[Medical nutrition therapy in intensive care medicine : Summary of the updated DGEM guideline]. / Klinische Ernährung in der Intensivmedizin : Kurzvorstellung der aktualisierten DGEM-Leitlinie.

The course of a critical illness is divided into several phases (early and late acute phase, post-acute phase) in which different metabolic processes take place. Accordingly, the medical nutrition therapy needs to be adapted to the patient's metabolic tolerance in each phase. When indicated, it should be started within 24 h. If oral administration is not possible, an enteral diet should be used. In individuals with contraindications, parenteral nutrition should be started. The target values for the diet of nonobese patients in the late acute phase are 24 kcal and 1.0 g protein (or 1.2 g amino acid) per kilogram bodyweight. The individual metabolic tolerance can be estimated based on the extent of insulin resistance and serum phosphate levels, and the nutrition therapy is adjusted accordingly.

[Speckle Tracking Echocardiography - a New Tool for the Intensive Care Unit?] / Speckle-Tracking-Echokardiografie ­ ein neues Tool für die Intensivstation?

The noninvasive evaluation of cardiac morphology and function by echocardiography is an essential part of modern intensive care therapy. However, this procedure can be challenging and beginners often lack the ability to objectively state the correct global and regional myocardial function. Recent developments allow a semi-automatic deformation (strain) analysis by a couple of more objective respective parametric techniques. Strain describes the change in length of a myocardial segment during the cardiac cycle. While this is primarily a regional analysis, an insight into the global left ventricular deformation is possible by averaging all relevant segments. Speckle tracking echocardiography (STE) is actually the only clinically relevant technique and is well scientifically and clinically approved. The advantages of STE are the angle-independency, the ease and fastness of its use, the availability at the bedside and low costs. Through proven good reproducibility it should be a good method for repeated analysis even by different echocardiographers. However, actually the greatest disadvantage is the variation of measures between different vendors of ultrasound machines and software-packages. At the moment, a task force of leading echocardiography experts and industry personal is working on a solution. Normal values have been published for healthy collectives and STE has been in use in the majority of cardiac diseases. Besides from a few research studies, the usage in critically ill patients actually is still limited.

Evaluation of longitudinal and radial left ventricular function by two-dimensional speckle-tracking echocardiography in a large cohort of normal probands.

Speckle tracking echocardiography (STE) is a novel tool to analyze left ventricular (LV) deformation in standard grey-scale images. The aim of our study was to characterize global and regional LV function by STE in a large cohort of healthy adult probands across a wide range of age. 144 healthy individuals (71 men, 73 women; mean age 42 ± 14 years, range: 17-80 years) who had undergone a standard echocardiographic examination were retrospectively investigated by STE. Longitudinal strain (LS) was measured in three apical views, and radial strain (RS) in a short-axis view at papillary muscle level. Averaged global LS was -20.6 ± 2.6%, and averaged RS 48.2 ± 13.8%. On a regional basis, LS showed an increase from base to apex (basal vs. mid vs. apical segments: -18.5 ± 2.7% vs. -19.9 ± 2.6% vs. -22.9 ± 4.5%; P < 0.001). RS increased with age (P < 0.05), while LS decreased in basal, and slightly increased in the apical segments. LS and RS decreased with body surface area and LV size (P < 0.05). In the longitudinal dimension about 38% of the segments showed some degree of systolic pre-stretching, with a higher likelihood in basal segments (P = 0.02 vs. mid and apical segments). In the radial dimension pre-stretching was even more frequent (60%). STE offers a simple and rapid method to measure regional myocardial deformation. Our results, based on a large cohort of normal probands covering a wide range of ages, may serve as reference for comparison with different disease entities.