Nutrition and Metabolic Support in Burn

Burn injury results in a dramatic increase of the basal metabolic rate. Severe burn injury nearly doubles resting energy expenditure and hypermetabolism associated with burn results in a loss of body fat stores and a loss of visceral and structural protein mass. The clinical effects of these changes include immunosuppression, delayed wound healing, and generalized muscle weakness. Post burn, the metabolic and catabolic responses are prolonged in severity and time course, lasting weeks to months in contrast to the days and weeks observed in other injuries. Nutrition support provides the substrates and nutrients to prevent the complications of deficiencies as well as supporting wound healing, and recovery from hormonal and metabolic abnormalities after thermal injury. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 21-5

İNHALASYON ANESTEZİSİ

Yoğun bakım ünitesindeki (YBÜ) hastalar organ yetersizliklerinin ve hemodinamik problemlerin olduğu kritik süreçteki hastalardır. Bu hasta grubunda, ilaçların hemodinami ve sistemler üzerine etkileri değişebilmekte, daha fazla yan etki ile karşılaşılabilmektedir. Ayrıca organ yetersizliklerine bağlı ilaçların eliminasyon ve etki süreleri de değişmektedir. İnhalasyon anestezikleri 18. yüzyıldan beri genel anestezi sağlamak için ameliyathanelerde kullanılmaktadır. Avantajlı farmakokinetik ve farmakodinamik özellikleri nedeni ile inhalasyon anestezikleri yoğun bakımda bazı durumlarda intravenöz ajanlara alternatif olabilirler. Modern inhalasyon anestezikleri (izofluran, sevofluran, desfluran) solunumla hızlı şekilde emilirler, etkileri hızlı başlar ve hızlı sonlanır. Vücutta çok az birikirler, böbrek ve karaciğerde düşük metabolizmaya sahiptirler. Esas olarak solunum sistemi ile atılırlar. Etkilerine taşiflaksi veya tolerans gelişimi önemsiz derecededir. Bunun yanısıra bronkodilatör etkileri vardır ve birçok organ üzerinde koruyucu özellik gösterebilirler (kardiyoprotektif, nöroprotektif) (1, 2). Hemodinamik instabilitesi olan kritik hastalarda iskemiden koruyucu avantajları olabilir. İnhalasyon ajanlarının bu avantajlarına rağmen yoğun bakımda kullanımları çok nadirdir. Bunun sebepleri ise atmosferik kontaminasyon riski ve yüksek akımlı yoğun bakım ventilatörlerinde volatil ajanların teknik olarak kullanım zorluğudur. Bu bölümde YBÜ’de inhalasyon anesteziklerinin kullanımından, kritik hastalıklarda sedasyon dışındaki diğer yararlı özelliklerinden ve kullanımlarındaki sınırlamalardan bahsedilecektir. Bunun yanısıra status astmatikus, dirençli status epileptikus, akut respiratuar distres sendromu (ARDS) gibi spesifik hastalıklarda inhalasyon anesteziklerinin kullanımına değinilecektir

Magnesium in ICU: Sine Qua Non

Magnesium is the main intracellular metal cation that plays an essential role in fundamental cellular reactions. Hypomagnesemia is frequent postoperatively and in the ICU, this often unrecognized condition is responsible for increased morbidity and mortality. Therefore, hypomagnesemia should be corrected. There are varieties of disorders in non-magnesium depleted patients where intravenous magnesium appears to have a therapeutic benefit. This review considers magnesium physiology - metabolism and magnesium status in critical illness. (Journal of the Turkish Society of Intensive Care 2011; 9: 30-7

Non-invasive Mechanic Ventilation During the “Weaning”

SUMMARY Weaning of the patients from mechanical ventilation is a clinically important subject. Recently, applications of non-invasive mechanic ventilation (NIV) are increasing in post extubation respiratory failure. Studies show that NIV is effective in the weaning of chronic obstructive pulmonary disease, presenting with hypercapneic respiratory failure and in the attacks of other chronic respiratory failure, but efficacy and reliability in the other patient group is limited. NIV must be applied by the experienced team in the selected patient group

Non-invasive Mechanic Ventilation During the “Weaning

SUMMARY Weaning of the patients from mechanical ventilation is a clinically important subject. Recently, applications of non-invasive mechanic ventilation (NIV) are increasing in post extubation respiratory failure. Studies show that NIV is effective in the weaning of chronic obstructive pulmonary disease, presenting with hypercapneic respiratory failure and in the attacks of other chronic respiratory failure, but efficacy and reliability in the other patient group is limited. NIV must be applied by the experienced team in the selected patient group

Clinical and electroencephalographic findings in patients with sepsis-associated encephalopathy and the evaluation of their effects on survival

Objective: Acute brain dysfunction is common in sepsis patients and is associated with increased mortality. This study aimed to investigate the clinical and electroencephalographic (EEG) findings of patients with acute neurological dysfunction due to sepsis and to evaluate their relationship with prognosis.Methods: Sixty-one patients with sepsis were included in this prospective observational study. All patients underwent a daily neurological examination. EEG monitoring was performed in patients with delirium, coma, clinical seizures, and focal neurological findings. The patients were divided into two groups as survivors and non-survivors.Results: Sixty-one patients included in the study had a median age of 60 years (range=21 to 81), Acute Physiology and Chronic Health Evaluation 2 score of 24 (range=14 to 39), and Sepsis-related Organ Failure Assessment score of 10 (range=3 to 24). During the EEG examination, coma was detected in 23 patients (38%), delirium/confusion in 20 patients (33%), clinical seizures in 16 patients (26%) and focal neurological findings in two patients (3%). The overall mortality rate was 42% (n=26). The EEG examination showed slowing of background activity in all patients. Also, among three patients who had seizure activity, two showed findings of an electrophysiological seizure. The EEG examination revealed a relationship between low-amplitude non-reactive background activity and mortality.Conclusion: EEG monitoring may be indicated in the follow-up of encephalopathy in sepsis, the determination of the severity of the disease, the presence of an accompanying seizure or status, and prognosis.Keywords: Sepsis, brain dysfunction, electroencephalography, prognosi