RESUMO
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.
Assuntos
Queimaduras/metabolismo , Queimaduras/terapia , Terapia Nutricional , Estado Terminal , HumanosRESUMO
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolyte metabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia, and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for the management of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic tools that allow to the ICU physician to recognize the population at high risk for developing the TLS, and outline a proper strategy for treating and preventing this serious complication.
Assuntos
Cuidados Críticos/métodos , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Alopurinol/uso terapêutico , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/prevenção & controle , Terapia por Quelação , Ensaios Clínicos como Assunto , Terapia Combinada , Hidratação , Humanos , Hiperpotassemia/tratamento farmacológico , Hiperpotassemia/etiologia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Incidência , Estudos Multicêntricos como Assunto , Prognóstico , Terapia de Substituição Renal , Fatores de Risco , Índice de Gravidade de Doença , Síndrome de Lise Tumoral/sangue , Síndrome de Lise Tumoral/epidemiologia , Síndrome de Lise Tumoral/prevenção & controle , Urato Oxidase/uso terapêuticoRESUMO
Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients.