Critical illness is associated with many complications that affect both medical and nutrition aspects of patient outcomes. Early enteral feeding is the preferred method of nutrition for patients in the intensive care unit due to apparent benefits in this patient population. However, these patients are also at risk for complications related to enteral nutrition (EN), which may be potentiated with the addition of vasopressors often used in the setting of hemodynamic instability. The clinician is often confronted with the decision of when to proceed with EN in critically ill patients who require vasopressors for hemodynamic support. This article reviews the effects of vasopressors on gastrointestinal blood flow, discusses complications associated with vasopressor use during EN, and proposes important considerations to determine the safety of EN in hemodynamically unstable patients requiring vasopressor support.

Aim To describe the perceptions of young adults with sickle cell disease concerning their disease experience. Background Sickle cell disease is a lifelong, genetic condition with both acute and chronic painful exacerbations. Little is known of the experiences of young adults with sickle cell disease. Design This study used a qualitative, descriptive design with semi-structured, life-review interviews. Methods Between August 2010 – September 2012, purposive sampling was used to recruit participants with a known sickle cell disease diagnosis who were ages 18–35 years, were being seen in an outpatient sickle cell clinic and were English speaking. Participants provided demographic information and responded to two interviews. A content analysis was then used to interpret participants’ narratives of their experiences of living with sickle cell disease. Results/Findings A sample of 29 young adults with sickle cell disease consisted of 79.3% females, 35.6% employed full-time or part-time, 71.6% single/never married and 57.8% with sickle cell anemia. Their mean age was 25.8 with 13.2 years of education. Four major interview themes were identified: 1) struggles to maintain or achieve good quality of life or life satisfactions; 2) strategies to maintain self-care; 3) interruptions to family, work and social roles; and 4) difficulties accessing needed healthcare. Conclusion Young adults face many challenges while living with sickle cell disease. With a better understanding of their disease experience and how it influences their quality of life, researchers can begin tailoring appropriate interventions to improve health outcomes in this vulnerable, minority population.

IntroductionLimited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP.MethodsA retrospective review of patients who were admitted to the trauma ICU for TBI, had an ICP monitor placed, and received at least one dose of HTS between January 2006 and March 2011 was performed. Data were collected for up to 120 hours after ICP monitor placement. The primary outcome was the relationship between serum sodium and maximum ICP. Secondary outcomes were the relationship between serum sodium and the mean number of daily interventions for ICP control, and the acute effect of HTS on ICP during the 6 hours after each dose. Linear regression was used to analyze the primary outcome. Analysis of variance on ranks and repeated measures analysis of variance were used to evaluate the number of interventions and the acute effect of HTS on ICP, respectively.ResultsEighty-one patients were enrolled with mean ± standard deviation age of 36 ± 15 years and median Glasgow Coma Scale score of 7 (interquartile range, 4 to 7). A total of 1,230 serum sodium values (range, 118 to174 mEq/l) and 7,483 ICP values (range, 0 to 159 mmHg) were collected. There was no correlation between serum sodium and maximum ICP (R2 = 0.0052). The overall mean ± standard deviation number of interventions for elevated ICP per day was 4.2 ± 2.9, 2.9 ± 2.0, and 2.6 ± 2.3 for patients with a mean serum sodium of < 145, 145 to 155, and > 155 mEq/l, respectively (P < 0.001). Regarding the acute effect of HTS on ICP, there was no statistical difference in mean ICP compared with baseline during hours 1 through 6 following HTS doses (baseline, 13.7 ± 8.4 mmHg; hour 1, 13.6 ± 8.3 mmHg; hour 2, 13.5 ± 8.8 mmHg; hour 3, 13.3 ± 8.7 mmHg; hour 4, 13.4 ± 8.7 mmHg; hour 5, 13.4 ± 8.3 mmHg; hour 6, 13.5 ± 8.3 mmHg; P = 0.84).ConclusionsSerum sodium concentrations did not correlate with ICP values. These results warrant further evaluation and possible reassessment of sodium goals for ICP management in patients with TBI.

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