Enteral nutrition in the ICU

2016 ◽  
Author(s):  
Shaul Lev ◽  
Pierre Singer
Keyword(s):  
Intensive Care Unit ◽  
Immune Response ◽  
Enteral Nutrition ◽  
Distress Syndrome ◽  
Omega 3 ◽  
Systemic Immune Response ◽  
Protein Targets ◽  
Patient Status ◽  
Aspen Guidelines

Enteral nutrition (EN) is an integral part of the patient care in the intensive care unit (ICU) in order to maintain gut integrity, to modulate stress and the systemic immune response, and to attenuate disease severity. The timing of commencing EN in critically-ill patients depends on patient status and should be initiated as soon as the patient is stabilized. The energy and protein targets should be estimated and the feed prescription should match the nutritional target. The rate of EN dose increment or the addition of supplemental parenteral nutrition (PN) to reach the nutritional target is still debatable and ranges between 3 days (ESPEN approach) and up to 8 days (ASPEN approach). Micronutrients should be supplemented to all patients. The role of pharmaconutrition is controversial due to recent negative trials, but the use of EN with supplemental omega-3 and GLA for acute respiratory distress syndrome patients is still advocated by ESPEN and ASPEN guidelines.

scholarly journals Anti-Inflammatory Activity of Flavonoids: Potential Role against COVID-19

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Muschietti LV ◽  
Keyword(s):  
Immune Response ◽  
Acute Respiratory Distress Syndrome ◽  
Potential Role ◽  
Distress Syndrome ◽  
Polyphenolic Compounds ◽  
Inflammatory Activity ◽  
Systemic Immune Response ◽  
Anti Inflammatory ◽  
Transmissible Disease

The Coronavirus Disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spread all over the globe and emerged as one of the most threatening transmissible disease. The infection can cause an acute respiratory distress syndrome associated with a systemic immune response and inflammation. Up to now, there is no specific drugs available for its treatment. Flavonoids are important natural polyphenolic compounds widely distributed in the plant kingdom. It has been demonstrated the potential role of these metabolites in the modulation of signaling pathways particularly those related to inflammation and immunity. This review focuses on the anti-inflammatory activity of flavonoids and their effectiveness as possible therapeutic options to fight SARS-COV-2 infection.

scholarly journals The Role of Micronutrients in Support of the Immune Response against Viral Infections

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3198 ◽  
Author(s):  
Francesco Pecora ◽  
Federica Persico ◽  
Alberto Argentiero ◽  
Cosimo Neglia ◽  
Susanna Esposito
Keyword(s):  
Fatty Acids ◽  
Immune Response ◽  
Immune System ◽  
Viral Infections ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Optimal Function ◽  
The Impact

Viral infections are a leading cause of morbidity and mortality worldwide, and the importance of public health practices including handwashing and vaccinations in reducing their spread is well established. Furthermore, it is well known that proper nutrition can help support optimal immune function, reducing the impact of infections. Several vitamins and trace elements play an important role in supporting the cells of the immune system, thus increasing the resistance to infections. Other nutrients, such as omega-3 fatty acids, help sustain optimal function of the immune system. The main aim of this manuscript is to discuss of the potential role of micronutrients supplementation in supporting immunity, particularly against respiratory virus infections. Literature analysis showed that in vitro and observational studies, and clinical trials, highlight the important role of vitamins A, C, and D, omega-3 fatty acids, and zinc in modulating the immune response. Supplementation with vitamins, omega 3 fatty acids and zinc appears to be a safe and low-cost way to support optimal function of the immune system, with the potential to reduce the risk and consequences of infection, including viral respiratory infections. Supplementation should be in addition to a healthy diet and fall within recommended upper safety limits set by scientific expert bodies. Therefore, implementing an optimal nutrition, with micronutrients and omega-3 fatty acids supplementation, might be a cost-effective, underestimated strategy to help reduce the burden of infectious diseases worldwide, including coronavirus disease 2019 (COVID-19).

scholarly journals How to Control Covid-19 with a Nanobiotherapy?

2020 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Immune Response ◽  
Acute Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Multiple Organ ◽  
World Health ◽  
Shortness Of Breath ◽  
The World ◽  
Health Organization ◽  
Muscle Ache

The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In a recent study of Nanshan Chen et al., on patients of Wuhan Jinyintan Hospital, Wuhan, China, from the 99 patients with SARSCoV-2 infection, 51% had chronic diseases and they had symptoms of fever (83%), cough (82%) shortness of breath (31%), muscle ache (11%), fatigue (9%), headache (8%), sore throat (5%), rhinorrhea (4%), chest pain (2%), diarrhea (2%), and nausea and vomiting (1%) [1, 2]. The majority of patients can recover, however, about 25% of patients will progress into severe complications including acute respiratory distress syndrome (ARDS), which may worsen rapidly into respiratory failure, need an intensive care unit (ICU) and even cause multiple organ failure [3]. Depending on the pathophysiological mechanisms supposed to be involved in the development of the various clinical forms of the disease, various types of treatment have been tested with varying degrees of success. We have developed a nanotherapy to block the entry of the virus into the host cell, to reduce its potential for replication and to regulate the immune response against the microbial aggressor [4].

scholarly journals The role of balanced supplementation in diet of age-related macular degeneration patients

2021 ◽  
Vol 8 (1) ◽  
pp. 19-25
Author(s):  
Iwona Kusz vel Sobczuk ◽  
Anna Święch
Keyword(s):  
Vitamin D ◽  
Immune Response ◽  
Macular Degeneration ◽  
Vitamin B6 ◽  
Age Related Macular Degeneration ◽  
Response Modulation ◽  
Omega 3 ◽  
Age Related ◽  
Immune Response Modulation

Aim: The aim of the article was to discuss the role of balanced supplementation in diet of age-related macular degeneration patients. Methods: This review was carried out using comprehensive and systematic literature reports on the role of supplementation of vitamin D, vitamin C, vitamin E, vitamin B6, vitamin B12, zinc, lutein, zeaxanthin, omega-3 acid and folic acid in the prevention of AMD. Results: Vitamins, minerals and carotenoids are essential for the proper retinal function over an inflammation and immune response modulation. Conclusions: Vitamins, minerals and carotenoids discussed in the article have anti-inflammatory and antioxidative properties in the management of AMD progression. Accordingly, it is relevant to assure the appropriate level of these nutrients in a diet of AMD patients.

scholarly journals The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
M. García de Acilu ◽  
S. Leal ◽  
B. Caralt ◽  
O. Roca ◽  
J. Sabater ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Acute Respiratory Distress Syndrome ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acids ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Acute Onset ◽  
Omega 3

Acute respiratory distress syndrome (ARDS) is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process. Recent report on the prognostic value of eicosanoids in patients with ARDS suggests that modulating the inflammatory response through the use of polyunsaturated fatty acids may be a useful strategy for ARDS treatment. The use of enteral diets enriched with eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) has reported promising results, showing an improvement in respiratory variables and haemodynamics. However, the interpretation of the studies is limited by their heterogeneity and methodology and the effect ofω-3 fatty acid-enriched lipid emulsion or enteral diets on patients with ARDS remains unclear. Therefore, the routine use ofω-3 fatty acid-enriched nutrition cannot be recommended and further large, homogeneous, and high-quality clinical trials need to be conducted to clarify the effectiveness ofω-3 polyunsaturated fatty acids.

Parenteral nutrition in the ICU

2016 ◽  
Author(s):  
Jonathan Cohen ◽  
Shaul Lev
Keyword(s):  
Animal Models ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Glutamine Supplementation ◽  
Artificial Nutrition ◽  
Omega 3 ◽  
Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

scholarly journals Galectin-3 as Prognostic Predictor in Patients with COVID-19 Acute Respiratory Failure

2021 ◽  
Author(s):  
Andrea Portacci ◽  
Fabrizio Diaferia ◽  
Carla Santomasi ◽  
Silvano Dragonieri ◽  
Esterina Boniello ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Intensive Care Unit Admission ◽  
Acute Respiratory Failure ◽  
Predictive Power ◽  
Distress Syndrome ◽  
Prognostic Predictor ◽  
Galectin 3

Abstract Background. Galectin-3 is β-galactoside-binding lectin with several roles in immune-inflammatory response. To date, there is no evidence of Galectin-3 role as a prognostic predictor in COVID-19 disease. The aim of this study is to clarify the prognostic role of Galectin-3 in patients with COVID 19 acute respiratory failure.Methods. We enrolled 156 consecutive patients with COVID-19 disease. Routine laboratory test, arterial blood gas, chest X-ray or Computed Tomography and Galectin-3 dosage were performed. The primary outcome was to assess Galectin-3 predictive power for 30-day mortality. Secondary outcomes were 30-day Intensive Care Unit admission and Acute Respiratory Distress Syndrome stratification according to Galectin-3 dosage. We performed Mann-Whitney U and Kruskal-Wallis tests for continuous variables comparison. Fisher’s exact test or Chi-square test were used for categorical variables analysis. Relationships between Galectin-3, clinical and laboratory data were identified using Spearman analysis. Receiver Operating Characteristic curves estimated Galectin-3 predictive power for the endpoints. With a fixed cut-off of 35.3 ng/ml, Kaplan-Meier with Log-Rank test and Cox Regression were performed to assess mortality and Intensive Care Unit admission risk. Results. Galectin-3 correlated with many other prognostic predictors tested in our analysis. Moreover, patients with serum levels of Galectin-3 above 35.3 ng/ml had increased risk for mortality, Intensive Care Unit admission and severe Acute Respiratory Distress Syndrome. Conclusions. Our study demonstrates the role of Galectin-3 as a predictor of mortality, Intensive Care Unit access and ARDS stratification in patients with COVID 19 acute respiratory failure.

scholarly journals Recovery from COVID-19 and acute respiratory distress syndrome: the potential role of an intensive care unit recovery clinic: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Kirby P. Mayer ◽  
Jamie L. Sturgill ◽  
Anna G. Kalema ◽  
Melissa K. Soper ◽  
Sherif M. Seif ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Case Report ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Polymerase Chain

Abstract Background In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019. Case presentation Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial pressure to fraction of inspired oxygen, 180). On day 2 of her intensive care unit admission, reverse transcription–polymerase chain reaction confirmed coronavirus disease 2019. Her clinical status gradually improved, and she was extubated on intensive care unit day 5. She had a negative test result for coronavirus disease 2019 twice with repeated reverse transcription–polymerase chain reaction before being discharged to home after 10 days in the intensive care unit. Two weeks after intensive care unit discharge, the patient returned to our outpatient intensive care unit recovery clinic. At follow-up, the patient endorsed significant fatigue and exhaustion with difficulty walking, minor issues with sleep disruption, and periods of memory loss. She scored 10/12 on the short performance physical battery, indicating good physical function. She did not have signs of anxiety, depression, or post-traumatic stress disorder through self-report questionnaires. Clinically, she was considered at low risk of developing post–intensive care syndrome, but she required follow-up services to assist in navigating the healthcare system, addressing remaining symptoms, and promoting return to her pre–coronavirus disease 2019 societal role. Conclusion We present this case report to suggest that patients surviving coronavirus disease 2019 with subsequent development of acute respiratory distress syndrome will require more intense intensive care unit recovery follow-up. Patients with a higher degree of acute illness who also have pre-existing comorbidities and those of older age who survive mechanical ventilation for coronavirus disease 2019 will require substantial post–intensive care unit care to mitigate and treat post–intensive care syndrome, promote reintegration into the community, and improve quality of life.

scholarly journals New Approaches to Critical Illness Polyneuromyopathy: High-Resolution Neuromuscular Ultrasound Characteristics and Cytokine Profiling

2020 ◽  
Author(s):  
Anna Lena Fisse ◽  
Caroline May ◽  
Jeremias Motte ◽  
Xiomara Pedreiturria ◽  
Thomas G. K. Breuer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Immune Response ◽  
Intensive Care ◽  
Critical Illness ◽  
Clinical Status ◽  
Axonal Damage ◽  
Systemic Immune Response ◽  
Cross Sectional ◽  
Cytokine Levels ◽  
Discharge From Hospital

Abstract Background Diagnosis of intensive care unit acquired weakness (ICUAW) is challenging. Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation to classical clinical and electrophysiological assessment contribute to the understanding of CIPNM. Methods Intensive care unit patients were examined every 7 days until discharge from hospital. Clinical status, nerve conduction studies, electromyography as well as ultrasound of peripheral nerves and tibial anterior muscle were performed. Cytokine levels were analyzed by a bead-based multiplex assay system. Results Of 248 screened patients, 35 patients were included at median of 6 days (IQR: 8) after admission to intensive care unit. Axonal damage was the main feature of CIPNM. At the peak of CIPNM (7 days after inclusion), nerve ultrasound showed cross-sectional area increase of tibial nerve as a sign of inflammatory edema as well as hypoechoic nerves as a possible sign of inflammation. Cytokine analyses showed signs of monocyte and macrophage activation at this stage. Fourteen days after inclusion, cytokines indicated systemic immune response as well as profiles associated to neovascularization and regeneration. Conclusions Exploratory neuromuscular ultrasound and cytokine analyses showed signs of inflammation like macrophage and monocyte activation at the peak of CIPNM followed by a systemic immune response parallel to axonal damage. This underlines the role of both axonal damage and inflammation in pathogenesis of CIPNM.

COVID-19: Inflammatory Profile

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Yuhang Wang ◽  
Stanley Perlman
Keyword(s):  
Immune Response ◽  
Distress Syndrome ◽  
Multiorgan Failure ◽  
Critical Role ◽  
Host Immune Response ◽  
Immune Dysregulation ◽  
Annual Review ◽  
Publication Date ◽  
Inflammatory Profile

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has resulted in a pandemic that has had widespread effects on human activities. The clinical presentation of severe COVID-19 includes a broad spectrum of clinical disease, most notably acute respiratory distress syndrome, cytokine release syndrome (CRS), multiorgan failure, and death. Direct viral damage and uncontrolled inflammation have been suggested as contributory factors in COVID-19 disease severity. The COVID-19 pandemic has emphasized the critical role of an effective host immune response in controlling a virus infection and demonstrated the devastating effect of immune dysregulation. Understanding the nature of the immune response to SARS-CoV-2 pathogenesis is key to developing effective treatments for COVID-19. Here, we describe the nature of the dysregulated host immune response in COVID-19, identify potential mechanisms involved in CRS, and discuss potential strategies that can be used to manage immune dysregulation in COVID-19. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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