Articles: critical-illness.
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Hypoalbuminemia is a common finding in critically ill patients. It has been well documented that hypoalbuminemic patients have a higher morbidity and mortality rate when compared with patients with a normal serum albumin. ⋯ There is, however, very little evidence that this practice is of any benefit. In this article the physiology of albumin in health and disease is reviewed, and those clinical studies that have investigated the use of albumin in acutely ill hypoalbuminemic patients are evaluated.
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Critical care medicine · Mar 1993
Enteral nutrition with simultaneous gastric decompression in critically ill patients.
Early enteral nutrition is an important adjunct in the care of critically ill patients. A double-lumen gastrostomy tube with a duodenal extension has been reported to enable early enteral feeding with simultaneous gastroduodenal decompression. We tested the ability of this device to achieve these goals in critically ill patients. ⋯ These data do not support the use of this device for early enteral feeding and simultaneous gastric decompression in critically ill patients.
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Critical care medicine · Mar 1993
The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.
To compare the Acute Physiology and Chronic Health Evaluation (APACHE II) score with resting energy expenditure obtained from indirect calorimetry to determine whether the APACHE II scoring system is an accurate, objective measure of the degree of critical illness and physiologic stress between groups of patients. ⋯ The APACHE II classification may be a valid marker of physiologic stress as demonstrated by its statistically significant (although weak) relationship with indirect calorimetric measures of energy expenditure associated with varying degrees of critical illness.
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Crit Care Nurs Clin North Am · Mar 1993
The significance of enteral nutrition in the intensive care unit patient.
The gut and its nonimmunologic and immunologic barriers have an important role in the survival of critically ill patients. Burns, hemorrhagic shock, intestinal obstruction, protein-calorie malnutrition, and several therapies (e.g., parenteral nutrition, steroids), used in critically ill patients are known to promote the breakdown of the mucosal barrier and to permit translocation of intestinal pathogens. Enteral nutrition, in conjunction with the use of certain immunostimulatory nutrients, can now be used to prevent or minimize damage to the mucosal barrier and to enhance its immunologic function in critically ill patients.
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During the past few decades, researchers have shed new light on the role of nutritional support in the immunocompromised critically ill patient. "Nutritional pharmacology" has become the catch phrase of the 1990s due to the impact of selected nutrients on host immune defenses. When feasible, enteral nutrition is preferred to parenteral nutrition to preserve the integrity of the gut mucosal barrier, especially when administered jejunally in the early stages of hypermetabolism. Glutamine and fiber provide necessary fuels for the gastrointestinal tract, whereas arginine and omega-3 fatty acids exert beneficial effects on certain cells of the immune system. Daly et al demonstrated that "enteral nutrition with supplemental arginine, RNA nucleotides and omega-3 fatty acids (Impact, Sandoz Nutrition, Minneapolis, MN) compared with a standard enteral diet, significantly improved immune, metabolic and clinical outcomes (22% mean reduction in length of stay) in UGI cancer patients undergoing surgery." Although more research is needed in the area of nutritional pharmacology, newly available nutrient-specific enteral products (Table 1) provide promise for altering the clinical outcome of immunocompromised patients.