Abstract
A postoperatively reduced concentration of AA in plasma (<45.5 μmol/l) is common due to increased metabolic requirements. Positive effects of AA in the postoperative period are well known (e.g. radical scavenger activity); hence there is an indication for the substitution of AA. However, the dosage commonly recommended for substitution during clinical nutrition is not adequate. Therefore, a postoperative AA substitution procedure 'overnight' to normal values in plasma was investigated in this randomized, prospective study on a postoperative ICU in a university hospital. Fifty-seven electively operated patients were assigned to a control group or an intervention group. In all patients the AA plasma concentration was analysed preoperatively and on the first three postoperative days. Patients of the intervention group received AA intravenously 'overnight' up to four times within 12 hours depending upon the initial AA concentration (< 34.1 μmol/l [4 × 500 mg AA]; < 56.8 μmol/l [2 × 500 mg AA]; < 68.2 μmol/l [1 × 500 mg AA]). The preoperative and postoperative AA values on the first postoperative day did not differ between both groups. However, the postoperative plasma concentration was lowered (< 45.5 μmol/l) in 82.4% of all patients. In the intervention group, the dosage regime increased the AA plasma concentration to > 45.5 μmol/l in 89.6% overnight. In conclusion, the investigated substitution procedure is sufficient to increase the AA plasma concentration overnight to high normal values in postoperative ICU patients.
Highlights
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Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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