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This book draws a pathway from metabolic assessment and nutrition support to advances in renal replacement therapy and organ support in critical care, underling the specific clinical aspect and focusing on medical clinical management in critical care. Metabolic alterations in critically ill patients have been studied for many years. Despite everything, the heterogeneity of critically ill patients, the duration and variable severity of the acute phase of the disease and the numerous confounding factors have hindered progress in this field.
A cornerstone of metabolic care is nutrition, that is an essential part of the care for critically ill patients, although the optimal feeding strategy for patients in the intensive care unit is still debated and often remains a challenge for the intensive care team in clinical practice. In addition, acute loss of renal function interferes with the metabolism of all macronutrients, responsible for pro-inflammatory, pro-oxidative and hyper-catabolic situations. The physiological and biological modifications related to acute renal failure in critically ill patients, including the current use of continuous renal replacement therapies, have dramatically changed the type and importance of the metabolic and nutrition disturbances observed during treatment of renal failure.
This book - addressed to healthcare providers working in intensive care units - aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition and critical care nephrology literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.
Antonella Cotoia is Associate Professor in Anesthesiology, Intensive Care and Pain Medicine at the Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, University- Hospital of Foggia, Foggia, Italy. Prof Cotoia is currently a Board Member of the Metabolism, Nutrition and Renal Therapies of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and member of Feeding, Rehabilitation, Endocrinology and Metabolism group of Intensive Care Medicine (ESICM). Her field of interest are Nutrition, Macro and Macronutrients, Microbiota, Sepsis, High- Fidelity Simulation.
Silvia De Rosa is Assistant Professor in Anaesthesiology, Intensive Care and Pain Medicine at Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy and Attending Physician in Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Italy. Prof. De Rosa is a AKI Section Representative in the Research Committee of European Society of Intensive Care Medicine (ESICM), but also Regional Coordinator of "Italian Society of Anesthesia Analgesia and Intensive Care" (SIAARTI - Veneto Region) and National Coordinator of Nutrition, Metabolism and Renal Therapies of SIAARTI. Her field of interest are Acute Kidney Injury and Extracorporeal Organ Support, Brain Trauma, Nutrition and Muscle Wasting, Airways Management.
Fiorenza Ferrari is Adjunct Professor of Anaesthesiology and Intensive Care. Senior consultant of the ICU and medical researcher. From 2015 to 2017, she was Scientific coordinator of International Renal Research Institute of Vicenza (IRRIV). Her field of interests are Acute Kidney Injury and Extracorporeal Organ Support, Extracorporeal drug removal. She currently serves as Regional Board Member of "Italian Society of Anesthesia Analgesia and Intensive Care" (SIAARTI - Lombardia Region) but also as board Member of the Metabolism, Nutrition and Renal Therapies section of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).
Vincenzo Pota is Assistant Professor in Anaesthesiology, Intensive Care and Pain Medicine at Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy. His field of interests are Acute Kidney Injury and Extracorporeal Organ Support. He currently serves as Board Member of the Metabolism, Nutrition and Renal Therapies section of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).
Michele Umbrello is Senior Consultant in Anaesthesia and Intensive Care at the Department of Intensive Care and Anaesthesia, ASST Ovest Milanese, Ospedale Civile di Legnano (Milan) and Adjunct Professor of Anaesthesia and Intensive Care at the University of Milan. He graduated in Anaesthesiology and Intensive Care Medicine from the University of Milan, and undertook a research fellowship at the Bloomsbury Institute of Intensive Care Medicine and Wolfson Institute for Biomedical Research, University College London. Dr. Umbrello's research has largely focused on nutrition support and the study of metabolism during critical illness, on respiratory physiology and lung imaging in acute respiratory failure and on the humanisation of intensive care. An active member of National and International scientific societies, he currently serves as Board Member of the Metabolism, Nutrition and Renal Therapies section of the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and as Member of the Scientific Committee of the Italian Society for Clinical Nutrition and Metabolism (SINPE).
Part I. Metabolism during critical illness.- Acute skeletal muscle wasting during critical illness.- Endocrine aspects of acute and prolonged critical illness.- Disorders of Fluid and Electrolyte Metabolism.- Critical illness polyneuropathy and myopathy.- Gut microbiome in the critically ill.- Nutrition Risk Screening Tools.- Dynamic metabolic changes measured by indirect calorimetry.- The Energy Intake - How Much is Enough?.- Protein Requirements - Refocusing on an Essential Nutrient.- Monitoring of muscle mass in critically ill patients.- Bioelectrical impedance vector analysis in critically ill patients.- Part II. Nutrition support, pharmaconutrition and special considerations.- Enteral and Parenteral Feeding: how to choose the route.- Enteral Nutrition Overview and Formula Selection Considerations.- Complications associated with Enteral Nutrition Parenteral Solutions Overview.- Complications associated with Parenteral Nutrition.- Pharmaconutrition in critical care.- Physical and functional recovery of critically ill patients.- Ethical considerations in critical care nutrition.- Part III. Nutrition Requirement in special condition.- Nutrition in ARDS, COVID-19 & ECMO.- Nutrition in Trauma and burns.- Nutrition in Sepsis, AKI and CRRT.- Nutrition in Acute liver failure and Severe acute pancreatitis.- Nutrition in Major surgery, intestinal failure and open abdomen.- Nutrition in Neurocritical care.- Part IV. Acute Kidney Injury.- Global epidemiology and outcomes of acute kidney injury.- Definition, staging criteria of acute kidney injury and controversies.- Biological Markers of Acute Kidney Injury.- Prediction and Machine Learning Models for early prediction of AKI.- Ultrasound in Acute Kidney Injury.- Management AKI: Fluids.- Management AKI: Vasopressors.- Management AKI: Diuretics.- Acute Kidney Disease.- Renal functional reserve and renal recovery after acute kidney injury.- Part V. Renal Replacement Therapy.- Nomenclature for renal replacement therapy.- Vascular Access for Renal Replacement Therapy.- Anticoagulation strategies in continuous Renal Replacement Therapy.- Dose prescription in Renal Replacement Therapy.- Indications and timing of Renal Replacement Therapy.- Nutritional assessment and support during continuous renal.- Drug dosing considerations in continuous renal replacement therapy.- Weaning and discontinuation of Renal Replacement Therapy.- Complications & troubleshooting in continuous renal replacement therapy.- Part VI. Extracorporeal organ support in critical illness.- Extracorporeal Blood Purification for Immunomodulatory and/or Kidney Support in Sepsis.- Extracorporeal Blood Purification for Acute Poisoning.- Renal replacement therapy combined with Artificial or Bioartificial Liver support system.- Low-flow extracorporeal CO2 removal managed with a renal replacement platform.- Continuous renal replacement therapy during extracorporeal membrane oxygenation.
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