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- •Contents
- •Outcome Evaluation
- •Introduction
- •Clinical Presentation of Muscular Weakness in the Critical Patients
- •Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM)
- •Ventilator-Induced Diaphragmatic Dysfunction (VIDD)
- •Dysphagia, Swallowing, and Effective Cough
- •The Pathophysiology of Acute Skeletal Muscle Wasting
- •Risk Factors
- •Short-Term and Long-Term Outcome
- •Conclusions
- •References
- •Introduction
- •The Neuroendocrine Response
- •Pathophysiology of Stress Response
- •The Hypothalamus-Pituitary-Adrenal (HPA) Axis
- •GH Axis
- •Pituitary-Thyroid Axis
- •Pituitary-Adrenal Axis
- •Mitochondrial Dysfunction
- •Metabolic Aspects of Stress Response
- •Conclusion
- •References
- •Introduction
- •Disorders of Fluid Balance
- •Dysionemias
- •Dysnatremias
- •Dyskalemias
- •Other Electrolyte Derangements (Calcium, Magnesium, Phosphorus)
- •Alterations of Acid Base Balance
- •Acid-Base Disturbances
- •Metabolic Acidosis
- •Respiratory Acidosis
- •Metabolic Alkalosis
- •Respiratory Alkalosis
- •Conclusion
- •References
- •Introduction
- •Epidemiology and Risk Factors
- •Diagnosis
- •Differential Diagnosis
- •Treatment
- •Prognosis
- •Future Perspectives
- •References
- •Introduction
- •Gut Microbiome
- •Gut-Organ Axis
- •Gut-Lung Axis
- •ICU Dysbiosis
- •Gut Changes
- •Microbial Therapy in ICU
- •Antimicrobial Stewardship
- •Nutrition as a Key Factor for Gut Microbiome Homeostasis
- •Probiotics, Prebiotics, and Synbiotics
- •Fecal Microbiota Transplantation
- •Conclusion
- •References
- •Introduction
- •Validation Process
- •Screening Tools Overview
- •Discussion
- •Conclusion
- •References
- •Introduction
- •Fight-and-Flight Reaction
- •Calorimetry and Total Energy Expenditure
- •Role of Mitochondria in the Various Stages of Intensive Care Recovery
- •REE in Different Clinical Scenarios
- •Conclusions
- •References
- •Introduction
- •Nutrition in ICU: Evidence from RCTs
- •Inclusion of Too Many Patients Considered at Low Nutritional Risk
- •Unfavorable Energy to Protein Doses
- •Absence of Indirect Calorimetry-Guided Energy Dosing
- •Anabolic Resistance
- •Suppression of Fasting-Induced Recovery Pathways
- •Future Perspectives
- •Development and Validation of Tools to Guide Individualized Nutritional Support
- •Implications for Clinical Practice
- •Conclusion
- •References
- •Introduction
- •Protein Metabolism in Critical Illness
- •Protein Requirements and Current Evidence
- •Timing of Introduction
- •Early mobilization, Exercise, and Adjuvant Therapies
- •Conclusion
- •References
- •Introduction
- •Computed Tomography Scan
- •Bioelectrical Impedance Analysis
- •Musculoskeletal Ultrasound
- •Respiratory Muscle Ultrasound
- •Limb Muscles
- •Conclusions
- •References
- •Functional Principles
- •Hydration Status Evaluations in Critically Ill Patients
- •Body Composition and Nutrition in ICU
- •Limits of BIVA in Critically Ill Patients
- •Conclusions
- •References
- •Introduction
- •Introduction
- •Historical Perspective
- •Enteral Versus Parenteral Nutrition Nowadays
- •Conclusions
- •References
- •Enteral Nutrition
- •Components of Enteral Mixtures
- •Choice of the Enteral Mixture
- •Special Composition Formulas
- •Conclusions
- •References
- •Introduction
- •Complications Related to Enteral Feeding Tubes
- •Aspiration
- •Gastrointestinal Intolerance
- •Diarrhea
- •New Horizons
- •New Technologies to Prevent Enteral Nutrition Complications
- •Advanced Tube Feedings
- •smART Platform
- •Conclusions
- •References
- •Introduction
- •Composition of PN Admixtures
- •Energetic Substrates
- •Carbohydrates
- •Lipid Emulsions
- •Proteins
- •Micronutrients: Electrolytes, Vitamins, and Trace Elements
- •Types of Parenteral Nutrition
- •Compatibility and Stability of the Parenteral Nutrition
- •References
- •Introduction
- •Metabolic Complications
- •Hyperglycemia
- •Hypertriglyceridemia
- •Liver Disease: Steatosis, Cholestatic Disease, and Gallbladder Stones
- •Refeeding Syndrome
- •Mechanical Complications
- •Infectious Complications
- •Conclusions
- •References
- •Introduction
- •Macronutrients
- •Glutamine
- •Arginine
- •Leucine
- •ω-3 Fatty Acids
- •Micronutrients
- •Antioxidant Vitamins
- •Antioxidant Trace Elements
- •Probiotics, Prebiotics or Symbiotics
- •Use of Probiotics in Clinical Practice?
- •References
- •Introduction
- •Pathophysiological Mechanisms, Risk Factors, and Clinical Implications
- •Pathophysiological Mechanisms of ICUAW
- •Risk Factors Associated with Physical and Functional Recovery in Critically Ill Patients
- •Clinical Impact of Poor Physical and Functional Recovery in Critical Illnesses
- •How to Assess Physical and Functional Recovery in Critical Illnesses
- •Management and Therapies
- •Nutritional Therapy
- •Other Supportive Therapies
- •Patient- and Family-centered ICU Environment
- •Conclusions
- •References
- •Bioethics in Clinical Practices
- •Ethical Consideration on Nutrition
- •Conclusion
- •References
- •Introduction
- •Nutrition in ARDS
- •Caloric Goals
- •Diet Composition
- •Immunonutrition
- •Oral Versus Enteral Versus Parenteral Nutrition
- •Nutrition in COVID-19 Respiratory Failure
- •Nutrition in ECMO Support
- •Enteral Nutrition
- •Parenteral Nutrition
- •Nutritional Goals
- •Conclusions
- •References
- •Introduction
- •Timing and Route of Nutritional Support
- •Initial Assessment of the Burn Patient
- •Estimation of Energy Expenditure
- •Macronutrients and Micronutrients
- •Proteins
- •Carbohydrates
- •Immunonutrients
- •Arginine
- •Nucleotides
- •ω3 Fatty Acids
- •Glutamine
- •Monitoring of Nutritional Support
- •Nutritional Support for Trauma Patients
- •Route of Feeding: Digestive Tract (Enteral Nutrition) Versus Intravenous (Parenteral Nutrition)
- •Standard or Immune-Enhancing Enteral Nutrition
- •Estimation or Measurement of Energy Requirements
- •Macronutrients
- •Conclusions
- •References
- •Introduction
- •General Considerations
- •Assessment of Nutritional Needs
- •Metabolic Changes Induced by Sepsis, AKI, and CRRT
- •Protein Metabolism
- •Lipid Metabolism
- •Vitamins and Trace Elements
- •Phosphates
- •Approaches to Nutrition
- •Enteral
- •Parenteral
- •Timing
- •Recommendations
- •Conclusion
- •References
- •Introduction
- •Acute Liver Failure
- •Nutrition in ALF
- •Acute Pancreatitis
- •IAP Management
- •Conclusions
- •References
- •Introduction
- •Nutritional Considerations in Major Surgery
- •Nutritional Requirements During and After Major Surgery
- •Challenges in Meeting Nutritional Needs Post-Surgery
- •Strategies for Enhancing Nutritional Intake and Absorption
- •Intestinal Failure: Nutritional Challenges and Management
- •Impact of Intestinal Failure on Nutritional Status
- •Nutritional Management Strategies for Patients with Intestinal Failure
- •Role of Parenteral Nutrition and Enteral Nutrition in Intestinal Failure Cases
- •Open Abdomen: Nutritional Support and Wound Healing
- •Nutritional Requirements for Patients with Open Abdomen Wounds
- •Challenges in Providing Nutritional Support to Patients with Open Abdomen
- •Clinical Protocols and Guidelines for Nutritional Support
- •Conclusions
- •References
- •Introduction
- •Nutrition Therapy
- •Determination of Energy Expenditure
- •Route and Timing of Enteral Nutrition
- •Intolerance to Enteral Nutrition
- •Brain Energy Metabolism and Energy Dysfunction Following Acute Brain Injury
- •In Vivo Brain Energy and Glucose Monitoring
- •Alternative Energy Substrates
- •Lactate
- •Ketone Bodies
- •Immunonutrition and Micronutrients
- •Conclusions and Future Directions
- •References
- •Introduction
- •AKI and Cardiac Surgery
- •AKI and Vascular Surgery
- •AKI and Sepsis
- •AKI and Surgery
- •Trauma
- •Burn
- •AKI and COVID-19
- •Conclusion
- •References
- •Introduction
- •AKI Etiology
- •Subclinical AKI and AKI Biomarkers
- •Subphenotyping AKI
- •Conclusions
- •References
- •Introduction
- •What Are Biomarkers?
- •Novel Biomarkers: How Can They be Implemented?
- •Biomarkers for the Prediction of AKI and Detection of Subclinical Stages
- •Postoperative Biomarker-Guided Prevention of AKI in Patients at High Risk
- •Biomarkers for Other Indications
- •Conclusion
- •References
- •Introduction
- •The Machine Learning Arena
- •The Challenges of Timely Prediction of Acute Kidney Injury
- •Early Machine Learning Models for AKI Prediction
- •New Techniques for AKI Prediction Using Deep Learning ML Models
- •Clinical Decision Support Systems
- •The Translational Research Gap and the Value of Data Sharing: A Plea for Data Sharing
- •Limitations of Machine Learning Models
- •Conclusions
- •References
- •Introduction
- •Doppler Assesses Vascular Congestion
- •Arterial Renal Doppler Ultrasound in AKI
- •Integration of Renal Resistive Index and Intrarenal Venous Flow
- •Contrast-Enhanced Ultrasound for Assessing Renal Perfusion
- •Conclusions
- •References
- •Introduction
- •Renal Perfusion and Goals of Fluids in AKI
- •Clinical Evaluation of a Patient with AKI in ICU
- •Studies Which Investigated the Association of Fluid Therapy and AKI
- •Volume of Fluid
- •Type of Fluid
- •Crystalloids
- •Colloids
- •Starches
- •Gelatins
- •Conclusion
- •References
- •Introduction
- •Pathophysiology of Renal Perfusion
- •Acute Kidney Injury
- •Norepinephrine
- •Epinephrine
- •Dopamine
- •Vasopressin
- •Terlipressin
- •Angiotensin II
- •Conclusions
- •References
- •Introduction
- •Pharmacology of Diuretics
- •Loop Diuretics
- •Other Classes of Diuretics
- •Indications for Diuretics in AKI
- •Control of Fluid Overload
- •AKI Prognostication
- •Situations in Which Diuretics Are Not Indicated
- •AKI Recovery
- •How to Use Diuretics in the ICU
- •Class and Dose Selection
- •Modality of Loop Diuretic Administration
- •Conclusions
- •References
- •Introduction
- •What Is Acute Kidney Disease?
- •Clinical Course of AKD Within the ICU
- •Management of AKD in Critical Care and Beyond
- •Conclusions and Future Directions
- •References
- •Introduction
- •Renal Functional Reserve
- •Renal Functional Reserve and Renal Recovery After Acute Kidney Injury
- •Conclusion
- •References
- •Background
- •Membrane and Filter Characteristics
- •Geometric Characteristics
- •Performance Characteristics
- •Mechanisms of Fluid and Solute Transport
- •Treatment Modalities
- •Treatment Dose
- •Nomenclature of Renal Replacement Therapies
- •Continuous Therapies
- •Intermittent Therapies
- •Hybrid Therapies
- •Conclusion
- •References
- •Introduction
- •Dialysis Catheters: Technical Aspects
- •Selection of the Site for Dialysis
- •Catheter Insertion Technique
- •Dialysis Catheter Complications
- •Dialysis Catheter Maintenance
- •Conclusions
- •References
- •Introduction
- •Non-pharmacological Strategies to Reduce Membrane Fouling
- •Pharmacological Strategies to Reduce Membrane Clotting
- •Unfractionated Heparin (UFH) Systemic Anticoagulation
- •Systemic Anticoagulation with Low Molecular Weight Heparin (LMWH)
- •Regional Citrate Anticoagulation (RCA)
- •Systemic Anticoagulation with Direct Thrombin Antagonists
- •Nafamostat
- •Conclusions
- •References
- •Introduction
- •CRRT Dose/Outcome Studies: Consideration of Solute Kinetics
- •CRRT Dose as a Quality Criterion
- •CRRT Dose in the Context of Therapy Quality
- •Conclusions
- •References
- •Introduction
- •Patient Selection and Indications for Starting RRT
- •Strategies to Identify Need for RRT
- •Rationale for an Early Strategy to Starting RRT
- •Rationale for a Conservative Strategy to Starting RRT
- •RRT Replacement Therapy and Clinical Outcomes
- •Current Clinical Practice Guideline Recommendations
- •Clinical Trial Evidence on Timing of Starting RRT
- •Implications for Practice
- •Existing Knowledge Gaps and Future Research
- •Conclusions
- •References
- •Introduction
- •Early ICU Phase before KRT
- •Nutrition Care
- •Monitoring
- •ICU Phase with KRT
- •Gains and Losses During CRRT
- •Electrolyte Loss in CRRT
- •Macronutrient Loss in CRRT
- •Macronutrient Gain in CRRT
- •Micronutrients and Vitamin Loss in CRRT
- •Management of Losses During CRRT
- •Monitoring During CRRT
- •Indirect Calorimetry During CRRT
- •ICU Phase After CRRT
- •EN and PN Product Selection
- •Conclusions
- •References
- •Introduction
- •Nomenclature
- •Continuous Therapies
- •Intermittent Renal Replacement Therapies (IRRTs)
- •Hybrid Therapies
- •Technical Aspects of RRT Techniques
- •Hemodynamic Stability
- •Solute Clearance
- •Fluid Balance
- •Vascular Access
- •Anticoagulation
- •Drug Dosing
- •Patient Mobilization
- •The Process of RRT Prescription and Administration
- •Indications of RRT
- •Timing
- •Prescription Parameters
- •Dosing
- •Membrane Choice
- •Dialysate and Reinfusion Solutions
- •Limitations of RRT in Critical Care
- •Patient Safety During RRT in Critical Care
- •Introduction
- •Steps in RRT Management and Protocol Application

Nutrition,
Metabolism and
Kidney Support
ACritical Care Approach
AntonellaCotoia
SilviaDeRosa
FiorenzaFerrari
VincenzoPota
MicheleUmbrello
Editors
123

Nutrition, Metabolism and Kidney Support

Antonella Cotoia•Silvia De Rosa
•
Fiorenza Ferrari•Vincenzo Pota
Michele Umbrello
Editors
•
Nutrition, Metabolism
and Kidney Support
A Critical Care Approach

Editors
Antonella Cotoia
Anesthesia, Intensive Care and Pain
Medicine
University Hospital of Foggia
Foggia, Italy
Silvia De Rosa
Anesthesia and Intensive Care, Centre for
Medical Sciences
CISMed, University of Trento
Trento, Italy
Fiorenza Ferrari
Department of Anaesthesia, Critical
Care and Emergency
Foundation IRCCS Ca’ Granda
Ospedale Maggiore Policlinico
Vincenzo Pota
of
Dept.
Women, Child, General and Specialised
Surgery
University of Campania “Luigi Vanvitell”
NAPOLI, Italy
Milan, Italy
Michele U
Department o
mbrello
f Intensive Care and
Anaesthesia
ASST Ovest Milanese, Ospedale Civile
di Legnano
Milan, Italy
ISBN 978-3-031-66540-0
ISBN 978-3-031-66541-7 (eBook)
https://doi.org/10.1007/978-3-031-66541-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
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If disposing of this product, please recycle the paper.

Contents
Part I Metabolism During Critical Illness
1 Acute Skeletal Muscle Wasting During Critical Illness .. .. .. .. .. 3
Etrusca Brogi, Michele Umbrello, Sergio Lassola,
ancesco Forfori
and Fr
2 Endocrine Aspects of Acute and Prolonged Critical Illness .. .. .. . 17
Maria Giuseppina Annetta
3 Disorders of Fluid, Electrolytes, and Acid Base Balance .. .. .. .. . 27
Zaccaria Ricci, Luigi Diaferia, Giulio Iacopetti, and Filippo Pelagatti
4 Critical Illness Polyneuropathy and Myopathy ... ... ... .... ... 43
Nicola Nasuelli, Isabella Caterina Campini, Laura Godi,
and Davi
de Colombo
5 Gut Microbiome in the Critically Ill ...................... .. 51
Antonella Cotoia, Tecla Giuseppina Zimotti, and Denise Battaglini
6 Nutrition Risk Screening Tools . .. ... .. ... .. .. ... .. ... .. .. . 61
Giorgio Fullin
7 Dynamic Metabolic Changes Measured by Indirect Calorimetry . . 7
Marialaura Scarcella, Emidio Scarpellini, Riccardo Monti,
Ludovico Abenavoli
and
8 The Energy Intake: How Much, and at What Time? .. ......... . 83
Caroline Lauwers, Michael P. Casaer, and Jan Gunst
9 Protein Requirements: Refocusing on an Essential Nutrient ..... . 95
Emmanuel Pardo and Jean-Charles Preiser
10 Monitoring of Muscle Mass in Critically Ill Patients . ... .. ... ... 105
Michele Umbrello, Paolo Formenti, Etrusca Brogi,
and
Francesco Forfori
1
v

vi Contents
11 Bioelectrical Impedance Vector Analysis in Critically Ill Patients ... 119
Cristian Deana, Sara Samoni, and Rinaldo Bellomo
Part II Nutrition Support, Pharmaconutrition and Special
Considerations
12 Enteral and Parenteral Feeding: How to Choose the Route ....... 131
Andrea Pezzana, Michela Zanardi, Luca De Carli,
and Davide Colombo
13 Enteral Nutrition Overview and Formula Selection
Considerations .............. .............. ............ 137
Cinzia di Venosa
14 Complications Associated with Enteral Feeding ............... 149
Miriam Theilla, Orit Raphaeli, Eyal Robinson, and Pierre Singer
15 Parenteral Solutions Overview .. ... .... .... ... .... ... .... . 161
D. Berlana and E. Leiva Badosa
16 Complications Associated with Parenteral Nutrition . ... .. ... .. . 171
Luca D’Alessandro and Francesco Barbani
17 Pharmaconutrition in Critical Care ........... ............ .. 181
Antonella Cotoia, Paola Sara Mariotti, Andreas Edel,
and Stefan J. Schaller
18 Physical and Functional Recovery of Critically Ill Patients ...... . 193
Roberto Martinez-Alejos, Joan-Daniel Martì, Paolo Pelosi,
and Denise Battaglini
19 Ethical Considerations in Critical Care Nutrition . ... ... ... ... . 207
Giorgio Fullin, Eugenia Magnanimi, Michela Zardin,
and Andrej Michalsen
Part III Nutrition Requirements in Special Conditions
20 Nutrition in ARDS, COVID-19, and ECMO ... ... ... ... .. ... . 215
Lorenza Moretto, Michela Bombino, Luca Gianotti,
and Emanuele Rezoagli
21 Nutrition in Trauma and Burns ................... ........ 229
Carmine Iacovazzo, Silvia Paganini, and Michela Rauseo
22 Nutrition in Sepsis, AKI, and CRRT .. ..... ..... ...... ..... . 247
Vedran Premuzic and Armin Atic
23 Nutrition in Acute Liver Failure and Severe Acute Pancreatitis . . . 259
Katia Donadell
o, Beatrice Milan, Giulia D’Agostini, and Enrico Polati

Contents vii
24 Nutrition in Major Surgery, Intestinal Failure, and Open
Abdomen ..... ...... ..... ...... ..... ..... ...... ..... .. 279
Lucia Cattin, Francesco Cundari, Silvia De Rosa,
and Fr
ancesco Corradi
25 Nutrition in Neurocritical Care ... ......................... 293
Sandra Magnoni, Marina Munari, Adriano Bernini, and Chiara Robba
Part IV Acute Kidney Injury
26 Global Epidemiology and Outcomes of Acute Kidney Injury .... . 30
7
Vincenzo Pota and Max Bell
27 Defi
nition, Staging Criteria of Acute Kidney Injury, and
Controversies . ..... .... ..... ..... ..... ..... ..... ..... . 319
Marisa Palmieri and Marco Fiorentino
28 Biomarkers for Acute Kidney Injury .. .... ..... .... .... .... . 329
Thilo von Groote, Lisa Loomann, Christian Strauß,
and Al
exander Zarbock
29 Prediction and Machine Learning Models for Early Prediction
of AKI ......................... ...................... 341
Massimiliano Greco, Ilesa Bose, and Giovanni Angelotti
30 Ultrasound in Acute Kidney Injury .. ... .. .. .. .. .. ... .. .. .. . 349
Gregorio Romero-González, Nicholas S. M. Bianchi Bosisio,
Sara Sa
moni, and Fioren za Ferrari
31 Management of AKI: Fluids .... ..... ..... ..... ..... ..... . 361
Gianluca Castellani, Marta Calatroni, and Antonio Messina
32 Management of AKI: Vasopressors ... .. .. .. ... .. .. .. .. ... .. 375
Paolo Persona and Tommaso Pettenuzzo
33 AKI Management: Diuretics ... .... ..... .... ..... ..... .... 389
Céline Monard and Antoine Schneider
34 Acute Kidney Disease ..... ...... ..... ...... ...... ...... . 399
G. Azzopardi and J. Prowle
35 Renal Functional Reserve and Renal Recovery After Acute Kidney
Injury ........... ........... ............ ........... .. 411
Gabriele Guglielmetti and Sara Samoni
Part V Renal Replacement Therapy
36 Nomenclature for Renal Replacement Therapy ...... .......... 421
Gianluca Villa and Dario Degl’Innocen
ti

viii Contents
37 Vascular Access for Renal Replacement Therapy ............ .. 429
Fabrizio Valente, Anna Lorenzin, and Giuliano Brunori
38 Anticoagulation Strategies in Continuous Renal Replacement
Therapy .... .... ..... .... .... ..... .... ..... .... ..... . 441
Antonio Fioccola and Gianluca Villa
39 Dose Prescription in Renal Replacement Therapy ....... ....... 453
William R. Clark, Danielle Soranno, Anna Lorenzin,
and Claudio Ronco
40 Indications and Timing of Renal Replacement Therapy ... ... .. . 461
Sean M. Bagshaw and Ron Wald
41 Nutrition in ICU Patients with Acute Kidney Injury .. .. .. .. .. .. 481
Michael Hiesmayr and Arabella Fischer
42 Overview, Technical Aspects, and Safety of RRT Modalities in
Critical Care . .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... . 493
Federico Nalesso, Martina Cacciapuoti, Marco Bogo,
and Marco D’Ascoli
43 Drug
Dosing Considerations in Continuous Renal Replacement
Therapy .... .... ..... .... .... ..... .... ..... .... ..... . 521
Fiorenza Ferrari, Gaetano Florio, Vincenzo Pota, and Silvia De Rosa
44 Weaning and Discontinuation of Renal Replacement Therapy ... . 53
5
Ilaria Godi and Thomas Rimmelé
45 Com
plications and Troubleshooting During Continuous Renal
Replacement Therapy ........... ...................... .. 547
Silvia De Ros a, Sara Miori, Andrea Sanna, Patrick Marchelli,
and Rinaldo
Bellomo
Part VI Extracorporeal Organ Support in Critical Illness
46 Extracorporeal Blood Purification for Immunomodulatory or
Hybrid Support in Sepsis .. ... .. ... .. .. ... .. ... .. .. ... .. . 567
Silvia De Ros a, Gianluca Villa, Fiorenza Ferrari, Rocco Pace,
and Ricard
Ferrer
47 Extracorporeal Blood Purification for Acute Poisoning .. .. ... ... 585
Francesca Bagagli, Marco Fiorentino, and Fiorenza Ferrari
48 Renal Replacement Therapy Combined with Artificial or
Bioartifi
cial Liver Support System .. .. .. ... .. .. .. ... .. .. ... 595
Federico Nalesso, Elisabetta Bettin, Marco Bogo,
Martina
Cacciapuoti, and Andrea Barbagallo

Contents ix
49 Low-Flow Extracorporeal CO2 Removal Managed with a Renal
Replacement Platform ... .... .... .... .... .... .... .... .... 611
Davide Colombo, Michele Battista, Gaetano Florio, Alberto Zanella,
Stefano Cusinato, and Francesco Alessandri
50 Continuous Renal Replacement Therapy During Extracorporeal
Membrane Oxygenation ... ....... ....... ....... ........ . 625
Silvia De Ros a, Kevin Roedl, Eleonora Balzani, Giacomo Bellani,
and Marlies Ostermann
Index . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639

Part I
Metabolism During Critical Illness
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