuous veno-venous hemofiltration

Abstract

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).

Methods

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.

Results

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.

Conclusions

In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.

Open access