Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Comparative Study
A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients.
Peripherally inserted central venous catheters (PICC) have become increasingly popular for medium to long-term parenteral nutrition (PN) but there is limited data on the complication rates in this sub-group. We aimed to compare the rates of complications associated with tunneled catheters (Broviac) and PICC in home PN (HPN) patients. ⋯ In HPN patients, overall complications were similar in both the PICC and the Broviac groups. However, the Broviac catheter could be associated with an increase in catheter infection.
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Adequate nutritional intake is essential during pediatric intensive care admission. We investigated whether achievement of energy intake goals at day 4 after admission and route of nutrition were associated with improved outcome. ⋯ Acute malnutrition was highly prevalent upon admission and at discharge. With our nutritional protocol we achieved high rates of (enteral) energy intake. A high percentage of our population received enteral energy above the target energy range. However, there was no association between the amount of energy intake or route of nutrition and clinical outcome.
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To evaluate the effect of nutrition therapy on protein turnover in critically ill patients isotopically labeled amino acids can be used. Here parallel measurements using (13)C-leucine and (2)H5-phenylalanine were performed to evaluate if one tracer was to be preferred. ⋯ Critically ill patients with multiple organ failure have an increased protein turnover. The findings in the healthy volunteers indicate that the use of the two different amino acid tracers in parallel in future studies should be considered.
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Accurate assessment of resting energy expenditure (REE) and metabolic state is essential to optimize nutrient intake in critically ill patients. We aimed to examine the accuracy of a simplified equation for predicting REE using carbon dioxide elimination (VCO2) values. ⋯ A simplified metabolic equation using VCO2 values was superior to the standard equation in estimating REE, and provided a reasonably accurate metabolic classification in mechanically ventilated children. In the absence of indirect calorimetry, bedside VCO2 monitoring could provide valuable continuous metabolic information to guide optimal nutrient intake.
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Preoperative oral carbohydrate (CHO) treatment is known to reduce postoperative insulin resistance, but the necessity of a preoperative evening dose is uncertain. We investigated the effect of single-dose CHO treatment two hours before surgery on postoperative insulin sensitivity. ⋯ Single-dose preoperative CHO treatment is sufficient to reduce postoperative insulin resistance, possibly due to the antilipolytic effects and antagonist properties of preoperative hyperinsulinemia on the suppressant actions of cortisol on carbohydrate oxidation.