Nutrition
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6 mo afterward. Long-HPN was assessed only at baseline. In short-HPN, there was a hyperkinetic turnover at baseline. ⋯ Mean OC was lower than that of short-HPN both at baseline (P < 0. 003) and at follow-up (P < 0.002). The results suggest that in the early period of HPN bone metabolism improved from a hyperkinetic turnover to a positive balance. A low bone-formation rate appeared to be a characteristic feature of long-term HPN.
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This study was designed to investigate the effects of preinfusion with total parenteral nutrition (TPN) using fish-oil (FO) versus safflower-oil (SO) emulsion as fat sources on hepatic lipids, plasma amino-acid profiles, and inflammatory-related mediators in septic rats. Normal rats, with internal jugular catheters, were assigned to two different groups and received TPN. TPN provided 300 kcal. kg(-1). d(-1), with 40% of the non-protein energy as fat. ⋯ These results suggest that catabolic reaction in septic rats preinfused with FO is not as obvious as those preinfused with SO. Compared with SO emulsion, TPN with FO emulsion prevents liver fat accumulation associated with sepsis. However, parenterally administered FO had no beneficial effect in lowering cytokines and LTB(4) levels in peritoneal lavage fluid in septic rats induced by cecal ligation and puncture.
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Randomized Controlled Trial Clinical Trial
Nasoenteric feeding tubes in critically ill patients (fluoroscopy versus blind).
Numerous complications have been encountered with small-bore nasoenteric feeding tubes, some potentially life threatening. Patients particularly at risk are those with anatomic abnormalities, debilitation, or neurologic impairment. Fluoroscopy has been reported to be a safe, efficacious modality for the placement of these tubes. ⋯ Costs were similar in both groups. The most frequent problems encountered were difficult insertion, tubes requiring replacement, and failure to intubate the duodenum. We conclude that critically ill patients intubated either endotracheally or with tracheostomy should have nasoenteric feeding tubes placed with the guidance of fluoroscopy.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation.
The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to specialty and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. ⋯ Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P < 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P = 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P < 0.001); Norton score < 10 versus > 14: 1.28 (1.01 to 1.62, P = 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P = 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence.
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Widespread metabolic changes associated with injury facilitate the delivery of nutrients to the immune system. The effect of specific nutrients administered by the enteral route on the immune response in trauma victims is not well understood. The purpose of this study was to examine whether the synthesis of proinflammatory cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-1 beta [IL-1 beta], and interleukin-6 [IL-6]) by peripheral blood mononuclear cells (PBMCs) are influenced by the nature of the dietary fat in critically injured trauma victims. ⋯ Stimulation of IL-1 beta by LPS was normalized by Crucial but was further enhanced by Impact. The higher fat content in Crucial may contribute in part to the apparent immunomodulation. Crucial seems to be a better choice in correcting the nutritional deficiency.