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Concurrent nutrition and physical rehabilitation interventions for patients with critical illness
(Ovid Technologies (Wolters Kluwer Health), 2024-12-16)
GONZALEZ SEGUEL, FELIPE ANDRES
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Kirby P. Mayer
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Renee D. Stapleton
The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness. Recent findings While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.</jats:p>
Scopus© Citations 6 1
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Muscle Dysfunction and Physical Recovery After Critical Illness
(SAGE Publications, 2025-02-04)
Matthew F. Mart
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Joshua I. Gordon
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GONZALEZ SEGUEL, FELIPE ANDRES
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Kirby P. Mayer
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Nathan Brummel
During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.
Scopus© Citations 14 2
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Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study
(2024)
Felipe Muñoz-Muñoz
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LEPPE ZAMORA, JAIME ESTEBAN
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Felipe González-Seguel
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CASTRO AVILA, ANA CRISTINA
<jats:p>Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.</jats:p>
Scopus© Citations 2 2
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Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes
(2021)
Jesus A. Serra
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Franco Díaz
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Pablo Cruces
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CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
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Maria J. Nuñez
<jats:title>Abstract</jats:title><jats:p>Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).</jats:p>
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Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol
(2023)
Ruvistay Gutierrez-Arias
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Dawid Pieper
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Peter Nydahl
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Felipe González-Seguel
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Yorschua Jalil
<jats:sec><jats:title>Introduction</jats:title><jats:p>Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence-Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>osf.io/kxwq9.</jats:p></jats:sec>
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Parámetros hematológicos y biomarcadores predictores de gravedad en Síndrome Inflamatorio Pediátrico Multisistémico asociado a SARS-CoV-2
(2021)
Patricia Verdugo
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Patricia Álvarez
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Patricia Aroca
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Vicente Enrique Montes-nogales
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POLI HARLOWE, MARIA CECILIA BERTA
<jats:p>El síndrome inflamatorio multisistémico pediátrico asociado a SARS-CoV-2 (MIS-C) se caracteriza por un estado hiperinflamatorio producto de una tormenta de citoquinas, evidenciado en alteraciones del laboratorio hematológico y proteínas de fase aguda.Objetivo: Describir las características clínicas y de laboratorio de pacientes hospitalizados por MIS-C e identificar marcadores predictores de gravedad.Pacientes y Método: Estudio retrospectivo de 32 pacientes. El grupo se dividió en crítico y no crítico según presentación clínica y tipo de terapia utilizada. En ellos se estudiaron aspectos clínicos y de laboratorio que incluyeron hemograma completo, pruebas de coagulación y biomarcadores. Resultados: 18/32 hombres, mediana de edad 6,8 años. Las manifestaciones más frecuentes fueron cardiovasculares (84,3%), digestivas (84%) y mucocutáneas (59%). El grupo de los críticos incluyó 15 pacientes, 12 hombres con mediana de edad de 8,9 años y los no críticos 17 pacientes; 6 hombres, con mediana de edad de 5,4 años. Los parámetros de laboratorio al ingreso en el grupo global mostraron aumento de la proteína C reactiva, dímero-D, leucocitos, neutrófilos, ferritina y fibrinógeno. La albúmina y la natremia en cambio se encontraban disminuidas. El grupo crítico se caracterizó por tener al ingreso: trombocitopenia, hipoalbuminemia, prolongación del tiempo de protrombina y elevación de la ferritina. Al deterioro hubo acentuación de la trombocitopenia, ascenso mayor de la proteína C reactiva junto a elevación de los neutrófilos.Conclusión: El hemograma, la proteína C reactiva y la albuminemia al ingreso resultaron ser de alto valor en la identificación de pacientes con riesgo de agravamiento clínico.</jats:p>
20Scopus© Citations 10
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No one is better than all together: the role of networks in pediatric intensive care
(2019)
Sebastián González-Dambrauskas
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Juan Camilo Jaramillo-Bustamante
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Franco Díaz
1Scopus© Citations 5
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Intensive Care Unit–Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review
(2023)
J. Pedro Teixeira
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Kirby P. Mayer
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Benjamin R. Griffin
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Naomi George
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Nathaniel Jenkins
Scopus© Citations 11 6
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Effectiveness of physical rehabilitation interventions in critically ill patients—A protocol for an overview of systematic reviews
(2023)
Ruvistay Gutierrez-Arias
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Peter Nydahl
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Dawid Pieper
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Felipe González-Seguel
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Yorschua Jalil
<jats:sec id="sec001"> <jats:title>Introduction</jats:title> <jats:p>Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Discussion</jats:title> <jats:p>The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Registration number</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023389672" xlink:type="simple">CRD42023389672</jats:ext-link>.</jats:p> </jats:sec>
20Scopus© Citations 1
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Critical illness myopathy and trajectory of recovery in acute kidney injury requiring continuous renal replacement therapy: a prospective observational trial protocol
(2023)
J Pedro Teixeira
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Benjamin R Griffin
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Chaitanya Anil Pal
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David Felipe Márquez González
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Nathanial Jenkins
<jats:sec><jats:title>Introduction</jats:title><jats:p>Acute kidney injury requiring renal replacement therapy (AKI-RRT) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. Continuous RRT (CRRT) non-selectively removes large amounts of amino acids from plasma, lowering serum amino acid concentrations and potentially depleting total-body amino acid stores. Therefore, the morbidity and mortality associated with AKI-RRT may be partly mediated through accelerated skeletal muscle atrophy and resulting muscle weakness. However, the impact of AKI-RRT on skeletal muscle mass and function during and following critical illness remains unknown. We hypothesise that patients with AKI-RRT have higher degrees of acute muscle loss than patients without AKI-RRT and that AKI-RRT survivors are less likely to recover muscle mass and function when compared with other ICU survivors.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This protocol describes a prospective, multicentre, observational trial assessing skeletal muscle size, quality and function in ICU patients with AKI-RRT. We will perform musculoskeletal ultrasound to longitudinally evaluate rectus femoris size and quality at baseline (within 48 hours of CRRT initiation), day 3, day 7 or at ICU discharge, at hospital discharge, and 1–3 months postdischarge. Additional skeletal muscle and physical function tests will be performed at hospital discharge and postdischarge follow-up. We will analyse the effect of AKI-RRT by comparing the findings in enrolled subjects to historical controls of critically ill patients without AKI-RRT using multivariable modelling.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>We anticipate our study will reveal that AKI-RRT is associated with greater degrees of muscle loss and dysfunction along with impaired postdischarge recovery of physical function. These findings could impact the in-hospital and postdischarge treatment plan for these patients to include focused attention on muscle strength and function. We intend to disseminate findings to participants, healthcare professionals, the public and other relevant groups via conference presentation and publication without any publication restrictions.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT05287204">NCT05287204</jats:ext-link>.</jats:p></jats:sec>
4Scopus© Citations 5

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