The effect of cisatracurium infusion on the energy expenditure of critically ill patients: an observational cohort study.

BACKGROUND: Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. A reliable estimation of the energy expenditure (EE) of ICU patients may help to avoid these phenomena. Several factors that influence EE have been studied previously. However, the effect of neuromuscular blocking agents on EE, which conceptually would lower EE, has not been extensively investigated. METHODS: We studied a cohort of adult critically ill patients requiring invasive mechanical ventilation and treatment with continuous infusion of cisatracurium for at least 12 h. The study aimed to quantify the effect of cisatracurium infusion on EE (primary endpoint). EE was estimated based on ventilator-derived VCO2 (EE in kcal/day = VCO2 × 8.19). A subgroup analysis of septic and non-septic patients was performed. Furthermore, the effects of body temperature and sepsis on EE were evaluated. A secondary endpoint was hypercaloric feeding (> 110% of EE) after cisatracurium infusion. RESULTS: In total, 122 patients were included. Mean EE before cisatracurium infusion was 1974 kcal/day and 1888 kcal/day after cisatracurium infusion. Multivariable analysis showed a significantly lower EE after cisatracurium infusion (MD - 132.0 kcal (95% CI - 212.0 to - 52.0; p = 0.001) in all patients. This difference was statistically significant in both sepsis and non-sepsis patients (p = 0.036 and p = 0.011). Non-sepsis patients had lower EE than sepsis patients (MD - 120.6 kcal; 95% CI - 200.5 to - 40.8, p = 0.003). Body temperature and EE were positively correlated (Spearman's rho = 0.486, p < 0.001). Hypercaloric feeding was observed in 7 patients. CONCLUSIONS: Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE, although the magnitude of the effect is small. Sepsis and higher body temperature are associated with increased EE. Cisatracurium infusion is associated with overfeeding in only a minority of patients and therefore, in most patients, no reductions in caloric prescription are necessary.

Pharmacokinetics of caspofungin in ICU patients.

OBJECTIVES: Caspofungin is used for treatment of invasive fungal infections. As the pharmacokinetics (PK) of antimicrobial agents in critically ill patients can be highly variable, we set out to explore caspofungin PK in ICU patients. METHODS: ICU patients receiving caspofungin were eligible. Patients received a loading dose of 70 mg followed by 50 mg daily (70 mg if body weight >80 kg); they were evaluable upon completion of the first PK curve at day 3. Additionally, daily trough samples were taken and a second PK curve was recorded at day 7. PK analysis was performed using a standard two-stage approach. RESULTS: Twenty-one patients were evaluable. Median (range) age and body weight were 71 (45-80) years and 75 (50-99) kg. PK sampling on day 3 (n = 21) resulted in the following median (IQR) parameters: AUC0-24 88.7 (72.2-97.5) mg·h/L; Cmin 2.15 (1.40-2.48) mg/L; Cmax 7.51 (6.05-8.17) mg/L; V 7.72 (6.12-9.01) L; and CL 0.57 (0.54-0.77) L/h. PK sampling on day 7 (n = 13) resulted in AUC0-24 107.2 (90.4-125.3) mg·h/L, Cmin 2.55 (1.82-3.08) mg/L, Cmax 8.65 (7.16-9.34) mg/L, V 7.03 (5.51-7.73) L and CL 0.54 (0.44-0.60) L/h. We did not identify any covariates significantly affecting caspofungin PK in ICU patients (e.g. body weight, albumin, liver function). Caspofungin was well tolerated and no unexpected side effects were observed. CONCLUSIONS: Caspofungin PK in ICU patients showed limited intraindividual and moderate interindividual variability, and caspofungin was well tolerated. A standard two-stage approach did not reveal significant covariates. Our study showed similar caspofungin PK parameters in ICU patients compared with non-critically ill patients.

Comparison of the Beacon and Quark indirect calorimetry devices to measure resting energy expenditure in ventilated ICU patients.

INTRODUCTION: Critically ill patients in the Intensive Care Unit (ICU) should receive nutritional support matched to their metabolic needs as both under- and overfeeding energy has been shown to increase mortality. Critical illness can significantly affect metabolism. Consequently, resting energy expenditure (REE) can vary markedly during critical illness. Therefore, indirect calorimetry to estimate REE is recommended to determine energy requirements in individual ICU patients and to guide optimal nutritional support. Currently, the Quark metabolic monitor is considered the gold standard in our ICU, but novel mechanical support devices are also equipped with indirect calorimetry functionalities. This study aimed to evaluate the performance of a currently unevaluated device. METHODS: A cross-sectional analysis in mechanically ventilated patients was conducted in a mixed medical-surgical ICU. The primary outcome was a numerical and visual comparison of the performance of the Beacon indirect calorimeter to calculate REE compared to the Quark device using Bland Altman plots. Performance was evaluated using bias, precision, accuracy, and reliability. Secondary analysis included a comparison with REE estimated by predictive equations. RESULTS: Seventy-one measurements were obtained in 27 mechanically ventilated subjects. An underestimation by the Beacon device in calculated REE of -96.2 kcal/day (4.5%) was found. There was a bias towards higher VCO2 and lower VO2 values with Beacon as compared to Quark. The reliability of the Beacon was good, with an absolute intraclass correlation coefficient of 0.897 (95%CI 0.751-0.955; p = 0.000). There was a poor correlation (<0.40) between the separate indirect calorimetry devices and most predictive equations. Only the Faisy predictive equations had good reliability (ICC 0.687, p = 0.002). CONCLUSIONS: Beacon indirect calorimetry accurately determined REE in mechanically ventilated critically ill patients compared to the gold standard in our ICU (Quark indirect calorimeter), although confidence intervals were wide. There was low bias and good reliability. On the other hand, predictive equations performed poorly compared to both devices, underestimating the true metabolic needs of mechanically ventilated ICU patients.

Micronutrient deficiencies in critical illness.

BACKGROUND & AIMS: Low micronutrient levels in critical illness have been reported in multiple studies. Because of the antioxidant properties of various micronutrients, micronutrient deficiency may augment oxidative stress in critical illness. However, it remains unclear whether micronutrient concentrations in ICU patients are different from those in healthy age-matched controls. It is also unclear whether micronutrient deficiency develops, worsens, or resolves during ICU admission without supplementation. METHODS: We prospectively studied a cohort of adult critically ill patients. Micronutrient levels, including selenium, ß-carotene, vitamin C, E, B1 and B6 were measured repeatedly during the first week of ICU admission. We compared the micronutrient concentrations at ICU admission to those of healthy age-matched controls. In addition, associations between micronutrient concentrations with severity of illness, inflammation and micronutrient intake were investigated. RESULTS: Micronutrient blood concentrations were obtained from 24 critically ill adults and 21 age-matched healthy controls. The mean micronutrient levels at admission in the ICU patients were: selenium 0.52 µmol/l, ß-carotene 0.17 µmol/l, vitamin C 21.5 µmol/l, vitamin E 20.3 µmol/l, vitamin B1 129.5 nmol/l and vitamin B6 41.0 nmol/l. In the healthy controls micronutrient levels of selenium (0.90 µmol/l), ß-carotene (0.50 µmol/l), vitamin C (45 µmol/l) and vitamin E (35.5 µmol/l) were significantly higher, while vitamin B1 (122 nmol/l) and B6 (44 nmol/l) were not significantly different between patients and controls. Selenium, vitamin B1 and vitamin B6 levels remained stable during ICU admission. Vitamin C levels dropped significantly until day 5 (p < 0.01). Vitamin E and ß-carotene levels increased significantly on days 5-7 and day 7, respectively (p < 0.01). Micronutrient levels were not associated with severity of illness, CRP or micronutrient intake during the admission. CONCLUSIONS: At admission, ICU patients already had lower plasma levels of selenium, ß-carotene, vitamin C and vitamin E than healthy controls. Vitamin C levels dropped significantly during the first days of ICU admission, while ß-carotene and vitamin E levels increased after 5-7 days. No association between micronutrient levels and severity of illness, C-reactive protein (CRP) or micronutrient intake was found. Progressive enteral tube feeding containing vitamins and trace elements does not normalize plasma levels in the first week of ICU stay. This was a hypothesis generating study and more investigation in a larger more diverse sample is needed.

Resting energy expenditure by indirect calorimetry versus the ventilator-VCO2 derived method in critically ill patients: The DREAM-VCO2 prospective comparative study.

BACKGROUND & AIMS: Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. Predictive equations of nutritional requirements, though easily implemented, are highly inaccurate. Ideally, the individual caloric target is based on the frequent assessment of energy expenditure (EE). Indirect calorimetry is considered the gold standard but is not always available. EE estimated by ventilator-derived carbon dioxide consumption (EEVCO2) has been proposed as an alternative to indirect calorimetry, but there is limited evidence to support the use of this method. METHODS: We prospectively studied a cohort of adult critically ill patients requiring mechanical ventilation and artificial nutrition. We aimed to compare the performance of the EEVCO2 with the EE measured by indirect calorimetry through the calculation of bias and precision (accuracy), agreement, reliability and 10% accuracy rates. The effect of including the food quotient (nutrition intake derived respiratory quotient) in contrast to a fixed respiratory quotient (0.86), into the EEVCO2 formula was also evaluated. RESULTS: In 31 mechanically ventilated patients, a total of 414 paired measurements were obtained. The mean estimated EEVCO2 was 2134 kcal/24 h, and the mean estimated EE by indirect calorimetry was 1623 kcal/24 h, depicting a significant bias of 511 kcal (95% CI 467-560, p < 0.001). The precision of EEVCO2 was low (lower and upper limit of agreement -63.1 kcal and 1087. o kcal), the reliability was good (intraclass correlation coefficient 0.613; 95% CI 0.550-0.669, p < 0.001) and the 10% accuracy rate was 7.0%. The food quotient was not significantly different from the respiratory quotient (0.870 vs. 0.878), with a small bias of 0.007 (95% CI 0.000-0.015, p = 0.54), low precision (lower and upper limit of agreement -0.16 and 0.13), poor reliability (intraclass correlation coefficient 0.148; 95% CI 0.053-0.240, p = 0.001) and a 10% accuracy rate of 77.5%. Estimated mean EEVCO2, including the food quotient, was 2120 kcal/24 h, with a significant bias of 496 kcal (95% CI 451-542; p < 0.001) and low precision (lower and upper limit of agreement -157.6 kcal and 1170.3 kcal). The reliability with EE estimated by indirect calorimetry was good (intraclass correlation coefficient 0.610, 95% CI 0.550-0.661, p < 0.001), and the 10% accuracy rate was 9.2%. CONCLUSIONS: EEVCO2, compared with indirect calorimetry, overestimates actual energy expenditure. Although the reliability is acceptable, bias is significant, and the precision and accuracy rates are unacceptably low when the VCO2 method is used. Including the food quotient into the EEVCO2 equation does not improve its performance. Predictive equations, although inaccurate, may even predict energy expenditure better compared with the VCO2-method. Indirect calorimetry remains the gold standard method.

Pleural Enterococcus faecalis empyema: an unusual case.

A 63-year-old female patient was admitted to the department of neurology following an acute ischemic infarction of the right medial cerebral artery. She developed fever, respiratory failure, and hypotension and had to be transferred to the intensive care unit (ICU) for intubation and mechanical ventilation. Chest X-ray showed increased density of the complete right hemi-thorax, indicative of massive pleural effusion. Chest tube drainage produced 1.5 l of pus in 1 h. Cultures revealed growth of Enterococcus faecalis. The patient was treated with amoxicillin and clavulanic acid with good clinical response. Enterococci very rarely cause spontaneous pleural empyema. The natural resistance of enterococci to several types of antibiotics can lead to selection of enterococci as seen in other clinical studies and may lead to this unusual clinical consequence.

Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence.

Persistent physical impairment is frequently encountered after critical illness. Recent data point towards mitochondrial dysfunction as an important determinant of this phenomenon. This narrative review provides a comprehensive overview of the present knowledge of mitochondrial function during and after critical illness and the role and potential therapeutic applications of specific micronutrients to restore mitochondrial function. Increased lactate levels and decreased mitochondrial ATP-production are common findings during critical illness and considered to be associated with decreased activity of muscle mitochondrial complexes in the electron transfer system. Adequate nutrient levels are essential for mitochondrial function as several specific micronutrients play crucial roles in energy metabolism and ATP-production. We have addressed the role of B vitamins, ascorbic acid, α-tocopherol, selenium, zinc, coenzyme Q10, caffeine, melatonin, carnitine, nitrate, lipoic acid and taurine in mitochondrial function. B vitamins and lipoic acid are essential in the tricarboxylic acid cycle, while selenium, α-tocopherol, Coenzyme Q10, caffeine, and melatonin are suggested to boost the electron transfer system function. Carnitine is essential for fatty acid beta-oxidation. Selenium is involved in mitochondrial biogenesis. Notwithstanding the documented importance of several nutritional components for optimal mitochondrial function, at present, there are no studies providing directions for optimal requirements during or after critical illness although deficiencies of these specific micronutrients involved in mitochondrial metabolism are common. Considering the interplay between these specific micronutrients, future research should pay more attention to their combined supply to provide guidance for use in clinical practise. REVISION NUMBER: YCLNU-D-17-01092R2.

Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia.

A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of therapeutic hypothermia with a temperature of 32.5 degrees C, the patient was rewarmed and sedation discontinued. Neurological evaluation after 24 h revealed a maximum Glasgow Coma Score of E4M4Vt with spontaneous breathing. However the patient developed a fever reaching 39 degrees C for several hours that was unresponsive to conventional cooling methods. In the subsequent 24 h patient developed apnoea, hypotension and bradycardia with deterioration of the coma score. Diabetes insipidus was confirmed. Cerebral CT was performed which showed diffuse brain oedema with herniation and brainstem compression. The patient died within hours. Autopsy showed massive brain swelling and tentorial herniation. Hyperthermia possibly played a pivotal role in the development of this fatal insult to this vulnerable brain after cardiac arrest and therapeutic hypothermia treatment. The acute histopathological alterations in the brain, possibly caused by the deleterious effects of fever after cardiac arrest in human brain, may be considered a new observation.

Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients.

BACKGROUND AND OBJECTIVE: Cardiac output is frequently monitored to maintain and improve cardiac function with the primary goal of adequate tissue perfusion. The pulmonary artery catheter is considered to be the gold standard although several non-invasive devices are being introduced and gaining attention. To evaluate the accuracy of the ultrasonic cardiac output monitor (USCOM)-1A (Pty Ltd, Coffs Harbour, NSW, Australia), a non-invasive cardiac output device including its capability to differentiate between different shock states in haemodynamically unstable ICU patients was used in this single-centre, prospective, observational study. METHODS: Cardiac output was measured with a pulmonary artery catheter and transcutaneously via a suprasternal approach with the USCOM-1A by continuous-wave Doppler ultrasound in 25 adult patients in a mixed medical and surgical ICU in a major teaching hospital in the Netherlands. RESULTS: A total of 1315 USCOM-1A cardiac output measurements were performed. In order to reduce time-variability, the mean of five consecutive USCOM-1A measurements was calculated. Total 263 values were compared with 263 thermodilution cardiac output measurements performed with a pulmonary artery catheter. Data were analysed for systematic error, precision and correlation. Systematic and random errors were found. On average USCOM-1A values were 12% lower than thermodilution measurements (systematic error), while the random error was 17% (coefficient of variation). The error comprised an inter-operator variability of 3%, an inter-patient variability of 11% and residual variability of 15%. The correlation coefficient of the calculated cardiac index with the USCOM-1A and the pulmonary artery catheter was r = 0.8024 and 0.6438, respectively. Temperature and gender did not influence correlations. The learning curve for USCOM-1A skill acquisition was steep. CONCLUSIONS: The correlation between the two techniques was acceptable, although relevant systematic and variable errors were detected. USCOM-1A provided adequate data to distinguish non-invasively different shock types in ICU patients.

Data on effects, tolerability and safety of Omega-3 Fatty Acids in Enteral Nutrition in the Critically ill.

In addition to the data reported in our systematic review and meta-analysis 'Current Evidence on Omega-3 Fatty Acids in Enteral Nutrition in the Critically ill' we present data on intensive care unit and hospital mortality, age distribution between included studies, tolerability and adverse events of enteral omega-3 supplementation compared with control interventions in the critically ill. Moreover, we report additional analyses on 28-day mortality comparing old versus new studies and high versus low quality trials. Finally, we report baseline and follow-up levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reported in the trials included in Koekkoek et al. (2018). For further interpretation and discussion we recommend reading our systematic review and meta-analysis Current Evidence on Omega-3 Fatty Acids in Enteral Nutrition in the Critically ill'.

Pre-post evaluation of effects of a titanium dioxide coating on environmental contamination of an intensive care unit: the TITANIC study.

BACKGROUND: Among patients admitted to European hospitals or intensive care units (ICUs), 5.7% and 19.5% will encounter healthcare-associated infections (HAIs), respectively, and antimicrobial resistance is emerging. As hospital surfaces are contaminated with potentially pathogenic bacteria, environmental cleanliness is an essential aspect to reduce HAIs. AIM: To address the efficacy of a titanium dioxide coating in reducing the microbial colonization of environmental surfaces in an ICU. METHODS: A prospective, controlled, single-centre pilot study was conducted to examine the effect of a titanium dioxide coating on the microbial colonization of surfaces in an ICU. During the pre- and post-intervention periods, surfaces were cultured with agar contact plates (BBL RODAC plates). Factors that were potentially influencing the bacterial colonization of surfaces were recorded. A repeated measurements analysis within a hierarchic multi-level framework was used to analyse the effect of the intervention, controlling for the explanatory variables. FINDINGS: The mean ratio for the total number of colony-forming units (cfus) in a room between the pre- and post-intervention periods was 0.86 (standard deviation 0.57). The optimal model included the following explanatory variables: intervention (P=0.065), week (P=0.002), culture surfaces (P<0.001), ICU room (P=0.039), and interaction between intervention and week (P=0.002) and between week and culture surfaces (P=0.031). The effect of the intervention on the number of cfus from all culture plates in Week 4 between the pre- and post-intervention periods was -0.47 (95% confidence interval -0.24 to - 0.70). CONCLUSION: This study found that a titanium dioxide coating had no effect on the microbial colonization of surfaces in an ICU.

Therapeutic hypothermia after prolonged cardiopulmonary resuscitation for pulseless electrical activity.

We report an 18-year-old female patient with cardiac arrest due to pulseless electrical activity caused by a massive pulmonary embolism. Cardiopulmonary resuscitation was continued for more than one hour. Although the initial clinical signs and symptoms suggested poor outcome, immediate intravenous thrombolysis was instituted. After return of spontaneous circulation (75 minutes) the patient was still comatose and mild therapeutic hypothermia (32.5 degrees C) was instituted for brain protection during the first 24 hours. She recovered uneventfully without neurological deficit. Therapeutic hypothermia may be effective for neuroprotection in non-VFcardiac arrest.

Severe Yersinia enterocolitica sepsis after blood transfusion.

A 23-year-old male received multiple blood transfusions following complicated thoracic surgery. He developed progressive haemorrhagic shock and multiple organ dysfunction syndrome. Blood cultures grew Yersinia enterocolitica. The patient was proven negative for Yersinia enterocolitica; however, one of the donors was found to be positive. Although strict selection of blood transfusion donors is warranted in the Netherlands, contamination of blood components may still occur and therefore should be considered whenever adverse events occur during or after blood transfusion.

[Isolated orchidodynia as the initial symptom of aneurysm of the abdominal aorta]. / Geïsoleerde orchidodynie als eerste uiting van een aneurysma aortae abdominalis.

A 67-year-old man presented with isolated pain of the right testicle. He was admitted and treated for epididymitis. His symptoms did not improve and lower abdominal pain developed. After hypotension and severe anaemia (Hb 2.1 mmol/l) had developed, abdominal echography was carried out, revealing a ruptured abdominal aortic aneurysm. The patient underwent surgical repair with an aortic-bifemoral prosthesis and was ultimately discharged without further complications. This is the fourth report in the literature of orchidodynia as referred pain from an aneurysm of the abdominal aorta.

[Sepsis: new insights, new definition]. / Sepsis: nieuwe inzichten, nieuwe definitie.

- Incidence of sepsis is increasing, partly due to an ageing population, increased use of immunosuppressants, and antibiotic resistance. Sepsis survival has improved substantially, in part because of continuously improving intensive care and implementation of evidence-based guidelines.- Sepsis is defined as 'life-threatening organ dysfunction due to a dysregulated host response to infection'. The Sequential Organ Failure Assessment (SOFA) score can be used to estimate organ dysfunction severity.- In this article, we discuss the new sepsis definitions - including reactions to these definitions, an overview of current insights in sepsis pathogenesis, and the new treatment guidelines.- Prevention of sepsis, faster pathogen detection, new lung and kidney function-preserving treatment strategies, further individualisation of patient care and attention to long-term consequences of sepsis will determine the research agenda for the coming years.

'Nutrothorax' due to misplacement of a nasogastric feeding tube.

we report a serious complication of blind nasogastric feeding tube insertion in a 65-year-old female patient, which was overlooked and caused severe respiratory failure.

[Severe pneumonia from psittacosis in a bird-keeper]. / Ernstige pneumonie door papegaaienziekte bij een vogelhouder.

A 67-year-old man was admitted due to severe pneumonia. Initially he was treated with beta-lactam antibiotics and oxygen. However, he developed respiratory failure and was transferred to the intensive-care unit for mechanical ventilation. He was a bird-keeper who collected many species of exotic birds, including parrots. The diagnosis psittacosis (parrot fever) was confirmed serologically and by PCR on bronchoalveolar lavage fluid. PCR techniques lead to rapid diagnosis which allows for early treatment. The initial treatment of atypical pneumonia with ciprofloxacin failed. After the patient was treated with doxycycline 200 mg i.v. his clinical condition improved and he was cured. The patient was discharged from intensive care after 10 days when acute respiratory-distress syndrome and pericarditis had resolved. Psittacosis is seen sporadically in the Netherlands. It may be encountered more frequently among patients who have had contact with birds and should be considered in the differential diagnosis of atypical pneumonia.

Relevance of non-nutritional calories in mechanically ventilated critically ill patients.

BACKGROUND/OBJECTIVES: Overfeeding in critically ill patients is associated with many complications. Propofol, dextrose infusion and citrate dialysis provide non-nutritional calories (NNCs), potentially causing overfeeding. The relevance of NNCs for total caloric intake has not been systematically studied. SUBJECTS/METHODS: We retrospectively studied adult mechanically ventilated intensive care unit (ICU) patients receiving enteral nutrition with or without supplemental parenteral nutrition. Primary outcome was the proportion of NNCs (from dextrose, propofol and trisodium citrate) to the total energy intake during the first 7 days after ICU admission. In addition, NNC intake groups were compared. RESULTS: In total, we identified 146 patients: 142 patients with NNC median value of 580 kcal (interquartile range 310-1043 kcal) over 7 days and 4 patients without NNC intake. The mean proportion of NNCs was larger during the first days after ICU admission (30.7-36.1%), because of the start-up phase of the nutrition. In the 'propofol' group and the 'dextrose' group this proportion levelled off at 6% on day 4. A more stable proportion of 18% was found during the first 7 days of ICU admission in the 'citrate' group. CONCLUSIONS: The mean proportion of NNCs in patients who receive dextrose and/or propofol is low (6%); however, in individual patients it may comprise one-third of the total daily calories. Patients receiving trisodium citrate have higher mean non-nutritional intakes (18%). As NNC intake can be marked in individual patients, close monitoring is warranted when administering high-dose propofol or trisodium citrate anticoagulation to prevent overfeeding.

Unexpected survival from severe metformin-associated lactic acidosis.

Lactic acidosis is a recognised complication of the antihyperglycaemic biguanide agent metformin, especially in patients with renal failure. We report a case of severe lactic acidosis and hypothermia due to metformin treatment and renal impairment. The favourable outcome despite extremely unfavourable clinical signs and symptoms for survival after admission and initial treatment was unexpected. Specific aspects of the clinical course are addressed.

[Admission and discharge criteria for intensive care departments]. / Criteria voor opname op en ontslag van intensive-careafdelingen.

Admission and discharge criteria for intensive care departments have been drawn up in order to optimise the use of scarce and costly intensive care facilities. Every patient who could benefit from admission must be assessed by the intensive care specialist beforehand. Admission is indicated for patients with disrupted vital functions in whom recovery of dysfunctioning or failing organ systems is expected, patients who will act as organ donors and patients who undergo diagnostic investigations associated with a high risk of vital complications. Frequent assessment (several times per day) of the 'indication to stay' is indicated in the case of many patients in order to maximise the admission capacity. Discharge from the intensive care department is indicated if the vital functions are stable without life support and no longer require monitoring or treatment, if nursing the patient in the ward is possible, if continuation of the medical treatment is no longer worthwhile, if the patient no longer consents to the treatment and if the benefit of a treatment no longer outweights its negative effects.