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  1. Article ; Online: Hope will never be silent: standing tall with the LGBTQ + community.

    Flower, Luke / Kamaruddin, Kamilla

    Intensive care medicine

    2023  Volume 50, Issue 1, Page(s) 150–151

    Language English
    Publishing date 2023-12-14
    Publishing country United States
    Document type Editorial
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07281-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1089: Show issues Location:
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  2. Article: The care of transgender patients in critical care: A call to action.

    Flower, Luke / Humphreys, Alice / Edwardson, Stuart

    Journal of the Intensive Care Society

    2023  Volume 24, Issue 3, Page(s) 245–246

    Language English
    Publishing date 2023-02-18
    Publishing country England
    Document type Editorial
    ZDB-ID 2701626-2
    ISSN 1751-1437 ; 1751-1437
    ISSN (online) 1751-1437
    ISSN 1751-1437
    DOI 10.1177/17511437221147476
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: The perioperative management of transgender patients: a knowledge gap we can no longer ignore.

    Flower, Luke / Kamarrudin, Kamilla / Lennie, Yasmin / Edwardson, Stuart

    British journal of hospital medicine (London, England : 2005)

    2022  Volume 83, Issue 9, Page(s) 1–6

    Abstract: Recent years have seen an increase in the number of people openly identifying as transgender in the UK, with current estimates ranging between 200 000 and 600 000 individuals. There has also been an increase in the number of patients undergoing both ... ...

    Abstract Recent years have seen an increase in the number of people openly identifying as transgender in the UK, with current estimates ranging between 200 000 and 600 000 individuals. There has also been an increase in the number of patients undergoing both medical and surgical gender-affirming treatment. There are several important, specific considerations that perioperative clinicians must be aware of when caring for transgender patients, including changes to the airway, potential respiratory and cardiovascular complications, and the management of hormone therapy. Alongside this, important general considerations include the correct use of patient pronouns and ensuring patients are admitted to correctly gendered wards. Despite the need for these considerations, the perioperative management of transgender patients is not covered in the Royal College of Anaesthetists' curriculum; to date, no national guidelines exist on the subject. This article discusses some of the key, specific perioperative considerations relevant to transgender patients, and highlights the need for national guidelines and improved education on the subject.
    MeSH term(s) Curriculum ; Data Collection ; Hormones ; Humans ; Sexual and Gender Minorities ; Transgender Persons
    Chemical Substances Hormones
    Language English
    Publishing date 2022-09-28
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2022.0038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Management of hypoxaemia in the critically ill patient.

    Flower, Luke / Martin, Daniel

    British journal of hospital medicine (London, England : 2005)

    2020  Volume 81, Issue 1, Page(s) 1–10

    Abstract: Hypoxaemia is a common presentation in critically ill patients, with the potential for severe harm if not addressed appropriately. This review provides a framework to guide the management of any hypoxaemic patient, regardless of the clinical setting. Key ...

    Abstract Hypoxaemia is a common presentation in critically ill patients, with the potential for severe harm if not addressed appropriately. This review provides a framework to guide the management of any hypoxaemic patient, regardless of the clinical setting. Key steps in managing such patients include ascertaining the severity of hypoxaemia, the underlying diagnosis and implementing the most appropriate treatment. Oxygen therapy can be delivered by variable or fixed rate devices, and non-invasive ventilation; if patients deteriorate they may require tracheal intubation and mechanical ventilation. Early critical care team involvement is a key part of this pathway. Specialist treatments for severe hypoxaemia can only be undertaken on an intensive care unit and this field is developing rapidly as trial results become available. It is important that each new scenario is approached in a structured manner with an open diagnostic mind and a clear escalation plan.
    MeSH term(s) Critical Illness ; Critical Pathways ; Humans ; Hypoxia/physiopathology ; Hypoxia/therapy ; Inpatients ; Oxygen Inhalation Therapy ; Respiration, Artificial ; Respiratory Insufficiency/classification ; Respiratory Insufficiency/therapy
    Language English
    Publishing date 2020-01-31
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2019.0186
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Muscle wasting in the critically ill patient: how to minimise subsequent disability.

    Flower, Luke / Puthucheary, Zudin

    British journal of hospital medicine (London, England : 2005)

    2020  Volume 81, Issue 4, Page(s) 1–9

    Abstract: Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness ... ...

    Abstract Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2-3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.
    MeSH term(s) Critical Illness/epidemiology ; Dietary Proteins/administration & dosage ; Energy Intake/physiology ; Exercise ; Humans ; Muscle Proteins/metabolism ; Quality of Life ; Risk Factors ; Severity of Illness Index ; Wasting Syndrome/epidemiology ; Wasting Syndrome/mortality ; Wasting Syndrome/physiopathology ; Wasting Syndrome/prevention & control
    Chemical Substances Dietary Proteins ; Muscle Proteins
    Language English
    Publishing date 2020-04-14
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2020.0045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Management of acute aortic dissection in critical care.

    Flower, Luke / Arrowsmith, Joseph E / Bewley, Jeremy / Cook, Samantha / Cooper, Graham / Flower, Jake / Greco, Renata / Sadeque, Syed / Madhivathanan, Pradeep R

    Journal of the Intensive Care Society

    2023  Volume 24, Issue 4, Page(s) 409–418

    Abstract: Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the ... ...

    Abstract Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.
    Language English
    Publishing date 2023-03-29
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2701626-2
    ISSN 1751-1437 ; 1751-1437
    ISSN (online) 1751-1437
    ISSN 1751-1437
    DOI 10.1177/17511437231162219
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT).

    Flower, Luke / Bares, Zdenek / Santiapillai, Georgina / Harris, Stephen

    BMJ case reports

    2021  Volume 14, Issue 9

    Abstract: A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24× ... ...

    Abstract A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×10
    MeSH term(s) Adult ; COVID-19 ; COVID-19 Vaccines ; Electrocardiography ; Humans ; Male ; Myocardial Infarction ; Purpura, Thrombocytopenic, Idiopathic/chemically induced ; Purpura, Thrombocytopenic, Idiopathic/drug therapy ; SARS-CoV-2 ; ST Elevation Myocardial Infarction/etiology ; Thrombocytopenia ; Thrombosis ; Vaccines
    Chemical Substances COVID-19 Vaccines ; Vaccines ; ChAdOx1 COVID-19 vaccine (B5S3K2V0G8)
    Language English
    Publishing date 2021-09-27
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-245218
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Novel methods to identify and measure catabolism.

    Page, Alexandria / Flower, Luke / Prowle, John / Puthucheary, Zudin

    Current opinion in critical care

    2021  Volume 27, Issue 4, Page(s) 361–366

    Abstract: Purpose of review: Assess current potential catabolism-biomarkers to characterize patients developing prolonged critical illness.: Recent findings: A raised urea-to-creatinine ratio (UCR) during critical illness is negatively associated with muscle ... ...

    Abstract Purpose of review: Assess current potential catabolism-biomarkers to characterize patients developing prolonged critical illness.
    Recent findings: A raised urea-to-creatinine ratio (UCR) during critical illness is negatively associated with muscle mass with greater increases in UCR seen patients developing persistent critical illness. Similarly, sarcopenia index (a ratio of creatinine to cystatin-c concentrations) correlates well to muscle mass in intensive care populations. Elevated growth/differentiation factor-15 (GDF-15) has been inconsistently associated with muscle loss. Although GDF-15 was a poor marker of feeding tolerance, it has been associated with worse prognosis in intensive care.
    Summary: UCR is an available and clinically applicable biomarker of catabolism. Similarly, sarcopenia index can be used to assess muscle mass and indirectly measure catabolism based on readily available biochemical measurements. The utility of novel biomarkers, such as GDF-15 is less established.
    MeSH term(s) Biomarkers ; Creatinine ; Critical Illness ; Humans ; Prognosis ; Sarcopenia/diagnosis
    Chemical Substances Biomarkers ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2021-06-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000842
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 4999: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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  9. Article ; Online: Should nutrition therapy be modified to account for mitochondrial dysfunction in critical illness?

    Flower, Luke / Page, Alexandria / Puthucheary, Zudin

    JPEN. Journal of parenteral and enteral nutrition

    2021  Volume 45, Issue S2, Page(s) 60–65

    Abstract: Metabolic dysfunction, and its associated muscle atrophy, remains the most common complication of critical care. At the center of this is mitochondrial dysfunction, secondary to hypoxia and systemic inflammation. This leads to a bioenergetic crisis, with ...

    Abstract Metabolic dysfunction, and its associated muscle atrophy, remains the most common complication of critical care. At the center of this is mitochondrial dysfunction, secondary to hypoxia and systemic inflammation. This leads to a bioenergetic crisis, with decreased intramuscular adenosine triphosphate content and a reduction in the highly energy-dependent process of protein synthesis. Numerous methods have been studied to try and reduce these effects, with only limited success. Trials investigating the use of increased energy and protein administration have instead found a decrease in relative lean body mass and a potential increase in morbidity and mortality. Ketone bodies have been proposed as alternative substrates for metabolism in critical illness, with promising results seen in animal models. They are currently being investigated in critical care patients in the Alternative Substrates in the Critically Ill Subjects trial (ASICS). The evidence to date suggests that individualized feeding regimens may be key in the nutrition approach to critical illness. Consideration of individual patient factors will need to be combined with personalized protein content, total energy load received, and the timing of such feeds. This review covers mitochondrial dysfunction in critical illness, how it contributes to muscle wasting and the resultant morbidity and mortality, and the scientific basis of why current nutrition approaches to date have not been successful in negating this effect. These two factors underpin the need for consideration of alternative nutrition strategies in the critically ill patient.
    MeSH term(s) Animals ; Critical Care ; Critical Illness/therapy ; Humans ; Mitochondria ; Nutrition Therapy ; Nutritional Support
    Language English
    Publishing date 2021-06-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 800861-9
    ISSN 1941-2444 ; 0148-6071
    ISSN (online) 1941-2444
    ISSN 0148-6071
    DOI 10.1002/jpen.2190
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  10. Article ; Online: The value of subcostal echocardiographic assessment, and directions for future research.

    Sanfilippo, Filippo / La Via, Luigi / Flower, Luke / Madhivathanan, Pradeep / Astuto, Marinella

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2022  Volume 69, Issue 5, Page(s) 676–677

    MeSH term(s) Echocardiography ; Heart Ventricles/diagnostic imaging ; Humans ; Ventricular Function, Right
    Language English
    Publishing date 2022-02-22
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-022-02225-0
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    Zs.A 109: Show issues Location:
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