Jpen Parenter Enter
-
Jpen Parenter Enter · May 2003
Randomized Controlled Trial Multicenter Study Clinical TrialSafety and metabolic tolerance of a concentrated long-chain triglyceride lipid emulsion in critically ill septic and trauma patients.
A concentrated fat emulsion (Intralipid 30%) with a phospholipid/triglyceride ratio of 0.04 was tested for clinical tolerance and metabolic effects in the short-term parenteral nutrition of septic and trauma critically ill patients and compared with Intralipid 20% (phospholipid/triglyceride ratio of 0.06). ⋯ Our results indicate that while both fat emulsions used in the TPN of critically ill patients are clinically safe, the 30% long-chain triglyceride fat emulsion with a phospholipid/triglyceride ratio of 0.04 causes fewer lipid metabolic disturbances.
-
Jpen Parenter Enter · Mar 2003
Randomized Controlled Trial Multicenter Study Clinical TrialEffect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants on antioxidant status in patients with acute respiratory distress syndrome.
We previously showed that enteral feeding of a diet containing eicosapentaenoic acid, gamma-linolenic acid, and elevated antioxidants improved clinical outcomes compared with a control diet in acute respiratory distress syndrome (ARDS) patients. It has been suggested that oxidative stress may overwhelm endogenous antioxidant levels and allow free radicals to further damage lung tissue. Therefore, we determined whether these ARDS patients were under oxidative stress and whether the experimental diet could improve antioxidant status. ⋯ Before treatment, ARDS patients were found to be in a state of oxidative stress and had reduced levels of antioxidants. Although enteral nutrition with the experimental diet for at least 4 to 7 days did not reduce oxidative stress as measured, it did restore plasma levels of beta-carotene and alpha-tocopherol to normal or higher levels and appeared to protect ARDS patients from further lipid peroxidation.
-
Jpen Parenter Enter · Nov 2001
Randomized Controlled Trial Multicenter Study Clinical TrialEarly enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet. The effect on nosocomial infections and outcome.
This study was designed to evaluate the effects of a high-protein formula enriched with arginine, fiber, and antioxidants compared with a standard high-protein formula in early enteral nutrition in critically ill patients. ⋯ Critically ill patients fed a high-protein diet enriched with arginine, fiber, and antioxidants had a significantly lower catheter-related sepsis rate than patients fed a standard high-protein diet. There were no differences in mortality or ICU and hospital length of stay. The subgroup of patients fed the study diet for >2 days showed a trend toward decreased mortality.
-
Jpen Parenter Enter · Jul 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA controlled comparison of traditional feeding tube verification methods to a bedside, electromagnetic technique.
Benefits of enteral feeding are diminished by aspiration pneumonia and mechanical complications of misplaced feeding tubes. To avoid complications, clinicians determine the location of the tip before feeding. This study compares diagnostic test characteristics of 4 techniques for tip localization. ⋯ The 4 methods agreed with the radiograph in (mean, 95% confidence interval): 84 (80 to 88)%, 50 (45 to 55)%, 56 (51 to 61)%, and 76 (72 to 81)% of observations, respectively. Only the electromagnetic method and aspiration identified all tubes located above the diaphragm (negative likelihood ratio 0 and sensitivity 100%). Aspiration was unsuccessful in making a determination in 53% of the observations, whereas the electromagnetic method was successful 90% of the time.
-
Jpen Parenter Enter · Nov 1998
Multicenter Study Comparative StudyAre patients fed appropriately according to their caloric requirements?
Specific morbidity related to underfeeding and overfeeding necessitates the design of nutrition support regimens that provide calories equal to those required on the basis of energy expenditure. This prospective multicenter trial was designed to determine what percent of patients in long-term acute care facilities receive feeding appropriate to their needs and whether accuracy of feeding has an impact on patient clinical status. ⋯ Because energy expenditure is difficult to predict on the basis of conventional equations, patients in long-term acute care facilities routinely are overfed and underfed, with only 25% receiving calories within 10% of required needs. Measuring a patient's energy requirement at least once by IC is important, because the degree of metabolism predicts how easily a patient will be underfed or overfed. The amount of infused calories should be compared with caloric requirements measured by IC, because the accuracy or degree of underfeeding or overfeeding has an impact on ventilatory status and the likelihood for developing azotemia. Although physician practice or bias may reduce the optimal clinical effect, the use of IC to determine caloric requirements may result in significant cost savings.