Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewEnteral fish oil in critical illness: perspectives and systematic review.
To summarize recent research addressing the role of enteral fish oil supplementation in critical illness. ⋯ Mechanistic data suggest that administration of fish oil may help attenuate the systemic inflammatory response and allow for appropriate resolution of inflammation in critically ill patients. Recent data indicate that enteral fish oil given as a continuous infusion as part of complete nutrition improves outcome in critically ill patients, especially those with acute lung injury/acute respiratory distress syndrome. In contrast, the bolus administration of fish oil cannot be recommended as clinically beneficial in acute lung injury/acute respiratory distress syndrome patients. Recent trials indicate that pharmacologically administered nutrients should be studied in the same manner as other new drugs, with appropriate attention to early dosing trials, proper pre-enrollment patient selection, and understanding of the role of concomitant protein/calorie nutrition. More research continues to be needed to optimize the proper patient, dose, and timing of administration for enteral fish oil therapy in the ICU.
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewImpact of the feeding route on gut mucosal immunity.
Enteral nutrition is recommended as a standard nutritional therapy in clinical settings. The rationale behind enteral nutrition may be decreased infectious morbidities compared with parenteral nutrition. However, the mechanism may not be well understood. ⋯ Because enteral nutrition is a practical way to preserve gut immunity, clinicians should make any efforts to shorten the period of enteral nutrition absence and increase the dose according to the degree of tolerance.
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To analyze the recent literature (2011-2013) on glutamine supplementation of parenteral and enteral nutrition in critically ill patients. Potential confounding factors that may explain conflicting results are suggested. ⋯ Glutamine supplementation has been recognized as beneficial in acutely injured patients. However, recent conflicting results in either 'real-life conditions' or very severe situations suggest that its indications need to be more precisely determined.
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This study will review the biologic roles of thiamine, niacin, folic acid, cobalamin, antioxidants, lipids, glucose, and water and their implications as contributors or causal agents in the development of delirium, particularly if deficiencies or excesses exist. ⋯ Delirium, characterized by an acute change in mental status along with diminished awareness and attention and disturbances in memory, language, or perception, confers high rates of morbidity and mortality and can be difficult to both diagnose and treat. Although the cause of delirium is often multifactorial, nutritional status and nutrients may play a role in predisposing or directly causing this acute cognitive dysfunction. Many nutritional deficiencies or excesses (i.e., B vitamins, antioxidants, glucose, water, lipids) have been shown to alter the way one thinks and restoring the balance in many of these nutrients can lead to resolution of delirium.
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Curr Opin Clin Nutr Metab Care · Nov 2013
ReviewZinc in traumatic brain injury: from neuroprotection to neurotoxicity.
In light of the recent recognition that even mild forms of traumatic brain injury (TBI) can lead to long-term cognitive and behavioral deficits, this review examines recent data on the neuroprotective and neurotoxic roles of zinc after brain injury. ⋯ This work shows the need for future research to clarify the potentially contradictory roles of zinc in the hippocampus and define the clinical use of zinc as a treatment following brain injury in humans. This is particularly important given the finding that zinc may reduce TBI-associated depression, a common and difficult outcome to treat in all forms of TBI.