The Abdomen in critical care Part IV
Part 4: Abdominal problems developing in ICU
Summary
Abdominal problems are common in critically ill patients, either as the primary indication for admission or, more commonly, as a reflection of underlying illness. The interaction between abdominal organs and critical illness are complex and can present in a variety of ways.
In order to manage abdominal problems effectively, a comprehensive initial diagnostic work up, together with an understanding of normal physiology and early assessment of disease severity (aetiological factors and predisposing conditions) is required. The following continuous monitoring in anticipation of complications is equally important. The present module is dedicated to the management of abdominal problems developing in the ICU.
Caveat: The evidence for clinical management of abdominal problems in critically ill patients is sparse. Many of the recommendations in this module are based on common sense or expert-opinion and, as such, the recommendations of this module should be interpreted with caution.
General Information
Enrolled trainees 1469
Open 15.07.2019
Available for ESICM members
Student effort 2
Last Updated March 8, 2024
Intended Learning Outcomes
After completing this module, the student should be able to:
- Identify the patient developing abdominal problems in ICU
- Apply supportive measures to avoid development of abdominal complications
- Promptly recognize the life-threatening conditions related to abdominal pathology and undertake respective management plan
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology.
- 2.2 Undertakes timely and appropriate investigations
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions.
- 3.7 Recognises and manages the patient with acute gastrointestinal failure.
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
The Abdomen in critical care Part III
Part 3: ICU patient admitted due to abdominal problems
Summary
Abdominal problems are common in critically ill patients, either as the primary indication for admission or, more commonly, as a reflection of underlying illness. The interaction between abdominal organs and critical illness are complex and can present in a variety of ways
In order to manage abdominal problems effectively, a comprehensive initial diagnostic work up, together with an understanding of normal physiology and early assessment of disease severity (aetiological factors and predisposing conditions) is required. This global approach should form the basis of patient management.
This is the third of four modules dedicated to abdominal problems in critically ill patients. Two key tasks are presented in this module
- The management of patients with abdominal emergencies
- The management of patients after elective abdominal surgery
Caveat: The evidence for clinical management of abdominal problems in critically ill patients is sparse. Many of the recommendations in this module are based on common sense or expert-opinion and, as such, the recommendations of this module should be interpreted with caution.
General Information
Enrolled trainees 1506
Open 15.07.2019
Available for ESICM members
Student effort 2
Last Updated March 8, 2024
Intended Learning Outcomes
After completing this module, the student should be able to:
- Identify the patient with abdominal pathology
- Apply structured approach in management of common abdominal emergencies
- Apply modern principles for postoperative care in elective abdominal surgery
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology.
- 2.2 Undertakes timely and appropriate investigations
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions.
- 3.7 Recognises and manages the patient with acute gastrointestinal failure.
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
The Abdomen in critical care Part II
Part 2: GI function, abdominal symptoms and acute gastrointestinal injury
Summary
Abdominal problems are common in critically ill patients, either as the primary indication for admission or, more commonly, as a reflection of underlying illness. The interaction between abdominal organs and critical illness are complex and can present in a variety of ways
In order to manage abdominal problems effectively, a comprehensive initial diagnostic work up, together with an understanding of normal physiology and early assessment of disease severity (aetiological factors and predisposing conditions) is required, followed by continuous monitoring in anticipation of complications. This global approach should form the basis of patient management.
This is second of four modules dedicated to abdominal problems in critically ill patients. Two key tasks are presented in this module
- Assessment of GI function in ICU patients and understanding common GI symptoms.
- Defining acute gastrointestinal injury: what is GI dysfunction and failure?
Caveat: The evidence for clinical management of abdominal problems in critically ill patients is sparse. Many of the recommendations in this module are based on common sense or expert-opinion and, as such, the recommendations of this module should be interpreted with caution.
General Information
Enrolled trainees 1586
Open 15.07.2019
Available for ESICM members
Student effort 2
Last Updated March 8, 2024
Intended Learning Outcomes
After completing this module, the student should be able to:
- Understand the importance of GI tract in multiorgan failure
- Apply structured assessment of GI function
- Recognize clinical symptoms indicating on GI dysfunction
- Apply structured approach in recognizing GI dysfunction and failure
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology.
- 2.2 Undertakes timely and appropriate investigations
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions.
- 3.7 Recognises and manages the patient with acute gastrointestinal failure.
- 4.9 Coordinates and provides nutritional assessment and support.
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
The Abdomen in critical care Part I
Part 1: Physiology
Summary
Abdominal problems are common in critically ill patients, either as the primary indication for admission or, more commonly, as a reflection of underlying illness. The interaction between abdominal organs and critical illness are complex and can present in a variety of ways.
In order to manage abdominal problems effectively, a comprehensive initial diagnostic work up, together with an understanding of normal physiology and early assessment of disease severity (aetiological factors and predisposing conditions) is required, followed by continuous monitoring in anticipation of complications. This global approach should form the basis of patient management.
This is first of four modules dedicated to abdominal problems in critically ill patients. The key objective of this module is to describe normal physiology of GI tract, and how this is affected by critical illness.
General Information
Enrolled trainees 1809
Open 15.07.2019
Available for ESICM members
Student effort 1
Last Updated March 8, 2024
Intended Learning Outcomes
After completing this module, the student should be able to:
- Describe functions of GI system
- Understand physiology of nutrient digestion and absorption
- Describe the anatomy of arteries supplying GI system
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology.
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Nutrition Part V
Part 5: Monitoring and Complications
Summary
Assessment and monitoring of nutritional support is mandatory in critically ill patients, to allow the prevention and early detection of complications.
General Information
Enrolled trainees 1384
Open 28.05.2019
Available for ESICM members
Student effort 3
Last Updated May 6, 2022
Intended Learning Outcomes
- Discuss controversies in glucose management in critically ill patients
- Outline complications of enteral and parenteral nutrition
- Describe refeeding syndrome including risk factors and prevention
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 1.4 Triages and prioritises patients appropriately, including timely admission to ICU
- 2.1 Obtains a history and performs an accurate clinical examination
- 2.2 Undertakes timely and appropriate investigations
- 2.8 Liaises with radiologists to organise and interpret clinical imaging
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 4.1 Prescribes drugs and therapies safely
- 4.2 Manages antimicrobial drug therapy
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
- 4.9 Co-ordinates and provides nutritional assessment and support
- 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
- 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Nutrition Part IV
Part 4: Parenteral Nutrition
Summary
In addition to the high prevalence of malnutrition in patients admitted to intensive care units, critical illness further increases the risk and severity of malnutrition. The breakdown of muscle proteins and lipolysis are undesired components of the stress response and cannot be inhibited during the acute phase of critical illness. If left uncontrolled, the long-term consequences include a high rate of disability, functional impairment, and healthcare-related costs. Appropriate provision of energy substrates, proteins and micronutrients (vitamins and trace elements) is required during the rehabilitation process, together with physical activity.
General Information
Enrolled trainees 1431
Open 28.05.2019
Available for ESICM members
Student effort 3
Last Updated May 6, 2022
Intended Learning Outcomes
- Describe the indications for parenteral nutrition
- Outline essentials of parenteral nutrition prescription
- Describe the advantages and disadvantages of parenteral nutrition
- Discuss when both methods of nutrition should be combined
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 2.2 Undertakes timely and appropriate investigations
- 2.8 Liaises with radiologists to organise and interpret clinical imaging
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 4.1 Prescribes drugs and therapies safely
- 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
- 4.9 Co-ordinates and provides nutritional assessment and support
- 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Nutrition Part III
Part 3: Enteral Nutritional
Summary
In addition to the high prevalence of malnutrition in patients admitted to intensive care units, critical illness further increases the risk and severity of malnutrition. The breakdown of muscle proteins and lipolysis are undesired components of the stress response and cannot be inhibited during the acute phase of critical illness. If left uncontrolled, the long-term consequences include a high rate of disability, functional impairment, and healthcare-related costs. Appropriate provision of energy substrates, proteins and micronutrients (vitamins and trace elements) is required during the rehabilitation process, together with physical activity. In addition, during the acute phase (3-7 days after injury), enteral nutrition support has an important trophic role for the gastrointestinal tract. Recent findings suggest that a high intake of macronutrients during the first 3-4 days may have detrimental effects due to metabolic overload and intestinal fragility. Guidelines have been recently worked out to translate the recent data into recommendations for clinical practice.
General Information
Enrolled trainees 1512
Open 28.05.2019
Available for ESICM members
Student effort 2
Last Updated May 6, 2022
Intended Learning Outcomes
After studying this module on Enteral Nutritional you should be able to:
- Describe the indications for enteral nutrition
- Outline essentials of enteral nutrition prescription
- Describe the advantages and disadvantages of enteral nutrition
- Describe indications and contra-indications for the percutaneous route
- Discuss the evidence for early enteral feeding
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 2.2 Undertakes timely and appropriate investigations
- 2.8 Liaises with radiologists to organise and interpret clinical imaging
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 4.1 Prescribes drugs and therapies safely
- 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
- 4.9 Co-ordinates and provides nutritional assessment and support
- 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
- 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
- 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Nutrition Part II
Part 2: Nutritional targets
Summary
The optimal energy and protein requirements of critically ill patients are difficult to define accurately. In addition, this approach is often complicated by hyperglycaemia, uraemia and fluid overload. For this reason, it is often best to refer to these as ‘targets’ rather than requirements.
General Information
Enrolled trainees 1564
Open 28.05.2019
Available for ESICM members
Student effort 3
Last Updated May 6, 2022
Intended Learning Outcomes
After studying this module on Nutritional targets you should be able to:
- Describe the advantages and disadvantages of indirect calorimetry and predictive equations for estimating energy targets
- Outline the target requirements of energy and proteins
- Outline the target requirements of micronutrients and electrolytes
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 2.2 Undertakes timely and appropriate investigations
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 4.1 Prescribes drugs and therapies safely
- 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
- 4.9 Co-ordinates and provides nutritional assessment and support
- 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
- 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
- 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Severe Acute Pancreatitis
Summary
Severe acute pancreatitis is an alarming condition, which presents many challenges for critical care staff. Although fluctuating due to environmental and diagnostic differences, the true incidence of acute pancreatitis is steadily increasing. Most countries in the Western world have reported a rise in the incidence over the last decades.
General Information
Enrolled trainees 2193
Open 05.07.2018
Available for ESICM members
Student effort 3
Last Updated August 8, 2023
Intended Learning Outcomes
After studying this module on Severe Acute Pancreatitis, you should be able to:
- Recognize clinical feature of acute pancreatitis
- Determine the severity and aetiological factors of acute pancreatitis
- Interpret test results in the work-up of acute pancreatitis
- Manage severe acute pancreatitis with appropriate use of supportive therapy for organ function, antibiotics and surgery.
- Identify and manage locoregional and systemic complications of acute pancreatitis.
- Feed the patient with acute pancreatitis. Determine the nutritional needs of patients with acute pancreatitis and the optimum mode of delivery.
Relevant competencies in CoBaTrICE
- 2.2 Undertakes timely and appropriate investigations
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins. Including the following Disorders: Respiratory, Cardiovascular, Neurological, Renal & Genito-Urinary, Gastrointenstinal, Haematological & Oncological, Infections, Metabolic, Endocrine
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Nutrition Part I
Part 1: Nutritional assessments
Summary
In addition to the high prevalence of malnutrition in patients admitted to intensive care units, critical illness further increases the risk and severity of malnutrition., The breakdown of muscle proteins and lipolysis are undesired components of the stress response and cannot be inhibited during the acute phase of critical illness. If left uncontrolled, the long-term consequences include a high rate of disability, functional impairment, and healthcare-related costs. Appropriate provision of energy substrates, proteins and micronutrients (vitamins and trace elements) is required during the rehabilitation process, together with physical activity. In addition, during the acute phase (3-7 days after injury), enteral nutrition support has an important trophic role for the gastrointestinal tract. Recent findings suggest that a high intake of macronutrients during the acute phase may have detrimental effects. Guidelines are currently being worked out to translate the recent data into recommendations for clinical practice.
General Information
Enrolled trainees 2072
Open 28.05.2019
Available for ESICM members
Student effort 3
Last Updated May 6, 2022
Intended Learning Outcomes
- Describe the metabolic response to critical illness
- Outline essentials of feeding during the different phase of critical illness
- Describe how to assess malnutrition in critically ill patients
- Outline the clinical markers for nutritional status and their limitations in clinical use.
- Outline the biochemical markers for nutritional status and their limitations in clinical use.
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 1.4 Triages and prioritises patients appropriately, including timely admission to ICU
- 2.1 Obtains a history and performs an accurate clinical examination
- 2.2 Undertakes timely and appropriate investigations
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.7 Recognises and manages the patient with acute gastrointestinal failure
- 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
- 4.9 Co-ordinates and provides nutritional assessment and support
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
- 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.