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OBJECTIVE To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients. PARTICIPANTS A multidisciplinary, multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care(More)
OBJECTIVE To determine whether a baseline (random) cortisol concentration <25 microg/dL in patients with septic shock was a better discriminator of adrenal insufficiency than the standard (250 microg) and the low-dose (1 microg) corticotropin stimulation tests as assessed by the hemodynamic response to steroid replacement. SETTING Intensive care unit. (More)
Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA(More)
OBJECTIVE To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. DATA SOURCES Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. STUDY SELECTION Randomised controlled studies that compared enteral nutrition with parenteral(More)
Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca++) measured. Of these 210(More)
Enteral delivery of nutrients is important for optimal treatment of critically ill patients. It maintains gut digestive and barrier functions, decreases gut bacterial translocation, decreases the incidence of sepsis, and improves outcome. Gastric emptying is impaired in many critically ill patients and feeding into a gastroparetic stomach leads to large(More)
Epidemiological evidence has established that ingestion of long-chain polyunsaturated omega-3 fatty acids (omega-3 PUFAs), abundant in fish oils, have profound effects on many human disorders and diseases, including cardiovascular disease and cancer. Here we briefly review the dietary recommendations and the food sources that are naturally enriched by these(More)
Malnutrition is a common comorbidity that places inpatients at risk of complications, infections, long length of stay, higher costs, and increased mortality. Thus, nutrition support has become an important therapeutic adjunctive to the care of these patients. For patients unable to feed themselves, nutrition can be delivered via the parenteral or enteral(More)
Epidemiological evidence from Greenland Eskimos and Japanese fishing villages suggests that eating fish oil and marine animals can prevent coronary heart disease. Dietary studies from various laboratories have similarly indicated that regular fish oil intake affects several humoral and cellular factors involved in atherogenesis and may prevent(More)