Current opinion in clinical nutrition and metabolic care
-
Curr Opin Clin Nutr Metab Care · Sep 2003
ReviewThe gastrointestinal tract in critical illness: nutritional implications.
Recognition that the gastrointestinal tract is a key element of the immune system has led to a greater interest in understanding its role as a central figure in host defenses. Biologic systems that are perturbed by any destabilizing stimulus are known to respond by adaptive strategies in an attempt to maintain or return to global homeostasis. In critically ill patients, the gut has previously been described as a promoter of progression to sepsis and multi-organ failure. However, with better understanding of gastrointestinal tract mucosal immunity, we are now provided with a new arsenal to combat nosocomial infection and significantly impact return to health. ⋯ Ongoing research in nutritional support in both normal and pathologic gastrointestinal function and response to injury has opened the door to several new opportunities for enhancing rapid recovery in critical care.
-
Curr Opin Clin Nutr Metab Care · Sep 2003
ReviewNew developments facilitating nutritional intake after gastrointestinal surgery.
Conventional perioperative care includes a period of semistarvation before bowel function returns and adequate oral intake is allowed. It has been clearly shown that there is no need for restriction in oral intake after, at least lower, gastrointestinal surgery, and that early oral feeding does not increase the risk for dehiscense of the anastomosis. In contrast, early feeding reduces postoperative complications. Even if early oral intake is allowed, however, it is common that side effects such as nausea and vomiting prevent patients from reaching the target energy intakes. Thus, developing routines and treatments that promote sufficient early oral intake after surgery and maintain adequate energy intake in the postoperative period are probably of great importance for the outcome from surgery. ⋯ In general, there is a great need for randomized controlled trials examining factors important for the regulation of oral intake after surgery and also the effects of early oral intake after upper gastrointestinal surgery. Future areas of research may also include regulation of appetite and use of peripherally acting opioid antagonists.
-
The bioelectrical impedance analysis method is a non-invasive, rapid accurate and practical method for assessing body composition. During last decade evidence has been gathered that supports the use of this method to monitor hydration status. This review critically examines different approaches and applications of segmental bioelectrical impedance analysis in the healthy and clinical situations. ⋯ This is a review of segmental bioelectrical impedance. The preponderance of the published applications of bioelectrical impedance analysis focused on applications in a healthy population and in the field indicate the validity of the methods. A short description of the set-up of the segmental method is also given. This review discusses the application of segmental bioelectrical impedance analysis in children in different ethnic populations, in clinical situations. We also examine the application of the method to assessing body composition, and monitoring rapid changes in internal fluid balance in the field of haemodialysis and during surgery.