Background: Since the hepatosplanchnic region plays a central role
in development of multiple-organ failure and infections in critically ill
trauma patients, this study focuses on the influence of ...glutamine, peptide,
and synbiotics on intestinal permeability and clinical outcome.
Methods: One hundred thirteen multiple injured patients were
prospectively randomized into 4 groups: group A, glutamine; B, fermentable
fiber; C, peptide diet; and D, standard enteral formula with fibers combined
with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula
containing live lactobacilli and specific bioactive fibers. Intestinal
permeability was evaluated by measuring lactulose-mannitol excretion ratio on
days 2, 4, and 7. Results: No differences in days of mechanical
ventilation, intensive care unit stay, or multiple-organ failure scores were
found between the patient groups. A total of 51 infections, including 38
pneumonia, were observed, with only 5 infections and 4 pneumonias in group D,
which was significantly less than combined infections (p = .003) and
pneumonias (p = .03) in groups A, B, and C. Intestinal permeability
decreased only in group D, from 0.148 (0.056–0.240) on day 4 to 0.061
(0.040–0.099) on day 7; (p < .05). In group A, the
lactulose-mannitol excretion ratio increased significantly (p <
.02) from 0.050 (0.013–0.116) on day 2 to 0.159 (0.088–0.311) on
day 7. The total gastric retention volume in 7 days was 1150 (785–2395)
mL in group D, which was significantly more than the 410 (382–1062) mL
in group A (p < .02), and 620 (337–1190) mL in group C
(p < .03). Conclusions: Patients supplemented with
synbiotics did better than the others, with lower intestinal permeability and
fewer infections.
The study focuses on the influence of specific immunonutrients on intestinal permeability and clinical outcome. Patients who received the immunomodulatory treatment supplemented with Synbiotic exhibited less infections and lower intestinal permeability compared with the other 3 treatment groups.
Abstract Study Objective To evaluate retrospectively serum albumin concentrations as well as morbidity and mortalitiy of abdominal surgical patients who –if hypoalbuminemic– did not receive human ...albumin solutions versus those who did receive such solutions. Design Retrospective observational study. Setting Academic community hospital. Measurements The records of 76 consecutive patients who had undergone elective abdominal surgery were reviewed. Preoperative and postoperative serum albumin concentrations up to the seventh day after surgery were recorded. Morbidity and mortality were followed until the time of discharge from the hospital. Results 38 patients who received albumin replacement if they were hypoalbuminemic versus 38 patients who did not receive albumin replacement showed no significant difference in cumulative ( P < 0.52) or individual postoperative complications (infections P < 0.35, cardiovascular complications P < 1.0, organ failure P < 0.67, thromboembolic incidents P < 0.26), and mortality ( P < 0.47). Conclusions Postoperative serum albumin concentration had no correlation with postoperative morbidity. There is no justification for perioperative albumin replacement in abdominal cancer surgical patients.
Background: Early enteral nutrition (EN) after injury reduces septic complications, but upper digestive intolerance (UDI) occurring immediately post-trauma is a risk factor for pneumonia. Our study ...aimed to determine whether early intragastric feeding may lead to gastric intolerance and subsequent pneumonia in ventilated multiply injured patients.
Methods: This prospective study involved two groups of patients randomized either to immediate intragastric EN, or to delayed intragastric EN started later than 24
h after admission. UDI was diagnosed when gastric residual volume, measured with a 50-ml syringe after stopping the feeding for 2
h, exceeded 200
ml at least at two consecutive measurements, and/or when vomiting occurred.
Results: Out of 52 patients, 27 were included in the early EN group, and 25 in the delayed-EN group. On day 4, the early EN group received a greater amount of feeding because of intolerance problems occurring in the delayed-EN group (1175±485
ml vs. 803±545
ml). Twenty-five subjects—33% of the early EN patients and 64% of the delayed-EN patients—met the criteria for pneumonia (
P=0.050). On average, patients with pneumonia were older, more severely injured, and therefore required more ventilator days and a longer stay in the intensive care unit than patients without pneumonia.
Conclusions: If properly administered, early enteral nutrition can decrease the incidence of upper intestinal intolerance and nosocomial pneumonia in patients with multiple injuries.
Conjugated linoleic acid (CLA) has diverse influences on the immune response in different experimental models. In the present study we investigated the effect of CLA feeding on inflammatory and ...immune responses in a piglet model. We studied the duration of this effect and possible detrimental effects of CLA feeding. After 12 weeks of CLA and control supplementation and washout, animals were sacrificed and parenchymal organs were histologically examined.
In activated peripheral mononuclear cells interferon-gamma was significantly (p = 0.008) lower in the CLA group by the end of the feeding period. This effect disappeared as soon as supplementation was stopped. No differences were found in the tumour necrosis factor-alpha, interleukin-10 production, serum immunoglobulin-G levels and fat infiltration of the liver, except that fat storage cell infiltration was significantly (p < 0.04) higher in the CLA-fed group. The effect of time for interferon-gamma, interleukin-10 and immunoglobulin-G levels was statistically significant.
At the end of the feeding period the interferon-gamma response was depressed. However, the maturation of the piglet immune system in our young pig model probably outweighs the impact of CLA feeding on the immune response, even though liver fat storage cell infiltration, which plays an important role in liver regeneration, increased during CLA feeding of the piglets.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs.
To record the prevalence, characteristics, ...and risk factors for conflicts in ICUs.
One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries).
Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings.
Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
The present article presents the Slovenian multidisciplinary agreement statement on the definition, staging, clinical classification and multimodal approach to the treatment of cachexia in cancer ...patients. The consensus was reached during a multidisciplinary plenary session, and is based on the international definition of cancer cachexia adopted in 2011. Cancer cachexia is a multifactorial metabolic syndrome defined by an ongoing loss of skeletal muscle with or without concomitant loss of fat, which cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterized by a negative energy and protein balance due to a variable combination of reduced food intake and metabolic changes. In cancer patients, the cachexia syndrome can develop progressively through various stages – from precachexia to cachexia and finally, to refractory cachexia–represent-ing a continuum of metabolic changes, clini-cal signs and symptoms. Patients can progress from precachexia to cachexia, and reverse from cachexia into precachectic stages, while (as the term itself implies), the condition of refractory or irreversible cachexia has poor therapeutic response. A clinical algorithm for recognition and treatment of cachexia in cancer patients is presented. All cancer patients should be screened for cachexia and precachexia on presentation. Patients who fulfil diagnostic criteria for cancer cachexia should have its clinical stage determined. According to phenotype / clinical stage, a multimodal approach should be adopted in the treatment of all cases of cancer cachexia. A typical multimodal management plan in cachectic patients consists of early dietary intervention, exercise, anti-inflammatory therapy and early cancer-related symptom relief. The cachexia treatment pathway should be adopted as a pathway parallel to conventional cancer treatment. Practical implementation of cancer cachexia consensus represents the therapeutic approach with possible positive impact on cancer burden control in Slovenia.
Objective : To find out if there was a relationship between increased intestinal permeability and the development of multiple organ failure (MOF) after multiple injuries, we correlated the extent of ...injury and MOF with intestinal permeability on the second and fourth day after injury. Design : Prospective open study. Setting : University hospital, Slovenia. Patients : 29 multiply injured patients, injury severity score (ISS) over 25, admitted shocked. Intervention : Intestinal permeability measured by giving lactulose and mannitol solution enterally on days 2 and 4. Main outcome measures : The lactulose: mannitol ratio calculated from the urinary portion of the probe molecules. ISS and the acute physiology and chronic health evaluation (APACHE II) calculated on admission. Results : The median lactulose: mannitol ratio for five volunteers was 0.014 (range 0.008-0.017) and that for 29 patients was 0.03 (0.01-0.1). On day 2 it was 0.03 (0.02-0.1), on day 4 0.02 (0.01-0.2). The ratio calculated on day 2 correlated with average and late MOF scores ( r = 0.41 R 2 = 0.1681, p < 0.03 and r = 0.38, R 2 = 0.1444, p < 0.04) and that measured on day 4 correlated with overall, early, and late MOF scores ( r = 0.47, R 2 = 0.2209, p < 0.01; r = 0.51, R 2 = 0.2601, p < 0.005; r = 0.39, R 2 = 0.1512, p < 0.04). No correlation was found between ISS, transport time, shock index, APACHE II, and days in intensive care. Conclusions : Even if intestinal permeability is invariably increased after injury, it seems to have some predictive value for MOF in multiply injured patients because it correlates with its development.
Summary
BACKGROUND: Preoperative bowel cleaning for elective colorectal surgery is a routine procedure. Synbiotics (probiotics plus prebiotics) are known for their beneficial effects on gut immune ...function and maintenance of the gut barrier. The main purpose of this study was to replace preoperative mechanical bowel cleaning with synbiotics and to assess the systemic inflammatory response and clinical outcome in patients undergoing colorectal surgery. PATIENTS AND METHODS: A prospective double-blind randomized placebo-controlled trial was conducted in 68 patients. The first group of 20 patients received synbiotics, the second group of 28 patients prebiotics and heat-deactivated probiotics, and the third (control) group of 20 patients mechanical bowel cleaning prior to the operation. RESULTS: Significantly higher values of interleukin 6 (IL-6) were detected 72 h after the operation in the synbiotic group (
P
= 0.025), as well as an increase of fibrinogen at 24 h postoperatively (
P
= 0.030). No statistical differences were found in leukocytes count, C-reactive protein or the lymphocyte/granulocyte ratio. There were no differences in postoperative complications between the groups. Mean hospital stay was 9.2 days in the prebiotic group, 9.5 days in the control group, and 10.95 days in the synbiotic group. CONCLUSIONS: Preoperative administration of prebiotics in elective colorectal surgery appears to have the same protective effect in preventing a postoperative inflammatory response as mechanical bowel cleaning. Further prospective studies are needed to verify the effects of synbiotics.
PURPOSE: The aim of the current study was to determine the incorporation of cis (c) 9, trans (t) 11-conjugated linoleic acid (CLA) and t10, c12-CLA into porcine erythrocytes—both isomers were ...supplemented in equal proportions. METHODS: The study group consisted of 16 piglets randomly assigned into experimental and control group. For the period of 5 weeks, the piglets from the experimental group were receiving a 1.2 % CLA supplement while the controls were supplemented with the same amount of sunflower oil. For the remaining 7 weeks, the piglets were fed without a supplement. Blood samples to evaluate incorporation of CLA into erythrocyte membranes were taken from all animals on weekly basis. RESULTS: Compared to t10, c12-CLA isomer, proportion of c9, t11-CLA isomer in the membrane of erythrocytes was higher for the whole time of the study period. After 4 weeks of feeding, it approaches the plateau. The peak value for both isomers was measured at the end of week 5, with a value of 3.24 g c9, t11-CLA/100 g of fatty acids and a 1.09 g t10, c12-CLA/100 g of fatty acids (p < 0.0001). After cessation of supplementation, the proportion of both isomers gradually decreased to be almost completely washed out—in 7 weeks. CONCLUSIONS: During supplementation with equivalent amounts of CLA isomers, their proportion in membranes of porcine erythrocytes increases with time, with higher proportion of c9, t11-CLA. CLA isomers probably differently incorporate into different cell membranes at different species which could explain its various biological functions.
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