Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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For adequate nutritional support of critically ill children, knowledge of the patient's energy expenditure is required. Steady state measurement by a metabolic monitor are defined as resting energy expenditure and may underestimate total energy expenditure in clinical practise. The aim of this study was to investigate total energy expenditure, resting energy expenditure and the relation with physical activity during critical illness and initial recovery. ⋯ During the week following pediatric intensive care admission, in the individual critically ill patient, activity related energy expenditure should be taken into account to prevent a negative energy balance.
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A wide variation in 24h energy expenditure has been demonstrated previously in intensive care unit (ICU) patients. The accuracy of equations used to predict energy expenditure in critically ill patients is frequently compared with single or short-duration indirect calorimetry measurements, which may not represent the total energy expenditure (TEE) of these patients. To take into account this variability in energy expenditure, estimates have been compared with continuous indirect calorimetry measurements. ⋯ Limits of agreement between the different equations and TEE values were unacceptably wide. Prediction equations may result in significant under or overfeeding in the clinical setting.
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Randomized Controlled Trial
Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study.
To examine whether probiotics would reduce the occurrence or duration of acute otitis media (AOM), or the nasopharyngeal carriage of otitis pathogens in otitis-prone children. ⋯ Probiotics did not prevent the occurrence of AOM or the nasopharyngeal carriage of otitis pathogens in otitis-prone children. A tendency showing a reduction in recurrent respiratory infections must be confirmed in further studies.
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Review Meta Analysis
The use of pre- pro- and synbiotics in adult intensive care unit patients: systematic review.
This review investigated whether the administration of enteral pre-, pro- and synbiotics compared with controls in adult intensive care unit (ICU) patients reduced the incidence of nosocomial infections, length of ICU stay, hospital mortality and specifically pneumonia. ⋯ The use of pre- pro- or synbiotics in adult critically ill patients confers no statistically significant benefit in the outcome criteria studied. There is currently a lack of evidence to support the use of pre- pro- or synbiotics in patients admitted to adult ICUs, and a large well-designed trial is needed in this area.
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The "gut origin of sepsis" hypothesis proposes that enteric bacteria may cause sepsis at distant extra-intestinal sites. Whilst there is much circumstantial evidence to support this hypothesis, there is no conclusive proof in humans. The nature of translocating bacteria remains unclear. The aim of this study was to establish the origin of Escherichia coli (E. coli) cultured from mesenteric lymph nodes (MLN) and determine if they belonged to any recognized pathotypes known to cause infections in humans. ⋯ This study confirms the gut origin of translocating bacteria. Most translocating E. coli do not belong to any recognised pathotype and are therefore normal commensal microflora. Our results suggest that bacterial translocation is more dependent upon the gut epithelium rather than the virulence properties of resident enteric bacteria.