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Background. People who have had a prolonged admission to an intensive care unit (ICU) commonly have profound debilitation and weakness. For the delivery of effective exercise training, an accurate assessment of exercise capacity is essential. Objective. The study objectives were to investigate how much ground-based walking is undertaken by inpatients recovering from critical illness within 1 week of discharge from an ICU and to evaluate the feasibility and safety of the Six-Minute Walk Test (6MWT) for this population. Design. This was an observational study. Methods. Within 1 week of discharge from the ICU, functional exercise capacity was measured with the 6MWT. The maximum distance ambulated on the ward in a single session as part of usual clinical management was extracted from the medical notes. The distance achieved during the 6MWT and the maximum distance ambulated on the ward were compared. Results. The participants (N=23) were survivors of a critical illness; their mean age was 57 years (SD=11). The median length of ICU stay was 11 days (interquartile range [IQR]=7). The mean 6-minute walk distance (6MWD) was 179 m (SD=101), and the maximum distance ambulated on the ward was 30 m (IQR=65). There was a moderate association between the distance participants ambulated on the ward and the 6MWD (r=.54). The maximum distance ambulated on the ward, expressed as a percentage of the 6MWD, was 29% (IQR=34%). Five participants (22%) experienced oxygen desaturation (oxygen saturation of Limitations. The maximum distance ambulated on the ward was estimated with premeasured distances. Conclusions. Most participants ambulated at a low percentage of their measured exercise capacity. The 6MWT appears to be a safe and useful test for inpatients recently discharged from the ICU., Profound debilitation and skeletal muscle weakness are common complications in patients recovering from critical illness. (1) Within the intensive care unit (ICU), muscle dysfunction is common, with 25% to 33% [...]

Background. Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). Objective. The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU). Design. This was a retrospective cohort study of an interdisciplinary quality-improvement program. Methods. Pre- and post-early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared. Results. No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post-early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased. Limitations. Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed. Conclusions. Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU., Patients who are critically ill and admitted to an intensive care unit (ICU) have traditionally been placed on bed rest. (1-3) Progression to sitting and standing often has been deferred [...]

Predicting energy needs in critical illness can be difficult because of uncertainties about the influence of multiple factors on energy expenditure. Understanding these components is important to avoid limiting optimal outcome by underfeeding and to avoid complications of overfeeding. Prediction strategies often use a patient's weight to estimate needs. For overweight patients, there is controversy as to whether actual or modified weight should be used in predictions. This study was designed to evaluate a proposed technique to improve the accuracy of predicting energy needs in critically ill, overweight subjects. Subjects' energy needs were predicted [with Harris-Benedict equation (HBE) and kilo-joules per kilogram (KPK) strategies] by using both actual weight and an adjusted weight developed to attempt to more accurately reflect lean mass. Results were compared with measured energy expenditure determined by indirect calorimetry. Results indicated that use of actual weights in predictions for overweight subjects may lead to overfeeding. Use of adjusted weights led to more accurate energy predictions with the KPK than with the HBE strategy. Adjusted-weight strategies could explain [is greater than] 45% of the variability of resting energy expenditure in subjects 130-159% of ideal body weight. Results of this study suggest that using adjusted weights with the KPK prediction strategy may be preferable for this population, particularly for patients [is greater than or equal to] 130% of ideal body weight. This study also indicated that multiple diagnoses may not lead to increased energy requirements. Am J Clin Nutr 1997;66:1250-6.

Byline: Melanie Evans Excela Health entered the Great Recession as the largest mental health provider for the Pennsylvania county that's home to its three hospitals. A year and a half [...]

Background: Food in the intestine drives the enterohepatic circulation of bile components. Objective: We investigated whether parenteral or enteral delivery of nutrients alters serum and biliary lipids in critically ill patients. Design: Eight intensive care unit (ICU) patients who had received [is greater than or equal to] 5 d of total parenteral nutrition (TPN) were compared with 8 ICU patients who had fasted for [is greater than or equal to] 5 d. Both groups were studied before and after 5 d of enteral nutrition (EN). Each patient served as his or her own control. Duodenal bile was analyzed for biliary lipid content and serum lipids were determined simultaneously. Duodenal bile samples from 18 healthy persons served as controls. Results: Bile salt concentrations in all ICU patients were 17% of control values before EN (P [is less than] 0.005) and 34% of control values after 5 d of EN (P [is less than] 0.005). Phospholipid concentrations were 12% of control before EN (P [is less than] 0.0005) but increased almost 4-fold after EN (P [is less than] 0.0005). Biliary cholesterol concentrations were 20% of control values before EN (P [is less than] 0.001) and did not improve afterward. No difference in bile composition was observed between fasted ICU patients and those who received TPN. The inverse correlation between the severity of illness and biliary lipid concentrations observed before EN disappeared with enteric stimulation. The low serum concentrations of HDL cholesterol and apolipoprotein A-I increased significantly with EN in all ICU patients. Conclusion: Lack of EN during critical illness was associated with profound decrements in biliary lipid concentrations that normalized partially after 5 d of EN. We hypothesize that loss of enteric stimulation in ICU patients impairs hepatic lipid metabolism. Am J Clin Nutr 1999;70:70-7.

Transport of acutely injured and ill patients by air has become an integral part of regionalized systems of health care. Patient outcomes are improved with use of such trauma systems, [...]

Hyperglycemia commonly occurs in critically ill patients. Indeed, a link between critical illness and hyperglycemia was recognized as early as the late 19th century, with the coining of the term [...]

Patients with gout tend to wear shoes that lack cushioning, provide minimal stability and motion control, limit gait efficiency, fit poorly, and show excessive wear, according to results of a [...]

BARCELONA -- The benefits of tight glucose control with insulin therapy may not be worth the risk of hypoglycemia for critically ill patients, Dr. Jean Charles Preiser said at the [...]