Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Parenteral nutrition-associated liver disease (PNALD) is a potentially fatal complication for children with intestinal failure. Fish oil-based lipid emulsions have shown promise for the treatment of PNALD but are not readily available. Six cases are presented in which cholestasis resolved after soybean lipid emulsion (SLE) was removed from parenteral nutrition (PN) and enteral fish oil was given. ⋯ Temporary elimination of SLE and supplementation with enteral fish oil improved cholestasis in PN-dependent infants. Further trials are needed to evaluate this management strategy.
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Critically ill patients who are subjected to high stress or with severe injury can rapidly break down their body protein and energy stores. Unless adequate nutrition is provided, malnutrition and protein wasting may occur, which can negatively affect patient outcome. Enteral nutrition (EN) is the mainstay of nutrition support therapy in patients with a functional gastrointestinal (GI) tract who cannot take adequate oral nutrition. ⋯ However, the ability to provide timely and adequate EN to critically ill patients is often hindered by GI motility disorders and complications associated with EN. This paper reviews the GI complications and intolerances associated with EN in critically ill patients and provides recommendations for their prevention and treatment. It also addresses the role of commonly used medications in the intensive care unit and their impact on GI motility and EN delivery.
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Gastrointestinal (GI) motility disturbances are common in critically ill patients. GI tract dysmotility has been linked to increased permeability of intestinal mucosa and bacterial translocation, contributing to systemic inflammatory response syndrome, sepsis, and multiple organ dysfunction syndrome. A key issue in providing nutrition to critically ill patients is intolerance of enteral feeding as a result of impaired GI motility. ⋯ The diagnosis of motility disturbances can be challenging to establish in critically ill patients. The available tests used for detection of abnormal motility have major limitations in the ICU setting. Recognition of the type and site of intestinal motility disorder is important to guide the therapy and improve the outcome.
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Sleep-disordered breathing (SDB) is a medical condition that has increasingly recognized adverse health effects. Obesity is the primary risk factor for the development of SDB and contributes to cardiovascular and metabolic abnormalities in this population. However, accumulating evidence suggests that SDB may be related to the development of these abnormalities independent of obesity. ⋯ One study demonstrated improvements in SDB severity using the weight-reducing medication sibutramine. In morbidly obese subjects, bariatric surgery effectively induces weight loss and improvement in SDB severity and symptoms, but long-term benefits remain uncertain. Large randomized trials are required to determine the utility of these strategies as long-term approaches to improving SDB and reducing associated complications.