R D Griffiths

..A number of trials of patients fed by the enteral or parenteral route have shown improved infectious morbidity when supplemented with glutamine. However, the exact mechanism of glutamine action in these patients remains to be determined...

..Real outcome benefits have been described with the new glutamine containing PN formulations. PN remains important in the presence of gastrointestinal feed intolerance or failure...

..Long-term psychological problems are not insignificant and before we can assume benefit or harm of any new approach we must not delude ourselves by using sampling methods that can miss those patients most at risk...

..This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD...

..Despite the apparent importance of this problem, much remains to be understood about its incidence, causes, prevention, and treatment...

..Over-feeding presents a significant metabolic stress but tight glycaemic control is now masking the traditional warning signs and does not on its own negate the need to give patients the right amount at the right time...

..Through a personal narrative, the authors discuss the lessons they have learned from 20 years of intensive care follow-up and rehabilitation...

..Simple tools are now available to recognise such problems. This review highlights neuropsychiatric and cognitive observations that have direct relevance to patient care and outcome...

..This review attempts to dispel these myths and compares and contrasts the risks of enteral nutrition with those of parenteral nutrition in the critically ill...

..How nutritional therapy can effect real clinical outcomes is not easily apparent from the clinical data. Despite reducing infectious incidence, many studies show little difference in meaningful clinical outcomes...

..A number of new clinical studies of glutamine supplementation have shown interesting outcomes that should be influencing clinical decision-making...

..We investigated the effect of a glutamine-supplemented parenteral nutrition on intensive-care-acquired infection (ICAI) and its relation to outcome...

..In the critically-ill it is associated with improvements in immune function, and improved survival from infection leading to an overall improved outcome...

..These changes occurred in the absence of overt damage to the muscle cells...

..This study suggests that even relatively unpleasant memories for real events during critical illness may give some protection from anxiety and the later development of PTSD-related symptoms when memories of delusions are prominent...

..At the 6-month follow-up, previous smokers given the rehabilitation package had a relative risk reduction for smoking of 89% (CI 98%-36%). Smoking cessation after critical illness is aided by the provision of a rehabilitation programme...

..The aim of the study was to conduct a preliminary validation of such a measure, the UK- Post-Traumatic Stress Syndrome 14-Questions Inventory (UK-PTSS-14)...

..However, the benefit of exogenous glutamine on morbidity and mortality is not universally accepted. This review critically appraises the current clinical evidence regarding glutamine supplementation in critical illness...

..The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient...

..Recent studies have shown significant cognitive problems some months after critical illness. However there has been no research examining cognitive function within the intensive care unit (ICU) in non-delirious patients...

..Encouraging new evidence is starting to show that outcome can be improved by implementing relatively simple therapies well that have an impact on nutrition and metabolic control...

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..The aim of the present study was to therefore investigate the role of increased muscle and core temperature in contributing to the exercise-induced production of the major HSP families in human skeletal muscle...

..Skeletal muscle is a major contributor to whole-body glucose and protein metabolism, exemplified by its role in nutrient provision for the immune system and other rapidly dividing tissues through glutamine production...

..However, in those patients recalling delusional memories from the ICU, further psychological care may be needed to reduce the incidence of anxiety and PTSD-related symptoms...

..To examine current research on the psychological needs of both patients and their families following critical illness, and discuss how these may be met in a cost-effective manner...

..To evaluate the effectiveness of the provision of information in the form of a rehabilitation program following critical illness in reducing psychological distress in the patients' close family...

..This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices...

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..Older adults (> 70) were also more susceptible to this effect. CONCLUSIONS: Contextual variables such as current media events can have a significant impact upon the contents of hallucinatory experiences...