The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes.

Critically ill and critically injured patients require specialized nutrition support to avoid the complications of progressive malnutrition. There is a paucity of information providing practical solutions to these difficult clinical problems. From Nutrition Support to Pharmacologic Nutrition in the ICU focuses on the theoretical and practical aspects of the management of this high-risk patient population. Each chapter presents a state-of-the-art discussion of nutritional and metabolic issues relevant to this resource-intensive patient population and contains current references, liberal tables and figures, and the personal insights of recognized international leaders in this field.

This book demonstrates how the latest insights into the physiopathology of the stress response can be integrated into clinical practice. The topic is particularly relevant since the metabolic changes triggered by acute stress, including adaptive responses such as resistance to anabolic signals, have recently been more precisely delineated. The underlying mechanisms of these changes are also now better understood. The authors analyse how these advances could result in better management and more effective prevention of the long-term clinical consequences of the alterations occurring during the acute phase. An international panel of respected experts discusses these topics and describes the management of some common clinical conditions.

Nutritional support of critically ill patients is a major treatment modality which will enhance recovery and shorten convalescence. New knowledge has emphasized that much of the organ dysfunction associated with sepsis and altered blood flow is related to oxidative injury. Specific nutrients are highly effective in counteracting these effects and their early administration may attenuate cellular damage and multi-organ failure. Patient outcome may also be enhanced by the route of feeding, administration of newer nutrient combinations, utilization of evolving methods of monitoring and the use of growth factors. This new knowledge has evolved to a new area of metabolic support which is addressed for the first time by a group of international experts. The topics presented and general conclusions are of major importance to the practitioners in this field, for they show, for the first time, a departure from the more traditional approaches of nutritional support in patients with life-threatening diseases.

The new edition of this popular text has been extensively revised and updated throughout. It will continue to provide the trainee or practising anesthetist with all the information, both background and practical, that will be needed in the busy clinical setting or during revision for qualifying examinations.Major changes for the new edition include

Completely revised and updated, Nutrition Support for the Critically Ill Patient: A Guide to Practice, Second Edition presents an unbiased, evidence-based examination of critical nutrition across the life cycle. Taking a multidisciplinary approach, each chapter has been carefully designed to provide a comprehensive review of the literature and a de

Nutrition Support for the Critically Ill Patient: A Guide to Practice provides state-of-the-art practices and key principles of nutrition support through evidence-based medicine. Following a review of the metabolic alterations that occur during critical illness, this book discusses the nutrient requirements of critically ill patients as well

This volume is a comprehensive, state-of-the-art review for clinicians with an interest in the peri-operative nutritional management of all surgical patients. The text reviews normal physiology, the pathophysiology of starvation and surgical stressors, and focuses on appropriate nutritional repletion for various common disease states. Specifically, the text addresses the severe metabolic demands created by systemic inflammation, infection, and major insults such as trauma and burns. In addition, the book addresses the growing problem of obesity in surgical populations, including appropriate strategies directed towards the metabolic management of these patients. The text is designed for clinicians across levels of training and provides clear and concise evidence based guidelines for the metabolic management and nutritional support of the surgical patient. Written by experts in the field, Surgical Metabolism: The Metabolic Care of the Surgical Patient is a valuable resource for all clinicians involved in the care of the critically ill.

Any healthcare professional with, or developing an interest in, clinical nutrition will be able to use this textbook, first published in 2001, as a source of information for the formation of a clinical nutrition support service of excellence. The first three parts of the book will enable a clear perspective of the metabolism and physiology of clinical nutrition to be related to the practical application of support techniques. The fourth part of the book highlights the role of nutrition support in specific disease groups. A number of additional chapters have been added for this second edition, and modifications made to the content of chapters from the first edition to cover newer areas or areas of omission.

Infection Control in the Intensive Care Unit has been entirely rewritten in this second edition. All statements are justified by the best available evidence, avoiding unsubstantiated expert opinion. The book contains a new section dedicated to the microbiology of the critically ill; specifically, how to process and interpret surveillance cultures to distinguish the ‘normal’ from the ‘abnormal’ carrier state. There are five totally new chapters dealing with evidence-based infection control molecular techniques for outbreak analysis; clinical virology in neonatal, paediatric and adult intensive care; the six basic principles of the therapy of an infection; and the role of the pharmacist in infection control. Attention is given to special topics such as nutrition, gut mucosal protection, and the control of antimicrobial resistance. The addition of enteral to parenteral antimicrobials contributes to the control of multi-resistant micro-organisms. This completely revised second edition is a must-have for anyone requiring in-depth knowledge in the ever expanding field of infection control.