Critical care clinics
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Critical care clinics · Jul 2010
Parenteral nutrition in critical illness: can it safely improve outcomes?
Total parenteral nutrition was developed in the 1960s and has since been implemented commonly in the intensive care unit (ICU). Studies published in the 1980s and early 1990s indicate that the use of total parenteral nutrition is associated with increased mortality and infectious morbidity. These detrimental effects were related to hyperglycemia and overnutrition at a period when parenteral nutrition was not administered according to the all-in-one principle. ⋯ Thus, the time has come to reconsider the use of parenteral nutrition in the ICU. Supplemental parenteral nutrition could prevent onset of nutritional deficiencies when enteral nutrition is insufficient in meeting energy requirements. Clinical studies are warranted to show that the combination of parenteral and enteral nutrition could improve the clinical outcome of patients in the ICU.
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Critical care clinics · Jul 2010
Gastric residual volumes in critical illness: what do they really mean?
The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). ⋯ This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.
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Sepsis is among the most common causes of death in patients in intensive care units in North America and Europe. In the United States, it accounts for upwards of 250,000 deaths each year. Investigations into the pathobiology of sepsis have most recently focused on common cellular and subcellular processes. ⋯ What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive.