Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2015
ReviewGlutamine and antioxidants: status of their use in critical illness.
Many studies in critically ill patients have addressed enteral or parenteral supplementation of glutamine and antioxidants to counteract assumed deficiencies and induce immune-modulating effects to reduce infections and improve outcome. Older studies showed marked reductions in mortality, infectious morbidity and length of stay. Recent studies no longer show beneficial effects and in contrast even demonstrated increased mortality. This opiniating review focuses on the latest information and the consequences for the use of glutamine and antioxidants in critically ill patients. ⋯ Given that the first dictum in medicine is to do no harm, we cannot be confident that immune-modulating nutrient supplementation with glutamine and antioxidants is effective and well tolerated for critically ill patients. Until more data are available, it is probably better not to routinely administer glutamine and antioxidants in nonphysiological doses to mechanically ventilated critically ill patients.
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Recent findings suggest that vitamin D is a marker for outcomes in critical illness. The purpose of this review is to summarize current biological, observational and interventional evidence in the critically ill. ⋯ Vitamin D deficiency is a potentially modifiable marker for adverse outcomes in critical illness and critical illness survivors. Vitamin D supplementation is inexpensive and appears safe in critical illness trials. A well powered interventional trial is required to determine the definitive answer regarding the role of vitamin D supplementation in the improvement of critical care outcomes. Until such data are available, a cautious approach to correction of vitamin D status in the ICU is warranted.
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Curr Opin Clin Nutr Metab Care · Mar 2015
ReviewVitamin C supplementation in the critically ill patient.
Vitamin C is not only an essential nutrient involved in many anabolic pathways, but also an important player of the endogenous antioxidant defense. Low plasma levels are very common in critical care patients and may reflect severe deficiency states. ⋯ The recent research on the modulation of oxidative stress and endothelial protection offer interesting therapeutic perspectives, based on the biochemical evidence, with limited or even absent side-effects.
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Skeletal muscle and lean body mass may be vital to prognosis and functional recovery in chronic and acute illness, particularly in conditions in which muscle atrophy is prevalent. Ultrasound provides a precise and expedient method to measure muscle mass and changes in skeletal muscle at the bedside. ⋯ Given the precision, practicality, and ease of use, ultrasound is emerging as a highly useful tool in expediently measuring the muscle mass and changes in muscle tissue at the bedside. Ultrasound may be valuable in identifying patients who are at risk of malnutrition, in tracking muscle atrophy for the purpose of calculating nutrient delivery, and in assessing the success or failure of nutrition, pharmacological and rehabilitative interventions that aim to counter muscle atrophy.
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Curr Opin Clin Nutr Metab Care · Sep 2014
ReviewEarly oral feeding after emergency abdominal operations: another paradigm to be broken?
The scope of this article is to provide an updated review examining the role of early feeding in the postoperative period. ⋯ Early oral intake is possible after elective abdominal surgery and should be moderate and progressive to be well tolerated. Any sign of nausea may mean intestinal or gastric disturbance and is a caution not to pursue this policy. The strategy in emergency abdominal surgery still requires adequately powered, randomized controlled trials.