From Ancient Enemas to Tube Feeding, I: History, Administration, and Nutritional Composition of Commercial Versus Food-Based Formulas in Critical Illness.

Improving Palliative Care For Patients In The Intensive Care Unit

Critical care and the global burden of critical illness in adults

Introduction Physiological changes affecting critically ill septic patients may impact on the effectiveness of licensed methods of antibiotic administration. It has been postulated that extending the infusion time over which time-dependent action antibiotics are administered, giving for example a 4-hour infusion rather than an injection over 5 minutes, this may increase efficacy whilst not compromising safety in critically ill septic patients. However, no single study or meta-analysis of similar studies has yet shown any significant benefit in patient orientated outcomes. Even so anecdotal evidence suggests that this practice is becoming established in the critical care environment but the extent of this in the United Kingdom (UK) has never been assessed. Method A questionnaire was developed to identify current intravenous antibiotic administration practice and the factors influencing choice in UK critical care units (CCUs). This was circulated to critical care pharmacists via the United Kingdom Clinical Pharmacy Association message board. Along side this a systematic review and meta-analysis were conducted to up date the evidence base. Results 17 of the 22 antibiotics surveyed have a single method of administration used on more than 50% of the responding UK CCUs. Piperacillin/tazobactam and meropenem are used on 22.2% and 20.3% respectively of responding CCUs as extended intermittent infusions (EIIs) and vancomycin by continuous infusion (CI) on 49.2%. Respondents most commonly sited both favourable pharmacokinetic/pharmacodynamics and an improvement in patient outcomes as reasons for adopting extended infusions. In addition, continuous infusions of vancomycin are seen to be a safer and a more predictable method of administration than intermittent infusions. Where extended infusions were in use, this practise was associated with a high level of pharmacist input into the multi-professional team such as seven-day ward cover. The systematic review identified 40 randomised controlled trials comparing extended infusions to the licensed administration practice of the same antibiotic covering in total 16 different antibiotics. Statistically significant differences in clinical cure and microbiological/bacteriological cure were found in favour of extended infusion methods. A statistically significant difference in mortality was observed when time-dependent antibiotics were analysed separately. No difference in adverse events was identified between the administration methods. Conclusion Current UK critical care practice of intravenous antibiotic administration is in 17 line with the evidence base. This meta-analysis shows that extended infusions are both safe and at least as effective as standard licensed administration methods.

Paracetamol in intensive care - intravenous, oral or not at all?

Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine. The demand for cardiovascular critical care is increasing with the aging of the population and is reflected by trends in the use of critical care in general.1 Between 2000 and 2005, although the total number of hospital beds in the United States declined by 4.2%, the number of critical care beds increased by 6.5% and the annual costs attributed to critical care increased by 44%, representing 13.4% of hospital costs.2 Projections for the next 15 years suggest that the need for critical care will increase markedly in the United States and globally.1,3–5 For example, in Canada, a 57% increase in the need for critical care beds is anticipated during that period.5 Concurrent with increases in demand, the medical demographics of general and cardiac critical care have evolved toward a patient population with an increasing number of comorbid medical conditions who require more prolonged and more technologically sophisticated invasive support. As a result, the delivery of critical care is advancing substantially in its complexity. Moreover, accumulating evidence has indicated that outcomes are better when critical care is provided by specially trained providers in a dedicated intensive care unit (ICU).6–9 In the context of this evolution, provision of optimal care in the contemporary cardiac ICU (CICU) presents a different set of challenges and requires an expanded set of skills compared with 10 years ago. Cardiovascular medicine has lagged behind other medical disciplines that have met the “critical care crisis”4 with ICU-focused innovations in organization, training, and quality improvement. Therefore, the American Heart Association Council on Cardiopulmonary, Critical …

careful selection of the appropriate mode of feeding and monitoring the success of the feeding strategy. The use of specific nutrients, which possess a drug-like effect on the immune or inflammatory state during critical illness, continues to be an exciting area of investigation. The lack of systematic research and clinical trials on various aspects of nutrition support in the PICU is striking and makes it challenging to compile evidence based practice guidelines. There is an urgent need to conduct well-designed, multicenter trials in this area of clinical practice. The extrapolation of data from adult critical care literature is not desirable and many of the interventions proposed in adults will have to undergo systematic examination and careful study in critically ill children prior to their application in this population. In the following sections, we will discuss some of the key aspects of nutrition support therapy in the PICU; examine the literature and provide best practice guidelines based on evidence from PICU patients, where available. While some PICU popu lations include neonates, A.S.P.E.N. Clinical Guidelines for neonates will be published as a separate series.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

First, Do No Harm: Less Training ≠ Quality Care

Critical Care During the Coronavirus Crisis—Reflections on the Roles of Anesthesiologists in Meeting the Challenges of the Pandemic

ESPEN Guidelines on Enteral Nutrition: Intensive care

As of April 2020, more than 2 million people worldwide had tested positive for COVID-19, and more than 200,000 deaths are attributed to this virus. It is estimated that around 15% of patients diagnosed with COVID-19 will develop severe health complications, and around 5- 10% will require intensive level care due to the seriousness of the symptoms and the high mortality risk (3-5%)( Baud et al., 2020; Murthy, Gomersall, & Fowler, 2020). At the time of writing, COVID-19 has caused the need for hospitalisation of thousands of people due to the serious pneumonia type symptoms that result in extreme breathing difficulty.

This article is the second in a 2-part series examining the role of commercial and food-based enteral formulas in critical illness. Part I (published in the September 2025 issue of AJCC) reviewed the historical evolution, administration, and nutritional content of formulas; part II focuses on clinical outcomes and future directions. Enteral feeding is essential in the intensive care unit to support patients who cannot meet nutritional needs orally. Although commercial formulas remain the standard of care, the use of food-based formulas is expanding. In this part of the review, we examine the evidence comparing commercial versus food-based formulas across gastrointestinal symptoms (eg, constipation, diarrhea, reflux), renal effects (eg, electrolyte disturbances, uremia), and endocrine effects (eg, hyperglycemia, insulin resistance). We also explore nonclinical outcomes such as patient satisfaction, circadian rhythm effects, environmental considerations, and access disparities. Notably, much of the current evidence arises from pediatric or outpatient settings, underscoring the need for high-quality research in intensive care unit populations. These evolving patterns highlight critical gaps in knowledge that must be addressed to optimize intensive care unit nutrition practices. Together with part I, this article offers a comprehensive overview to guide evidence-based selection and implementation of enteral nutrition in critical care.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Critical care workforce in crisis: A path forward

A Systematic Review of Relocation Stress Following In-House Transfer Out of Critical/Intensive Care Units.