Clinicians should have a heightened awareness of the risk for serum copper, carnitine, and vitamin B6 deficiencies among CRRT patients. The vast majority of CRRT patients presented with micronutrient deficiencies. A greater percentage of copper (p < 0.001) and carnitine (p < 0.001) deficiencies were found among patients exposed to CRRT, while more zinc deficiencies were noted among non-CRRT patients (p = 0.001). At least one micronutrient deficiency was reported in 90% of CRRT patients compared to 61% patients unexposed to CRRT (p = 0.002).
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Micronutrient deficiencies were defined as below the reference range and carnitine deficiencies were interpreted as an acyl to free carnitine ratio (ACFR) of >0.4.ġ06 ICU patients met inclusion criteria and 46% were exposed to CRRT. The study group consisted of patients at high malnutrition risk requiring intensive care unit (ICU) admission from - with one or more of the following serum micronutrient levels checked: carnitine, copper, zinc, selenium, and vitamins B1, B6, B9, and C. The aim of this study was to describe and compare the prevalence of micronutrient and carnitine deficiencies in critically ill patients at high malnutrition risk exposed to CRRT to a group of patient unexposed to CRRT.Ī retrospective chart review was conducted at Duke University Hospital using the electronic medical record. Current literature describes serum micronutrient values in CRRT patients to be below-reference range, yet seldom compares such values to other critically ill populations unexposed to CRRT. Unfortunately, large quantities of micronutrients are shown to be lost in CRRT effluent. (Funded by the Canadian Institutes of Health Research number, NCT00133978.).Continuous renal replacement therapy (CRRT) is essential to the management of acute kidney injury (AKI) in critical illness. There were no differences among the groups with respect to serious adverse events (P=0.83).Įarly provision of glutamine or antioxidants did not improve clinical outcomes, and glutamine was associated with an increase in mortality among critically ill patients with multiorgan failure. 28.8% with no antioxidants adjusted odds ratio, 1.09 95% CI, 0.86 to 1.40 P=0.48) or any other secondary end point. Antioxidants had no effect on 28-day mortality (30.8%, vs. Glutamine had no effect on rates of organ failure or infectious complications. In-hospital mortality and mortality at 6 months were significantly higher among those who received glutamine than among those who did not.
There was a trend toward increased mortality at 28 days among patients who received glutamine as compared with those who did not receive glutamine (32.4% vs. Because of the interim-analysis plan, a P value of less than 0.044 at the final analysis was considered to indicate statistical significance. The primary outcome was 28-day mortality. Supplements were started within 24 hours after admission to the ICU and were provided both intravenously and enterally. In this blinded 2-by-2 factorial trial, we randomly assigned 1223 critically ill adults in 40 intensive care units (ICUs) in Canada, the United States, and Europe who had multiorgan failure and were receiving mechanical ventilation to receive supplements of glutamine, antioxidants, both, or placebo. Glutamine and antioxidant supplementation may offer therapeutic benefit, although current data are conflicting.
Critically ill patients have considerable oxidative stress.
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