[Laboratory and calorimetric monitoring of medical nutrition therapy in intensive and intermediate care units : Second position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)].

This second position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provides recommendations on the laboratory monitoring of macro- and micronutrient intake as well as the use of indirect calorimetry in the context of medical nutrition therapy of critically ill adult patients. In addition, recommendations are given for disease-related or individual (level determination) substitution and (high-dose) pharmacotherapy of vitamins and trace elements.

[Assessment and technical monitoring of nutritional status of patients in intensive and intermediate care units : Position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI)].

At the time of admission to an intensive or intermediate care unit, assessment of the patients' nutritional status may have both prognostic and therapeutic relevance with regard to the planning of individualized medical nutrition therapy (MNT). MNT has definitely no priority in the initial treatment of a critically ill patient, but is often also neglected during the course of the disease. Especially with prolonged length of stay, there is an increasing risk of malnutrition with considerable prognostic macro- and/or micronutrient deficit.

[German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children-perioperative management].

Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications.

[Ultrasound-guided regional anesthesia: best practice upper extremities].

Regional anesthesia of the upper extremities is now part of the standard repertoire of a clinical anesthesiologist. Assigning the correct procedure to the individual needs of the patient is becoming increasingly more difficult due to the wide variety of options. The principle use of regional anesthesiological procedures is hardly ever questioned anymore but it needs to be carefully considered and must be adapted exactly to the case at hand.

How anesthetists manage growing demands with dwindling resources in German university hospitals: Overview and outlook.

As a central service provider in medical care, anesthetists manage the growing demand on medical services, thereby increasing specialization and patient morbidity. Various indicators and measurements have been used to match staff capacity, competence, and workload. It remains unclear whether the problems are due to real shortages or "just" to a wrong distribution.

Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex-preterm and full-term infants.

Background: Awake caudal anesthesia is a potentially attractive option, because the administration of general anesthesia is associated with a high rate of respiratory complications and hemodynamic disturbances and potential neurotoxic effects. To facilitate the caudal puncture and subsequent surgical intervention, additional sedatives are commonly administered.

Aim: We aimed to establish a new, safe, and effective anesthetic procedure for very young children with comorbidities.

[Are subspecialties and fellowship programs in German Anesthesia required?].

Rapid progress in medical science and technique offer new complex individual treatment modalities. Distinct profile qualifications like echocardiography, electroencephalography are required for anesthesia in high risk populations (cardiovascular, pediatric and neuro surgical patients) to guarantee best patient care and outcome. Accredited subspecialties and distinct fellowship programs are required to improve medical education, training and research.

[Patient blood management: Does the approach also make sense in children?].

Patient blood management describes an interdisciplinary concept which aims at rational and adequate use of blood products accompanied by strategies to prevent and treat anemia, to reduce blood loss and to use alternatives to blood transfusion. While patient blood management has been widely implemented in adult medicine, concepts for such measures in the care of children are rare. The basic principles of preoperative evaluation, optimization of blood volume, perioperative minimizing of blood loss and a differentiated use of blood products are effective both in adults and children.

Age- and procedure-specific differences of epidural analgesia in children--a database analysis.

Objective: Several audits demonstrated the safety of epidural catheters in children undergoing surgery. Within the present data analysis, we investigated whether older compared with younger children and children with specific types of surgical procedures might report higher pain scores.

Methods: All children (0-18 years) treated with an epidural catheter for postoperative pain treatment between March 2006 and December 2010 at the University Hospital of Muenster (Germany) were included.

Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target.

Background & Aims: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start.

Methods: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013.

Results: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary.

Glutamine in the ICU: who needs supply?

Many ICU patients are glutamine depleted and have low glutamine plasma concentrations. Beneficial effects by glutamine supply could be proven in these patients. In some medical conditions, especially those with acute right heart failure, elevated glutamine plasma concentrations are present and glutamine supply may be disastrous and a toxic burden.

Anesthetic management of children undergoing hematologic-oncologic procedures outside the operating room.

Purpose Of Review: There is an increasing demand on anesthetic services to provide care for children undergoing hematologic-oncologic procedures outside the operation room; in particular, to mitigate the pain and unpleasant side-effects of these treatments. This review provides an update of the latest findings on this topic.

Recent Findings: An Italian survey of the management of procedural pain in children undergoing hematologic-oncologic interventions indicates that international guidelines are still not completely realized.

[Applications of ultrasound in the intensive care unit].

Ultrasonography has developed as an indispensable and highly versatil tool in the diagnosis and treatment of critically ill patients. Nowadays intensive care medicine without the use of ultrasound is hard to imagine. The advantages of ultrasound are instantaneous availability at the bedside and high diagnostic output especially in life-threatening situations.

Amino acids - Guidelines on Parenteral Nutrition, Chapter 4.

Protein catabolism should be reduced and protein synthesis promoted with parenteral nutrion (PN). Amino acid (AA) solutions should always be infused with PN. Standard AA solutions are generally used, whereas specially adapted AA solutions may be required in certain conditions such as severe disorders of AA utilisation or in inborn errors of AA metabolism.

[Parenteral, enteral or combined parenteral and enteral nutrition].

Perioperatively early oral food intake is achieved in most cases. A temporary protein and energy deficit is rarely associated with increased complication rates. Concerning the route of nutritional support there is no difference in mortality but in complication rates.

Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients.

Objective: We assessed the effects of a novel lipid emulsion with reduced content of n-6 fatty acids (FA), increased share of MUFA and n-3 FA and supplemental vitamin E on fatty acid and leukotriene pattern in surgical patients.

Methods: In a double-blind, randomized study 33 patients received isonitrogenous, isocaloric TPN over 5 postoperative days following major abdominal surgery. 19 patients received the new SMOFlipid 20% and 14 patients a standard soybean oil emulsion (Lipovenoes 20%, both Fresenius Kabi), each 1.

Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients.

Objective: Glutamine is recognized as a conditionally indispensable amino acid. The purpose of the current study was to investigate whether supplemental l-alanyl-l-glutamine to parenteral nutrition can alter clinical outcome in intensive care unit patients.

Design: Prospective, open, randomized trial.

Stability of a sufentanil-ropivacaine mixture in a glass and a PVC reservoir.

Background And Objective: Drug mixtures containing sufentanil may be unstable owing to absorption into the drug reservoirs of patient-controlled epidural analgesia systems that contain polyvinylchloride. The stability of sufentanil in a mixture of ropivacaine 0.2% in a 750 mL reservoir was therefore investigated.

Sedation assessment in critically ill patients with bispectral index.

Background And Objective: Clinical sedation assessment becomes insufficient in deeply sedated patients. Bispectral index as a processed electroencephalogram parameter provides a continuous and observer-independent value reported to change with sedation. The aim of this prospective observational study was to determine the reliability and possible confounding factors of the bispectral index to assess sedation in surgical intensive care patients.

Multimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery.

We sought in this prospective study to use a multimodal approach to reduce stress and improve recovery in patients undergoing major surgery. During an initial study period, 30 patients were randomly allocated to receive general anesthesia (GA; Group 1) or a combination of GA and intraoperative thoracic epidural analgesia (TEA; Group 2) when undergoing radical cystectomy. Parenteral nutrition was provided for 5 days after surgery.

Alanyl-glutamine dipeptide does not affect hemodynamics despite a greater increase in myocardial heat shock protein 72 immunoreactivity in endotoxemic sheep.

The possible beneficial effect of supplemental glutamine (Gln) in critically ill patients has been suggested to be mediated by the induction of the cytoprotective heat shock proteins (HSP)32 and HSP72. There is evidence that HSP72 and HSP32 have opposite effects on the hemodynamic situation during endotoxemia. Therefore, the effect of Gln supplementation on the cardiovascular system is not clear.

Minimal flow sevoflurane and isoflurane anaesthesia and impact on renal function.

Background And Aim: Compound A generation and accumulation in sevoflurane anaesthesia is dependent on fresh gas flow. We investigated the extent of generation of compound A.

Methods: After Institutional Review Board approval and informed consent, patients with normal renal function were randomized to receive either sevoflurane (n = 33) or isoflurane (n = 43) minimal flow anaesthesia (0.

Cost containment through L-alanyl-L-glutamine supplemented total parenteral nutrition after major abdominal surgery: a prospective randomized double-blind controlled study.

Background & Aims: Glutamine is recognized as a conditionally essential amino acid. Recent studies indicate that glutamine-containing total parenteral nutrition improves nitrogen economy, enhances gastrointestinal and immune functions and shortens hospital stay.

Methods: Thirty-seven patients (19 w and 18 m; age 61.