RESUMO
This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, prospective randomized trials that might elucidate some o f these questions would probably be incompatible with good clinical practice. Nevertheless, nutritional support in critically-ill patients unable to voluntarily meet their own nutritional requirements is currently an unquestionable part of their treatment and care and is essential to the successful management of their illness.
Assuntos
Cuidados Críticos , Nutrição Enteral/normas , Nutrição Parenteral/normas , Sociedades Médicas/normas , Sociedades Científicas/normas , Cuidados Críticos/métodos , Estado Terminal/terapia , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Medicina Baseada em Evidências , Alimentos Formulados , Gastroparesia/fisiopatologia , Humanos , Desnutrição/prevenção & controle , Metanálise como Assunto , Nutrição Parenteral/métodos , Pneumonia Aspirativa/prevenção & controle , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha , Fatores de TempoRESUMO
This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, prospective randomized trials that might elucidate some o f these questions would probably be incompatible with good clinical practice. Nevertheless, nutritional support in critically-ill patients unable to voluntarily meet their own nutritional requirements is currently an unquestionable part of their treatment and care and is essential to the successful management of their illness.
Assuntos
Estado Terminal/terapia , Apoio Nutricional/métodos , Consenso , Cuidados Críticos/normas , Ingestão de Energia , Nutrição Enteral/métodos , Humanos , Nutrição Parenteral/métodos , Prognóstico , Estudos Prospectivos , Fatores de TempoRESUMO
Status epilepticus is a neurological emergency that requires prompt care. The diagnosis and treatment must be continuous from the first minutes to its resolution. The most frequent cause in epileptic patients is drug change or non-compliance and in the non-epileptic patients are cerebrovascular diseases, head trauma, drug toxicity and metabolic disturbances. Status epilepticus can be convulsive or non-convulsive and continuous electroencephalographic monitoring is useful for diagnosis and to evaluate response to treatment. Benzodiazepines and phenytoin or fosphenytoin are first-line and second-line therapy. There is no agreement on third and fourth line therapy: phenobarbital, valproate, levetiracetam, propofol, midazolam, barbiturates and others. The prognosis of status epilepticus is related to etiology, age, type and duration of the status. Thus, drug treatment for status epilepticus should be started without delay.
