Current opinion in clinical nutrition and metabolic care
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A lipid emulsion for use in parenteral nutrition containing a significant proportion of olive oil in place of soybean oil (ClinOleic; Baxter, Maurepas, France) is now available. The purpose of this review is to provide background information about the rationale for this emulsion, to collate and synthesize the literature about it, and to highlight recent studies in which it has been used. ⋯ ClinOleic is safe and well tolerated in preterm infants, and in home parenteral nutrition, haemodialysis, trauma and burn patients and may offer advantages with regard to liver function, oxidative stress and immune function. ClinOleic may offer significant advantage over soybean oil-based emulsions in terms of glucose metabolism in preterm infants. More clinical studies of ClinOleic are required and these should include evaluation of oxidative stress markers and immune function as well as of clinical outcomes.
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Curr Opin Clin Nutr Metab Care · Mar 2007
ReviewPractical aspects of intensive insulinization in the intensive care unit.
Strategies used for intensive insulin therapy of critically ill patients and differences of approach according to medical condition are reviewed. ⋯ Attainment and preservation of glycemic control among critically ill patients are best attempted with intravenous insulin infusion. Advances in the design of decision support and insulin delivery systems, and progress in the technology of continuous blood glucose monitoring, are likely to reduce the risk of hypoglycemia, without compromise of target range control, such that the patient outcomes enjoyed by experienced centers in the future will prove generalizable to others through the extension of new technologies.
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To review recent articles and evaluate hypoglycemia as a major complication of intensive insulin therapy in anticipation of emerging data from current clinical studies. ⋯ Hypoglycemia is associated with adverse outcome in intensive care unit patients. It remains unclear whether intensive insulin therapy-induced hypoglycemia per se is responsible for this adverse outcome. The threat of hypoglycemia is a barrier to intensive insulin therapy in critical care, supporting the need for frequent glucose monitoring, readily available concentrated intravenous dextrose infusions, better training of nurses and technological advances in glucose-sensing and insulin-dosing algorithms.
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Curr Opin Clin Nutr Metab Care · Mar 2007
ReviewCurrent controversies around tight glucose control in critically ill patients.
This review updates our knowledge on the benefits and risks of tight glucose control by intensive insulin therapy in critically ill patients, as well as discussing unanswered questions related to the subject. ⋯ Practical recommendations for the implementation of tight glucose control using intensive insulin therapy cannot be disseminated until questions relating to optimal blood glucose level and the corresponding categories of patients have been resolved. The issues of glucose variability and the most efficient method of preventing hypoglycaemia will probably represent important parameters for comparing the safety and quality of protocols used for tight glucose control.