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A Systematic Review Identifies Risk Factors for Malnutrition in Critically Ill Patients

A systematic review and meta-analysis published in Journal of International Medical Research aimed to identify the risk of malnutrition in critically ill patients at an early stage and propose targeted preventive measures. Ten studies were included for meta-analysis. The results of the meta-analysis indicated that anemia (OR 1.48; 95% CI, 1.23-1.78), parenteral nutrition (OR 4.93; 95% CI, 2.69-9.03), enteral nutrition (OR 3.2; 95% CI, 1.04-9.83), and advanced age (OR 1.24; 95% CI, 1.01-1.51) were key risk factors for malnutrition in critically ill patients. The conclusion was that particular attention should be paid to monitoring and correcting anemia in critically ill patients, optimizing nutritional support plans, and conducting continuous nutritional screening and assessment to reduce the incidence of malnutrition and improve prognosis.

Procalcitonin-Guided Antibiotic Discontinuation May Be Effective for Critically Ill Patients With Sepsis

A rapid systematic review and meta-analysis published in Anaesthesia assessed the effectiveness and safety of using procalcitonin- or C-reactive protein-guided protocols for antibiotic discontinuation in patients who are critically ill with sepsis. A meta-analysis of 19 trials comprising 6382 patients demonstrated that procalcitonin-guided protocols probably reduced antibiotic therapy by 2.0 days (95%CI, -2.6 to -1.4) compared with standard care. A meta-analysis of 18 trials comprising 6228 patients with moderate certainty evidence demonstrated a 5% reduction in mortality risk when using procalcitonin-guided protocols compared with standard care (RR 0.95; 95% CI, 0.83-1.07); however, the certainty of evidence was low. The findings suggest the potential importance of utilizing procalcitonin to inform antimicrobial discontinuation in critical care settings.

Automated Closed-Loop Ventilation Did Not Increase Ventilator-Free Days in ICU Patients Compared to Conventional Ventilation

An RCT published in JAMA aimed to determine whether early initiation of automated closed-loop ventilation increases ventilator-free days by day 28 compared with protocolized conventional ventilation. Among 1514 randomized patients, 1201 (79%) were included in the modified intention-to-treat analysis. The median ventilator-free days by day 28 was 16.7 days (IQR, 0.0-26.1) in the closed-loop ventilation group and 16.3 days (IQR, 0.0-26.5) in the conventional ventilation group (OR 0.91; 95% CI, 0.77-1.06; P = .23). There were no differences between groups regarding duration of ventilation in survivors and 28-day mortality.

Multiple Factors Influence Chronic Pain After Critical Illness

A systematic review and meta-analysis published in Nursing in Critical Care evaluated the incidence and risk factors of chronic pain after critical illness. A total of 20 studies involving 4726 patients from 11 different countries were included. The results of the meta-analysis showed that the incidence of chronic pain after critical care illness at 3 months was 47.0% (95% CI, 41.4-52.6), at 6 months was 29.4% (95% CI, 18.9-41.0), and at 12 months was 30.9% (95% CI, 16.9-46.9). Depressive symptoms (OR 2.64; 95% CI, 1.67-4.18, P < 0.001), female (OR 1.82; 95% CI, 1.51-2.19, P < 0.001), ICU length of stay (OR 1.31; 95% CI, 1.09-1.57, P = 0.005), and APACHE II score (OR 1.13; 95% CI, 1.08-1.18, P < 0.001) were risk factors for chronic pain after critical care illness. In all, 27 related factors were identified. 

Liberal Glucose Control Is the Optimal Strategy for Most ICU Patients 

A network meta-analysis of RCTs published in Diabetes Research and Clinical Practice compared the efficacy and safety of 4 glucose control strategies: strict (≤110 mg/dL), intermediate strict (≤150 mg/dL), liberal (≤180 mg/dL), and very liberal (≤252 mg/dL) among critically ill adults in the ICU. The analysis included 63 trials comprising 31556 patients. No statistically significant differences in all-cause mortality were observed among strategies; however, liberal control ranked highest in reducing mortality (SUCRA 0.8720) and balanced safety. Significant heterogeneity existed in adverse events (I2 = 75.8%, P < 0.01), especially hypoglycemia risk. In surgical ICUs, strict control may be considered but requires watchful hypoglycemia monitoring.

Omega-3 Fatty Acid Supplementation May Be Effective in Modulating Hyperinflammatory Responses in Critically Ill Patients

A meta-analysis published in Intensive and Critical Care Nursing explored the effects of omega-3 fatty acids on hyperinflammatory response and clinical outcomes in critically ill patients. The analysis included 41 RCTs comprising 3152 patients. Omega-3 fatty acids significantly reduced the following biomarkers: WBC count on day 3 and day 6/7, TNF-α on day 3 and day 5, IL-1, IL-6, and procalcitonin at the last observation post-intervention. The intervention also reduced the SOFA score on day 5 and lowered the risk of secondary infections and new sepsis/septic shock. It also significantly shortened the ICU stay and reduced the 28-day mortality rate, although ICU mortality rate remained unchanged. Omega-3 fatty acids may serve as a potential nutritional therapy for critically ill patients.

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