Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Randomized Controlled Trial Comparative Study
Olive oil-based fat emulsion versus soy oil-based fat emulsion in abdominal oncologic surgery.
In parenteral nutrition (PN), essential fatty acids are provided by soy oil-based fat emulsions, which may exert adverse effects on the immune system and lipid peroxidation. Olive oil -based fat emulsions have been said to prevent these undesired effects. This study compares effects of olive oil - and soy oil -based fat emulsions in 22 patients who underwent abdominal surgery for cancer. ⋯ Second group had increases in alkaline phosphatase (85.80 ± 13.46 vs 147.20 ± 34.17), γ-glutamyl transferase (48.40 ± 12.86 vs 129.40 ± 42.03), total protein (5.14 ± 0.19 vs 6.06 ± 0.49), and albumin (2.62 ± 0.14 vs 3.00 ± 0.18) (P < .05). Changes in thiobutyric acid levels were not statistically significant in either group. In postoperative cancer patients, olive oil-based fat emulsion had similar effects on BMI, body temperature, biochemical values, and thiobutyric acid levels as soy oil-based fat emulsions.
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Review
Acute respiratory distress syndrome: use of specialized nutrients in pediatric patients and infants.
With a high rate of mortality, acute respiratory distress syndrome (ARDS) has limited treatments options. Immune-enhanced formulas, containing eicosapentaenoic acid, borage oil, and antioxidants, have shown to be beneficial in adults patients with ARDS, decreasing mortality, length of mechanical ventilation, and new organ dysfunction. There is promising research in pediatric patients with improvement in oxygenation status found, but further trials are needed to realize these benefits in pediatric and infant populations.
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Review
Nutrition support for the acute lung injury/adult respiratory distress syndrome patient: a review.
Support for Acute Lung Injury (ALI) and Adult Respiratory Distress Syndrome (ARDS) in many ways represents the summation of all intensive care unit nutrition modalities. Basic tenets of management are based on those established for the general population of mechanically ventilated patients. ⋯ Specific issues to be considered in this population include carbon dioxide production, prevention of aspiration, and modulation of the inflammatory response. These particular areas, with special attention paid to the role of lipids in ALI/ARDS, will be reviewed.
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Hyperglycemia commonly occurs in acutely ill patients who receive nutrition support, even in patients without a history of diabetes. The traditional view that stress hyperglycemia may be a beneficial adaptive response has been replaced by data linking hyperglycemia with increased morbidity and mortality in critically ill populations. ⋯ Review of the methods, protocols, and nutrition provided during these randomized studies is crucial to understanding the different conclusions reached and how these results may be used to influence protocols in intensive care units today. Evidence is reviewed and practical considerations are provided for nutrition support regimens to minimize stress hypoglycemia and assist glucose management.
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Despite considerable efforts to define energy requirements for critically ill patients, no single method has been found to be precise and unbiased for all patients. As a result, clinicians have used various methods that may overestimate energy requirements for some patients. Provision of target caloric intake without regard to the complications of overfeeding, such as hyperglycemia, hypercapnia, or gastric feeding intolerance, could result in overall detrimental clinical outcome. ⋯ A pivotal paper by Krishnan and colleagues published in 2003 brought these issues to the forefront of clinical practice. Key papers that support or refute the practice of "permissive underfeeding" are reviewed. Further research is necessary to determine the minimum amount of nutrition required to achieve a therapeutic benefit as well as to ascertain at what amount of additional nutrition intake offers no further improvement in clinical outcome.