Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2009
ReviewEnteral omega-3 in acute respiratory distress syndrome.
The acute respiratory distress syndrome (ARDS) is a severe illness that is often the cause of death in ICU patients. A safe and effective intervention for this condition is lacking. Fish oil-based enteral nutrition [rich in n-3 polyunsaturated fatty acids (PUFAs) and antioxidants] improved clinical outcomes in a previous trial on ARDS patients but was ineffective, or even harmful in other studies utilizing different fish oil formulae (rich in n-3 PUFAs and arginine) in severely ill ICU patients. Until most recently, consistent evidence that enteral n-3 PUFA is therapeutic in ARDS was lacking. ⋯ Enteral administration of fish oil, antioxidants and physiologic amounts of arginine improve oxygenation and clinical outcomes in ICU patients with impaired oxygenation. Whether n-3 PUFA per se produces such benefit is the subject of an ongoing clinical study.
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Expression of defective cystic fibrosis transmembrane conductance regulator (CFTR), the cause for cystic fibrosis, affects fatty acid, cholesterol and sphingolipid metabolism. This review summarizes recent observations and evaluates current understanding of mechanisms. ⋯ Expression of defective CFTR has profound effects on fatty acid, cholesterol and sphingolipid metabolism, for which mechanisms are currently poorly understood. Recent studies in different cystic fibrosis models suggest a causal relationship between altered ceramide mass and increased inflammation and susceptibility to infection. Studies in cystic fibrosis knockout mouse models suggest that normalization of ceramide decreases infection and inflammation. Studies that evaluate the diagnostic and clinical relevance of sphingolipids in patients with cystic fibrosis are needed.
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Curr Opin Clin Nutr Metab Care · Mar 2009
ReviewGastrointestinal complications in critically ill patients: what differs between adults and children?
The objective of this review has been to analyse and compare the causes, incidence, severity and treatment of gastrointestinal complications in critically ill children and adults. ⋯ Gastrointestinal complications limit the efficacy of enteral nutrition in the critically ill patient and can affect morbidity and mortality. Consensus must be reached on the definition of the criteria of excessive gastric residues, constipation and diarrhoea, and studies must be performed that evaluate the efficacy of prokinetic agents on altered gastrointestinal motility and the effects of diet and laxatives on constipation in the critically ill adult and child.
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Curr Opin Clin Nutr Metab Care · Mar 2009
ReviewBisphosphonates and metabolic bone disease in the ICU.
The purpose of this review is to discuss the elements of critical illness that predispose to rapid and severe bone loss and illustrate how potent nitrogen containing intravenous bisphosphonates can mitigate this potentially serious disease. ⋯ Metabolic bone disease in the ICU is potentially a devastating consequence of critical illness. Screening with biochemical markers of bone turnover may allow identification of those most likely to have fracture after ICU discharge. Intravenous bisphosphonates are safe and very effective at preventing osteoporotic fracture in other populations. There is likely a subset of individuals who remain critically ill for a prolonged period of time that may benefit from an intravenous infusion of a potent aminobisphosphonate.