Nutrition
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Comparative Study
A 10-year survey of nutritional support in a surgical ICU: 1986-1995.
Total parenteral nutrition (TPN) has long been considered the optimal nutrition technique in critically ill patients, but recently the use of enteral nutrition (EN) has increased. This study describes the evolution of the different nutritional support techniques in a surgical intensive care unit (ICU) in a university hospital, through (1) a global survey over 10 y assessing the evolution of the use of EN and TPN, and (2) a prospective study performed over 6 mo. Severity of illness and diagnostic categories were stable (n = 11,539 patients). ⋯ The frequency of nutritional support provided in general has increased to 40% of ICU treatment days. TPN has been largely overtaken by EN, with the risk of insufficient energy delivery, related to the difficulties of EN in the critically ill. These results reinforce the importance of continuous quality control by daily assessment of nutrient supply.
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Comparative Study
Effects of MCT/LCT and LCT emulsions on plasma lipids and nitrogen retention in streptozotocin-induced diabetic rats receiving total parenteral nutrition.
This study was designed to investigate the effects of emulsions containing medium-chain triacylglycerols (MCT) or long-chain triacylglycerols (LCT) on plasma lipids and nitrogen retention in diabetic rats receiving total parenteral nutrition (TPN). Diabetes was induced in rats by streptozotocin (STZ). Control and diabetic rats were divided into two TPN groups. ⋯ Plasma glucose and TG levels, however, remained higher in diabetic groups than in control groups. No difference in the concentrations of plasma TG, cholesterol, NEFA, beta-hydroxybutyrate or nitrogen retention were observed between the two diabetic groups. These results suggest that MCT/LCT infusion did not lead to hyperketonemia and hypercholesterolemia as compared with LCT infusion, and had no beneficial effect on nitrogen retention in rats with STZ-induced diabetes under the present experimental conditions.
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Sixty male Sprague-Dawley rats were randomized to receive parenteral nutrition (PN) only; PN plus continuous infusion of Escherichia coli 026:B6 lipopolysaccharide (PN + LPS) at 6 mg.kg-1.d-1; or PN plus LPS plus a continuous infusion of the alpha-adrenergic antagonist phentolamine (PN + LPS + PHEN) at 5 mg.kg-1.d-1 or 20 mg.kg-1.d-1 for 48 h. All animals received isocaloric, isonitrogenous PN. LPS significantly lowered nitrogen balance (mmol/48 h) from PN control; however, addition of PHEN substantially worsened nitrogen balance compared with LPS (14.2 +/- 3, 2.4 +/- 5.2, -1.6 +/- 4.5, -0.8 +/- 5.4, for the PN, PN + LPS, PN + LPS + PHEN5 and PN + LPS + PHEN20 groups, respectively; P < 0.0001). ⋯ The high-dose PHEN resulted in 82 +/- 9% blockade. To ascertain if any beneficial effect upon body protein loss is achieved during severe stress, 30 rats were given PN + LPS at 12 mg.kg-1.d-1 or PN + LPS12 + PHEN20. These data showed similar changes in nitrogen balance and 3-methylhistidine/creatinine with the use of PHEN during severe endotoxemia. alpha-adrenergic antagonism with PHEN worsens body protein loss as measured by nitrogen balance and 3-methylhistidine/creatinine in PN-fed endotoxemic rats.