scholarly journals Nutritional interventions in critical illness

2007 ◽  
Vol 66 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Jeremy Powell-Tuck
Keyword(s):  
Growth Hormone ◽  
Critical Illness ◽  
Nutritional Support ◽  
Optimal Timing ◽  
High Dose ◽  
Refeeding Syndrome ◽  
Nutritional Interventions ◽  
The Face ◽  
The Subject ◽  
And Function

The metabolism of critical illness is characterised by a combination of starvation and stress. There is increased production of cortisol, catecholamines, glucagon and growth hormone and increased insulin-like growth factor-binding protein-1. Phagocytic, epithelial and endothelial cells elaborate reactive oxygen and nitrogen species, chemokines, pro-inflammatory cytokines and lipid mediators, and antioxidant depletion ensues. There is hyperglycaemia, hyperinsulinaemia, hyperlactataemia, increased gluconeogenesis and decreased glycogen production. Insulin resistance, particularly in relation to the liver, is marked. The purpose of nutritional support is primarily to save life and secondarily to speed recovery by reducing neuropathy and maintaining muscle mass and function. There is debate about the optimal timing of nutritional support for the patient in the intensive care unit. It is generally agreed that the enteral route is preferable if possible, but the dangers of the parenteral route, a route of feeding that remains important in the context of critical illness, may have been over-emphasised. Control of hyperglycaemia is beneficial, and avoidance of overfeeding is emphasised. Growth hormone is harmful. The refeeding syndrome needs to be considered, although it has been little studied in the context of critical illness. Achieving energy balance may not be necessary in the early stages of critical illness, particularly in patients who are overweight or obese. Protein turnover is increased and N balance is often negative in the face of normal nutrient intake; optimal N intakes are the subject of some debate. Supplementation of particular amino acids able to support or regulate the immune response, such as glutamine, may have a role not only for their potential metabolic effect but also for their potential antioxidant role. Doubt remains in relation to arginine supplementation. High-dose mineral and vitamin antioxidant therapy may have a place.

Nutrition support in acute cardiac care

2016 ◽  
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
New Findings ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

Nutrition support in acute cardiac care

2015 ◽  
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
New Findings ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

VENUS BY BOTTICELLI AND HER PITUITARY ADENOMA

2019 ◽  
Vol 25 (10) ◽  
pp. 1067-1073
Author(s):  
Paolo Pozzilli ◽  
Luca Vollero ◽  
Anna Maria Colao
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Three Dimensional ◽  
Sufficient Evidence ◽  
Methods Comparison ◽  
Pituitary Growth Hormone ◽  
Beautiful Woman ◽  
The Face ◽  
The Subject

Objective: Simonetta Vespucci, considered the most beautiful woman of the Renaissance, is the inspiration and face of one of the most famous paintings of all times, “The Birth of Venus,” by Botticelli. She died in 1476 at the age of 23 years. We postulate she suffered from a pituitary-secreting tumor progressing to pituitary apoplexy. The goals of this study were 3-fold: (i) verify that the subject depicted by Botticelli in different paintings represents the same woman; (ii) identify the facial traits affected by the progression of a growth hormone– and prolactin-secreting tumor; and (iii) confirm that the observed changes of the face traits observed in the portraits of Simonetta Vespucci are compatible with the facial traits changes identified earlier. Methods: Comparison among face traits was based on the analysis of the face regions measured by means of fiducial points and their distances, and after pose compensation based on three-dimensional head modelling. Results: In favor of the hypothesis that Simonetta suffered from a pituitary growth hormone– and prolactin-secreting tumor stands changes of her lineaments, a feature which becomes evident over the years and particularly manifest in the Allegorical Lady, where galactorrhea is depicted. Conclusion: We conclude that sufficient evidence is presented to suggest that Simonetta Vespucci, the Venus depicted by Botticelli, suffered from pituitary adenoma secreting prolactin and growth hormon with parasellar expansion. The current interpretation of the Venus strabism should be revisited according to this finding. Abbreviation: GH = growth hormone

scholarly journals Guia prático de referências e recomendações nutricionais para indivíduos acometidos pelo coronavírus e para a população em isolamento social durante a pandemia: COVID-19

2020 ◽  
Vol 2 (35) ◽  
pp. 181-186
Author(s):  
Hadassa Hillary Novaes Pereira Rodrigues ◽  
Wanderson Hugo Drescher ◽  
Ana Carolina Pinheiro Volp
Keyword(s):  
Nutritional Status ◽  
Social Isolation ◽  
Health Professionals ◽  
Nutritional Support ◽  
Respiratory Syndrome Virus ◽  
Reference Guide ◽  
Nutritional Recommendations ◽  
The Face ◽  
The Subject ◽  
The Needy

Introduction: After an outbreak of pneumonia caused by an unknown cause registered in China in December 2019, a disease of zoonotic origin was detected, caused by severe acute respiratory syndrome virus (SARS-CoV), which became known as coronavirus disease due to days sickness 2019 (COVID-19). Of those affected, a portion needs hospitalization and nutritional support is necessary. However, those who are in social isolation must amplify their nutritional status, as well as their immunity, in the process of creating more resistance if they are affected. The goal of care is not to overload the health system, so that little by little the needy have dignified care. Considering the need for greater ammunition for health professionals and the population in general, and in a simplified way in the face of the “rain” of information that everyone is receiving, the objective of the present work was to summarize and present a practical reference guide for the population in social isolation during the pandemic. Methods: A literary search was carried out on references already published on the subject on scientific websites, including the main themes: nutritional status, nutritional recommendations, immunity and coronavirus. Results: The following were included in this guide, presented very clearly: guidelines for the population that is in social isolation; lactating with COVID-19; immunomodulation; shopping and returning home. Conclusion: This article has summarized what is available on the subject in the literature until today. We believe that this material can help professionals and the general population in times of pandemic.

CURRENT NUTRITIONAL RECOMMENDATIONS AND NOVEL DIETARY STRATEGIES TO MANAGE SARCOPENIA

2013 ◽  
pp. 1-16
Author(s):  
R. CALVANI ◽  
A. MICCHELI ◽  
F. LANDI ◽  
M. BOSSOLA ◽  
M. CESARI ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Independent Living ◽  
Optimal Timing ◽  
Nutritional Interventions ◽  
Adverse Health Outcomes ◽  
Age Related ◽  
Aging Muscle ◽  
And Function ◽  
Dietary Agents ◽  
Dietary Strategies

Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated withincreased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living,and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression ofsarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related musclewasting. The combination of nutritional interventions and physical exercise appears to be the most effectivestrategy presently available for the management of sarcopenia. The purposes of this review are to summarize thecurrent knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of actionof relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preservemuscle mass and function into old age. Issues related to the identification of the optimal timing of nutritionalinterventions in the context of primary and secondary prevention are also discussed. Finally, the prospect ofelaborating personalized dietary and physical exercise recommendations through the implementation ofintegrated, high-throughput analytic approaches is illustrated.

Nutrition support in acute cardiac care

2021 ◽  
pp. 360-372
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
Nutrition Practices ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Full enteral feeding in vasopressor dependent patients recovering from hemodynamic shock increases the risk for bowel ischemia. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

Nutritional support in the critically ill

2018 ◽  
Author(s):  
Matt Wise ◽  
Paul Frost
Keyword(s):  
Stress Response ◽  
Critical Illness ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Refeeding Syndrome ◽  
Protein Requirements ◽  
Major Injury ◽  
Underlying Illness ◽  
Parasitic Effect ◽  
Adaptive Stress Response

Major injury evokes a constellation of reproducible hormonal, metabolic, and haemodynamic responses which are collectively termed ‘the adaptive stress response’. The purpose of the adaptive stress response is to facilitate tissue repair and restore normal homeostasis. If critical illness is prolonged, the adaptive stress response may become maladaptive, in essence exerting a parasitic effect leaching away structural proteins and impairing host immunity. Primarily therapy should be directed towards the underlying illness, as nutritional support per se will not reverse the stress response and its sequelae. Nonetheless, adequate nutritional support in the early stages of critical illness may attenuate protein catabolism and its adverse effects. This chapter covers nutritional assessment; detection of malnutrition; energy and protein requirements; monitoring the effectiveness of nutritional replacements; nutritional delivery; complications; and refeeding syndrome.

scholarly journals Transition from Oxycodone to Buprenorphine/Naloxone in a Hospitalized Patient with Sickle Cell Disease: A Case Report

2022 ◽  
Author(s):  
Sarah Leyde ◽  
Leslie Suen ◽  
Lisa Pratt ◽  
Triveni DeFries
Keyword(s):  
Chronic Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Optimal Timing ◽  
High Dose ◽  
Cell Disease ◽  
Full Agonist ◽  
Hospitalized Patient ◽  
And Function ◽  
Buprenorphine Treatment

AbstractBuprenorphine is increasingly used to treat pain in patients with sickle cell disease but optimal timing and approach for transitioning patients from full agonist opioids to buprenorphine is unknown. We present the case of a 22-year-old woman with sickle cell disease and acute on chronic pain who transitioned from high-dose oxycodone to buprenorphine/naloxone during a hospital stay for vaso-occlusive episode. Utilizing a microdosing approach to minimize pain and withdrawal, buprenorphine/naloxone was gradually uptitrated while she received full agonist opioids. During the transition, she experienced some withdrawal in the setting of swallowed buprenorphine/naloxone tablets, which were intended to be dosed sublingually. Nevertheless, the transition was tolerable to the patient and her pain and function significantly improved with buprenorphine treatment. This case also highlights the challenges and unique considerations that arise when providing care for the hospitalized patient who is also incarcerated.

Nutrition support in acute cardiac care

2018 ◽  
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
New Findings ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

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