Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial.

While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the intensive care unit (ICU) stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesise that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the ICU.

[Ethical implications in the therapeutic management of dehydrated patients at the end of life].

Background: The ethical framework for fluid management in the palliative care setting can vary.

Objectives: What are the relevant ethical implications related to dehydration during end-of-life care and what are the special requirements we need to consider as far as "terminal dehydration" is concerned?

Materials And Methods: A comprehensive literature search was conducted to identify relevant articles published in English and German.

Results: Our inferences represent an attitude rather than an evidence-based position-a fact that is due to the underlying normative and ethical references which are hardly amenable to statistical evaluation.

[Legal considerations in the care of patients with "terminal dehydration" in Germany].

Background: The legal framework for fluid management in the palliative care setting varies between continents and even between countries.

Objectives: What legal implications must be taken into account in Germany in dealing with "terminal" dehydration?

Materials And Methods: Relevant publications in English and German have been identified. Notably, German recommendations and guidelines were reviewed, whereas national mindsets were contrasted with those of other countries like the United Kingdom and Canada.

["Terminal" dehydration : Differential diagnosis and body of evidence].

Dehydration in palliative care patients can be associated with increased morbidity and mortality and is nevertheless therapeutically controversial. This article provides an overview of possible causes of dehydration at the end of life and places special emphasis on "terminal" dehydration in the dying. Empirical attitudes of healthcare professionals and persons concerned (patients and relatives) as well as evidence-based findings on "terminal" dehydration are elucidated and the limitations are described.

How to manage terminal dehydration.

Although dehydration is a serious condition associated with significant morbidity and mortality in palliative care patients, as in any other patient group, treatment remains controversial. A narrative review of the causes of dehydration during end of life was conducted paying special attention to the nature of terminal dehydration. A comprehensive search of the literature was performed to identify relevant articles published in English and German languages between 1960 and 2018.