Argon and Subarachnoid Hemorrhage.
Argon and Subarachnoid Hemorrhage.
复制标题
氩气和蛛网膜下腔出血。
作者：
Anwen Shao;Jianmin Zhang
e1008 www.ccmjournal.org 2016年10月·第44卷·第10号评估，近期生长史，体格检查和其他标志物。不幸的是，这些方法需要大量的资源和时间，而这些资源和时间往往是有限的。此外，包含这些元素的复合筛查工具可用于住院儿童，但其临床应用最近受到质疑，并且尚未在PICU人群中得到验证（2）。BMI的局限性众所周知。由于PICU中的一些患者的液体转移和危重疾病，体重和身高测量仍然具有挑战性。尽管存在这些挑战，人体测量评估现在被广泛认为是入院程序的重要组成部分，并有助于指导营养，液体，呼吸机和药物处方。在拥有营养支持者和足够培训的中心，这些测量可以在PICU的大多数患者中成功可靠地获得（3）。较高的BMI已被证明是儿童白血病生存率较差的风险因素（4）。我们的研究结果支持在PICU人群中使用BMI作为一种简单的筛查工具，以检测高危患者，这些患者应该成为更深入的营养评估的目标。我们不建议它应该取代入院时和PICU住院期间的详细营养评估。前瞻性研究设计允许高比例的招募患者在入院时测量体重和身高。没有像科隆博等人（1）在其信函中错误建议的那样对数据进行插补。对于9%的体重测量和28%的身高测量，参与研究中心的床边提供者记录了入院时测量不可行时的最佳估计值。估计PICU中一小部分患者的体重和身高，特别是在疾病严重程度高的机械通气患者队列中，在PICU中并不罕见。尽管我们承认这些估计值可能不精确，但这些值是临床信息。为了证实与结果的相关性，我们对67%的队列（n = 1，093）进行了重复分析，测量了体重和身高，发现与文章中所述结果相似。我们承认BMI z评分来自健康人群。z评分是用于解释人体测量测量结果的推荐统计量，以便在受试者和参考值之间进行适当比较。人体测量只是营养评估的一个组成部分，需要对所有可用的患者数据进行个性化评估，以告知喂养决策。我们的研究结果强调了营养评估的重要性，解决了经常被忽视的人体测量学问题，并提供了一种简单可行的筛查方法，可应用于大多数PICU患者的入院检查。Bechard博士获得了雀巢营养公司的资助。她的机构得到了营养与饮食学会的资助。Mehta博士透露，他没有任何潜在的利益冲突。
e1008 www.ccmjournal.org October 2016 • Volume 44 • Number 10 assessment, recent growth history, physical examination, and other markers. Unfortunately, these methods require significant resources and time that are often limited. Furthermore, composite screening tools that incorporate some of these elements are available for hospitalized children, but their clinical application has recently been questioned and they have not been validated in the PICU population (2). The limitations of BMI are well known. Weight and height measurements remain challenging to obtain due to fluid shifts and critical illness in some patients in the PICU. Despite these challenges, anthropometric assessments are now widely recognized as an important part of admission procedures and help guide nutritional, fluid, ventilator, and pharmaceutical prescriptions. In centers with nutrition champions and adequate training, these measurements can be successfully and reliably obtained in a majority of patients in the PICU (3). Higher BMI has been shown to be a risk factor for poorer survival in pediatric leukemia (4). Our results support the use of BMI as a simple screening tool in the PICU population to detect at-risk patients who should be targeted for a more in-depth nutritional assessment. We do not propose that it should replace a detailed nutritional assessment at admission and during the PICU stay. The prospective study design allowed a high proportion of the recruited patients to have measured weights and heights at admission. No data were imputed as incorrectly suggested by Colombo et al (1) in their letter. For 9% of weight measurements and 28% of height measurements, bedside providers at participating sites recorded their best estimate for values when measurements were not feasible at admission. Estimating weight and height in a small fraction of patients in the PICU, especially in a cohort of mechanically ventilated patients with high severity of illness, is not uncommon practice in the PICU. Although we acknowledge the potential imprecision of these estimates, these values were clinically informed. To confirm the associations with outcomes, we repeated the analysis in the 67% of the cohort (n = 1,093) with measured weight and height, and found similar results to those presented in the article. We acknowledge that BMI z scores are derived from healthy populations. The z score is the recommended statistic for interpretation of anthropometry measurements for appropriate comparison between the subject and the reference value. Anthropometric measurements are just one component of a nutritional assessment, and individualized evaluations of all available patient data are needed to inform feeding decisions. Our results emphasize the importance of nutritional assessments, address anthropometry that is often ignored, and provide a simple and feasible screen that can be applied at admission in a majority of the patients in the PICU. Dr. Bechard received funding from Nestle Nutrition. Her institution received funding from Academy of nutrition and dietetics. Dr. Mehta has disclosed that he does not have any potential conflicts of interest.
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影响因子：
7.1
作者：
Orgel, Etan;Genkinger, Jeanine M.;Ladas, Elena J.
通讯作者：
Ladas, Elena J.
DOI：
10.1073/pnas.92.12.5510
发表时间：
1995-06-06
影响因子：
11.1
作者：
WANG, GL;JIANG, BH;SEMENZA, GL
通讯作者：
SEMENZA, GL
Argon：“惰性”气体的神经和有机保护特性的系统综述。
影响因子：
5.6
作者：
Höllig A;Schug A;Fahlenkamp AV;Rossaint R;Coburn M;Argon Organo-Protective Network (AON)
通讯作者：
Argon Organo-Protective Network (AON)
影响因子：
8.8
作者：
Hoellig, Anke;Weinandy, Agnieszka;Coburn, Mark
通讯作者：
Coburn, Mark