Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Randomized Controlled Trial Clinical Trial
The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients.
Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. ⋯ TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.
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Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. ⋯ Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity.
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Accurate determination of energy expenditure is essential in patients receiving nutritional support to meet metabolic needs. The purpose of this study was to assess and compare the energy expenditure as measured by indirect calorimetry (MEE) and estimated by 5 equations in the mechanically ventilated critically ill patients. Forty-six patients were divided into either enteral nutrition (EN) (n=l2), total parenteral nutrition (TPN) (n=16) or combined (EN plus TPN) (n=l8) groups. ⋯ Energy expenditure calculated by using Harris- Benedict, Kleiber and Liu equations times the estimated stress factor did not significantly different than the values of MEE in all groups. There were significant correlations (P<0.01) between MEE and patients' sex (r=-0.499), age (r=-0.402), height (r=0.533), knee height (r=0.431), current body weight (r=0.379), usual body weight (r=0.407), ideal body weight (r=0.466) and urinary urea nitrogen (r=0.383) in the pooled group. Results demonstrated that energy expenditure could be estimated in most critically ill patients by using Harris-Benedict, Kleiber and Liu equations if the estimated stress factor is in the reasonable value.
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Randomized Controlled Trial Clinical Trial
The local vascular tolerance to an intravenous infusion of a concentrated glutamine solution in ICU patients.
The beneficial effects of glutamine is well-documented in ICU patients. However, the documentation and control of enteral administration of glutamine is still insufficient. As an adjunct to enteral nutrition, a concentrated dipeptide solution may be given in a central venous line, but administration via a peripheral vein would be preferable. Therefore, we systematically evaluated local vascular tolerance following a concentrated dipeptide infusion in ICU-patients. ⋯ Administration of a glutamine-containing dipeptide concentrate (20%) by peripheral veins is safe in terms of local tolerance, if a strict protocol is adapted for this purpose is used.
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Randomized Controlled Trial Clinical Trial
Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.
Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies. ⋯ No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded. Vitamin supplementation may have slight but economically important benefit.