Enteral Nutritional Supplementation With Key Nutrients in Patients With Critical Illness and Cancer

Heys, Steven Darryll; Walker, Leslie G.; Smith, Ian; Eremin, O.

doi:10.1097/00000658-199904000-00004

Cited by 447 publications

(222 citation statements)

References 36 publications

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“…While early studies and meta-analyses suggested reduced infection rates, ICU length of stay, and duration of mechanical ventilation, in both medical and surgical patients in a general ICU [59], Heyland and colleagues found a modest reduction in hospital length of stay, particularly in medical patients [60]. Furthermore and according to ASPEN Guidelines, current evidence does not support the use of enteral fish oil administration, particularly in medical ICU patients, due to heterogeneity of studies, variety of experimental and commercial lipid formulations, variable dosage of individual components, and increased costs [55].…”

Section: Clinical Studiesmentioning

confidence: 99%

The Role of Fish Oil Feeding Rich in ω‐3 Polyunsaturated Fatty Acids in Patients with Sepsis and Septic Shock

Papaioannou¹

2017

Sepsis

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Different clinical studies have demonstrated that fish oil, rich in the very-long-chain ω-3 polyunsaturated fatty acids (PUFAs), has immunomodulatory effects, suppressing the production of pro-inflammatory cytokines in diverse groups of critically ill patients. Moreover, such compounds have been found to attenuate the inflammatory response within 2-3 days upon parenteral administration. Recent experimental data suggest that activation of the cholinergic anti-inflammatory pathway constitutes a novel mechanism of such immune-regulatory effects. Since enhanced vagal tone has been associated with decreased cytokine secretion, novel monitoring tools of its activity at the bedside are needed, in order to evaluate nutritional manipulation of inflammatory response in the critically ill. The present chapter provides an overview of the mechanisms of action through which ω-3 PUFA modulates immune response in critically ill patients suffering from sepsis and septic shock. Furthermore, it summarizes the current evidence regarding clinical effects from administration of fish oil rich in ω-3 PUFAs in septic patients. Finally, it presents data that suggest the existence of a continuous interrelation between immune status and autonomic nervous system during systemic inflammation and proposes novel tools of autonomic nervous system monitoring at the bedside, in order to assess pharmacological manipulation of immune response by ω-3 PUFAs in acute illness.

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Section: Clinical Studiesmentioning

confidence: 99%

The Role of Fish Oil Feeding Rich in ω‐3 Polyunsaturated Fatty Acids in Patients with Sepsis and Septic Shock

Papaioannou¹

2017

Sepsis

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“…Six major meta-analyses reviewing these trials in surgical and trauma patients have been published (64)(65)(66)(67)(68)(69) . The two most recent studies by Marik et al and Drover et al describe both substantial reduction in post-operative complications and a shorter LOS with the use of arginine administration.…”

Section: Arginine Supplementation In Surgical Patientsmentioning

confidence: 99%

Novel nutritional substrates in surgery

et al. 2013

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Pharmaco-nutrients have beneficial effects on protective and immunological mechanisms in patients undergoing surgery, which are important for recovery after injury and in combating infectious agents. The aim of this review article was to outline the potential of the administration of nutritional substrates to surgical patients and the underlying mechanisms that make them particularly important in peri-operative care. Surgery causes a stress response, which has catabolic effects on the body's substrate stores. The amino acid glutamine is a stimulating agent for immune cells. It activates protective mechanisms through its role as a precursor for antioxidants and it improves the barrier function of the gut. Arginine also enhances the function of the immune system, since it is the substrate for T-lymphocytes. Furthermore, n-3 PUFA stabilise surgery-induced hyper-inflammation. Taurine is another substrate that may counteract the negative effects of surgical injury on acid–base balance and osmotic balance. These pharmaco-nutrients rapidly become deficient under the influence of surgical stress. Supplementation of these nutrients in surgical patients may restore their protective and immune-enhancing actions and improve clinical outcome. Moreover, pre-operative fasting is still common practice in the Western world, although fasting has a negative effect on the patient's condition and the recovery after surgery. This may be counteracted by a simple intervention such as administering a carbohydrate-rich supplement just before surgery. In conclusion, there are various nutritional substrates that may be of great value in improving the condition of the surgical patient, which may be beneficial for post-operative recovery.

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“…Z kolei Heys i wsp. [16] przedstawili obszerną metaanalizę, z której wyodrębniono 6 badań porównujących dojelitowe leczenie żywieniowe typu immunonutrition (arginina, kwasy omega-3, RNA, bez glutaminy) z żywieniem standardowym u chorych operowanych z powodu nowotworów przewodu pokarmowego. W grupie otrzymującej immunonutrition stwierdzono istotnie mniejszą liczbę powikłań pooperacyjnych (zapaleń płuc, ropni wewnątrzbrzusznych, zakażeń rany, zakażeń septycznych) oraz krótszy czas hospitalizacji w porównaniu z grupą kontrolną.…”

Section: Zalecenia Espen Dla Chorych Poddawanych Zabiegom Chirurgicznymunclassified

“…Więk-szość badań wykonywano jednak w niejednolitych grupach chorych po różnych urazach, u chorych poddawanych zabiegom chirurgicznym lub po oparzeniach, co znacznie utrudniło interpretację uzyskanych wyników. W kilku metaanalizach opartych na grupach chorych, u których stosowano złożone preparaty żywieniowe zawierające glutaminę, argininę oraz nukleotydy, stwierdzono, że immunomodulujące żywienie dojelitowe w porównaniu z żywieniem standardowym powoduje istotne zmniejszenie liczby powikłań infekcyjnych, skraca czas pobytu chorych na OIT oraz w szpitalu [16][17][18][19]. Immunonutrition nie miało jednak wpływu na śmiertelność w tej grupie chorych.…”

Section: Intensywna Terapiaunclassified

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

Kędziora¹,

Słotwiński²,

Dąbrowska³

2010

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StreszczenieW stanach stresu metabolicznego (np. urazy, zapalenia, oparzenia, choroby nowotworowe, kacheksja) glutamina wykorzystywana jest jako źródło energii w większych ilościach niż w stanie fizjologicznym i staje się związkiem warunkowo niezbędnym. Dlatego też w takich sytuacjach zalecana jest jej suplementacja. Europejskie Towarzystwo Żywienia Klinicznego i Metabolizmu (ESPEN) od 2005 r. przedstawia zalecenia żywieniowe dotyczące pozajelitowego lub dojelitowego stosowania glutaminy w poszczególnych jednostkach chorobowych i konkretnych sytuacjach klinicznych. Niniejsza praca ma na celu zebranie i uporządkowanie aktualnych zaleceń ESPEN dotyczących suplementacji tego aminokwasu zarówno w żywieniu enteralnym, jak i parenteralnym. AbstractIn conditions of metabolic stress (trauma, burns, cancer, cachexia) glutamine as a source of energy is used more than in the physiological state and becomes a conditionally essential amino acid. Because of this, glutamine should be supplemented in these conditions. The European Society for Clinical Nutrition and Metabolism (ESPEN) since 2005 has presented recommendations of glutamine's use in different diseases and clinical states. This article presents current recommendations of glutamine supplementation in both enteral and parenteral nutrition.

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Enteral Nutritional Supplementation With Key Nutrients in Patients With Critical Illness and Cancer

Cited by 447 publications

References 36 publications

The Role of Fish Oil Feeding Rich in ω‐3 Polyunsaturated Fatty Acids in Patients with Sepsis and Septic Shock

The Role of Fish Oil Feeding Rich in ω‐3 Polyunsaturated Fatty Acids in Patients with Sepsis and Septic Shock

Novel nutritional substrates in surgery

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

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