Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill.

Hadfield, R.J.; Sinclair, D. G.; Houldsworth, Phillip E.; Evans, Timothy W.

doi:10.1164/ajrccm.152.5.7582291

Cited by 284 publications

(135 citation statements)

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“…A number of studies have revealed significant effects of nutritional support on intestinal permeability. [6][7][8] However, in the current study, there was no relationship between sugar recoveries and enteral intake.…”

Section: Discussioncontrasting

confidence: 82%

“…Recognition of the potential consequences of gastrointestinal barrier failure has prompted investigations into ways to support gastrointestinal function and integrity in critically ill patients, including the effects of route of nutrition (enteral versus parenteral), intestinal fuels (eg, glutamine, butyrate), and growth factors. [6][7][8][9] Normal digestion and absorption of nutrients occurs via carrier-mediated mechanisms or by passive diffusion. Diffusion can occur across (transcellular) or between cells (paracellular).…”

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confidence: 99%

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Intestinal Permeability and Absorption in Dogs with Traumatic Injury

et al. 2002

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The objectives of this study were to assess the feasibility of using urinary recovery of sugars to evaluate intestinal permeability and absorption in dogs with traumatic injury and to determine if intestinal permeability and absorption are altered in dogs with traumatic injury. After a 6-hour fast, a sugar solution containing lactulose, rhamnose, 3-O-methyl-D-glucose, and xylose was administered via nasoesophageal tube. Urine was collected and quantitated over the 6-hour study period via closed collection urinary catheters. Urinary sugar recoveries were measured by high-pressure anion exchange liquid chromatography and pulsed amperometric detection. Urinary sugar recoveries in the trauma group at 24, 48, and 72 hours after trauma were compared to normal controls. In addition, severity of trauma was compared to urinary sugar recoveries. Twelve client-owned dogs with traumatic injury and 6 healthy controls were enrolled in the study. Lactulose recovery and the lactulose : rhamnose recovery ratio were significantly higher in the trauma group at 48 hours but were no longer different from controls by 72 hours. Xylose recovery was significantly higher in the trauma group when compared to controls at 72 hours, whereas 3-O-methyl-D-glucose recovery was significantly lower in the trauma group at 24 hours. The xylose : 3-O-methyl-D-glucose ratio was higher in the trauma group at all time points. Significant correlation was found between severity of trauma and xylose and 3-O-methyl-D-glucose recoveries 24 hours after injury. Results of this study support the hypothesis that intestinal permeability and absorption are altered in dogs with traumatic injury.

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Section: Discussioncontrasting

confidence: 82%

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confidence: 99%

Intestinal Permeability and Absorption in Dogs with Traumatic Injury

et al. 2002

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“…These studies included eleven RCTs concerning mortality rates295, 296, 297, 299, 300, 301, 302, 303, 304, 305, 306 and seven RCTs concerning infection frequency 297, 298, 299, 300, 301, 302, 305…”

Section: Cq13: Nutritionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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“…Enteral nutrition is the best model of feeding in the critically ill patients as it favors intestinal trophism, stimulates the immune system, reduces bacterial translocation and the incidence of sepsis and multisystem failure and has few side effects (Hadfield et al, 1995;De Lucas et al, 2000;Galbán et al, 2000;Artinian et al, 2006). However, oral or nasogastric feeding is sometimes poorly tolerated, particularly in the patients on mechanical ventilation, owing to the reduced gastric motility secondary to the administration of drugs or to the disease itself, with the onset of distension, the accumulation of gastric residues and an increased risk of pulmonary aspiration (Montejo, 1999;Mentec et al, 2001;(Montejo et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 mg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

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Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill.

Cited by 284 publications

References 11 publications

Intestinal Permeability and Absorption in Dogs with Traumatic Injury

Intestinal Permeability and Absorption in Dogs with Traumatic Injury

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

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