Nutritional support in the management of critically ill patients in surgical intensive care

Streat, Stephen; Hill, Graham L.

doi:10.1007/bf01656402

Cited by 46 publications

(14 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A more recent and detailed study performed in 1993 and 1994 [12] confirmed the extent of early posttrauma body composition changes reported previously [20]. The absolute values of the changes were remarkably similar in both studies.…”

Section: Elective Surgerysupporting

confidence: 87%

Overview of Modern Management of Patients with Critical Injury and Severe Sepsis

2000

Self Cite

View full text Add to dashboard Cite

Over the last 10 years there have been substantial changes in the issues confronting intensivists and surgeons caring for critically ill patients. A substantial increase in the number of elderly patients with surgical illness and complex co-morbidity has accompanied the increase in the proportion of elderly in populations in the developed world. This phenomenon has been seen particularly with sepsis. Incidence rates for blunt trauma have declined overall, but the problems of the elderly trauma patient have become more evident. Major elective surgery remains a common indication for short-term intensive care in many countries, but the need for cost-containment has led to increased use of high-dependency care for many such patients. Expectations of both society and clinicians have increased, and this has been reflected in the increased demand for complex procedures (e.g., liver transplantation, cerebral artery aneurysm clipping, aortic aneurysm repair) in patients previously considered at too high risk. Along with these expectations have come pressures on clinicians to reduce costs at the same time as improving clinical outcomes. Despite many advances in the care of critically ill patients with injury or sepsis, mortality, morbidity, and cost remain high; and nutritional support is frequently required. The duration and extent of the metabolic changes seen in response to critical surgical illness and intensive care treatments have become better characterized. Although some of the changes in body water and fat are modifiable, loss of large amounts of (functional) protein has been resistant to various strategies so far studied.

show abstract

Section: Elective Surgerysupporting

confidence: 87%

Overview of Modern Management of Patients with Critical Injury and Severe Sepsis

2000

Self Cite

View full text Add to dashboard Cite

show abstract

“…Even when large amounts of carbohydrate, fat and protein or amino acids are supplied, loss of lean body mass of septic patients is difficult to prevent [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Aspects of organ protein, amino acid and glucose metabolism in a porcine model of hypermetabolic sepsis

2003

View full text Add to dashboard Cite

Although glucose and protein metabolism have been investigated extensively in experimental models of hypodynamic sepsis, relatively little information is available regarding the compensated stage of sepsis. We investigated interorgan amino acid and glucose metabolism in a porcine model of compensated hyperdynamic sepsis. Fasting catheterized pigs received endotoxin ( Escherichia coli lipopolysaccharide; 3 microg.h(-1).kg(-1); intravenous) or saline (controls) and volume resuscitation over 24 h to reproduce hyperdynamic sepsis. Primed-constant infusions of p -aminohippurate and (3)H-labelled isotopes were used to measure glucose, amino acid and protein metabolism across the portal-drained viscera, liver and hindquarters (to represent muscle) at 0 and 24 h of endotoxaemia. Whole-body protein and glucose flux were increased during hyperdynamic compensated sepsis. In endotoxaemic pigs, visceral protein was conserved, and hindquarter protein breakdown exceeded the increase in liver protein synthesis, resulting in net whole-body protein loss. Endotoxaemia increased hindquarter and visceral glycolysis and branched-chain amino acid transamination. The rate of efflux of glutamine and alanine from the hindquarters was higher than anticipated from protein breakdown, indicating de novo synthesis of these amino acids during endotoxaemia. In addition to the hindquarters, the portal-drained viscera provided substantial gluconeogenic amino acids and lactate to the liver. Although increased liver glutamate release constitutes an important nitrogen-sparing mechanism and carbon skeletons are effectively being cycled in glucose, net body protein is lost through increased ureagenesis during the hyperdynamic stage of sepsis. Specific amino acid requirements may develop in compensated hyperdynamic sepsis that is characterized by maintained organ perfusion and increased substrate utilization at the expense of body protein.

show abstract

“…2 Increased production of glucagon, insulin, cortisol, catecholamines, vasopressin and aldosterone results in a profound change in protein and energy metabolism. 3 Without adequate nutritional support the energy requirements of these patients are primarily met by the breakdown of body proteins with a consequent loss of lean body mass. 4 These metabolic changes are clinically manifested by delayed healing, wound infection and prolonged rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anthropometric indices in patients with maxillomandibular fractures undergoing intermaxillary fixation

Simon¹,

.M²,

Ajithkumar.³

et al. 2022

JOOO

View full text Add to dashboard Cite

Intermaxillary fixation affects the anthropometric measurements like body mass index (BMI) and skin fold thickness with possible changes in lipid and total protein profile while promoting loss of water, protein and fat. This study aims to determine the effect of IMF on BMI and skinfold thickness. Changes in the physiological levels of total protein, albumin, lipid profile factors and calcium were also assessed. It was a cross sectional study in patients with maxillomandibular fractures conducted at the Department of Oral and Maxillofacial Surgery, Government Dental College, Thiruvananthapuram, Kerala, India. BMI and skinfold thickness was recorded before and after the 4-week IMF period in 45 patients. SPSS software version 20.0 was used. Categorical and quantitative variables were expressed as frequency and mean +/- SD respectively. Paired t test was used on certain quantitative parameters. p < 0.05 was considered significant. This study showed that treatment with IMF can lead to changes in anthropometric indices namely BMI and skin fold thickness and possible change in total protein and albumin.

show abstract

Nutritional support in the management of critically ill patients in surgical intensive care

Cited by 46 publications

References 48 publications

Overview of Modern Management of Patients with Critical Injury and Severe Sepsis

Overview of Modern Management of Patients with Critical Injury and Severe Sepsis

Aspects of organ protein, amino acid and glucose metabolism in a porcine model of hypermetabolic sepsis

Evaluation of anthropometric indices in patients with maxillomandibular fractures undergoing intermaxillary fixation

Contact Info

Product

Resources

About