Nutrition and Ventilatory Failure

Pingleton, S. K.

doi:10.1007/978-3-642-84554-3_11

Cited by 1 publication

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“…In our study, serum urea levels were consistently below 30 mmol/1 in a population of which the majority (76%) received TPN. Prolonged pro tein-calorie malnutrition can precipitate or worsen venti latory failure [21], There is some evidence to suggest that high calorie feeding results in better outcome than low cal orie feeding in surgical ARF [19], With CAVHD. unlike IFID, it may be possible to counteract excessive catabolism and, at least in some patients, to establish positive nitrogen balance [22].…”

Section: Discussionmentioning

confidence: 99%

High-Risk Surgical Acute Renal Failure Treated by Continuous Arteriovenous Hemodiafiltration: Metabolic Control and Outcome in Sixty Patients

Bommel¹,

Bouvy

So³

et al. 1995

Nephron

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The outcome and metabolic control was studied in 60 critically ill patients with acute renal failure (ARF) treated by continuous arteriovenous hemodiafiltration (CAVHD) in a single surgical intensive care unit. Mean age ( ± SEM) was 60 ± 2 years with a male predominance (80%). The majority of patients required mechanical ventilation (83%) and/or vasopressor support (70%) and suffered from multiorgan failure [mean number of organ system failures 3.3 ± 0.3 (range 1-6)]. CAVHD resulted in a rapid decline of serum urea and creatinine levels during the first 72 h (urea 47.4 ± 2.3 to 30.3 ± 1.4 mmol/l, p < 0.05, and creatinine 572 ± 27 to 361 ± 23 µmol/l, p < 0.05); thereafter, controlled steady-state levels were achieved with serum urea levels kept below 30 mmol/l with full protein alimentation and often despite hypotension, surgery and septicemia. Significant electrolyte derangements could be easily corrected and maintained within normal limits. Bicarbonate homeostasis could be restored within 48 h in patients with severe metabolic acidosis (HCO^-₃ < 20 mmol/l) with use of bicarbonate as a buffering anion (17 ± 0.5 to 23.2 ± 0.6, p < 0.05). CAVHD allowed rapid removal of excess body and lung water (up to 5 liters/day) without hemodynamic instability. Despite a mean pretreatment APACHE II score of 26.5, 26 patients (43%) survived until discharge from the intensive care unit, of whom 23 (38%) survived to leave hospital. Requirement of mechanical ventilation or vasopressor support, higher APACHE II scores and septicemia were all associated with a poor prognosis. Although prognosis was inversely correlated with the number of organ system failures, 24% of patients with 3 or more organ system failures survived to leave hospital. Data suggest that CAVHD represents a significant advance in the management of critically ill patients with ARF and may have contributed to improved survival.

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Section: Discussionmentioning

confidence: 99%