摘要:

The benefits of maintaining and stimulating gastrointestinal function in critically ill patients have led to a growing interest in the use of enteral nutrition in the critically ill, reversing a pattern of high use of parenteral nutrition in intensive care units in the last decade. In the past year, many studies have documented the importance of “early” (<24 hours of admission) enteral nutrition support. Endoscopic placement of postpyloric nasoenteric feeding tubes is being used more frequently to establish early reliable enteral access and thereby allow early initiation of enteral nutrition in intensive care unit patients. Additional studies have determined that the provision of specialized enteral nutrition or “immunonutrition” (supplemented with arginine, glutamine, ribonucleotides and omega-3 fatty acids) is associated with a significant reduction in the risk of developing infectious complications and reduces the overall hospital stay in specific groups of patients with critical illness. These data clearly have important implications for the management of nutritional support in critically ill patients.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The presence of a gastrointestinal (GI) fistula significantly complicates the management of intensive care patients. Fistulae arise as a consequence of a full thickness defect in the wall of the GI tract. Fistulae represent an abnormal communication from the lumen of the GI tract to another site within the body, or to the surface of the body. GI fistulae can produce severe metabolic, nutritional, and fluid balance derangements. Local or systemic infections can arise from GI fistulae and complicate their resolution. It is important to gain control over nearby infections and to rule out distal GI obstruction to have the greatest chance for nonoperative healing. There is not currently a clear-cut role for somatostatin analogues in treatment of GI fistulae. Operative treatment is reserved for patients who do not respond to nonoperative measures. Despite significant improvements in nutritional and metabolic critical care support of patients with GI fistulae, the mortality and morbidity remain high.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Interleukin-11 (IL-11) is a unique cytokine and growth factor with numerous immunologic and trophic effects that affect multiple cell lines. Among its most favorable attributes is its physiologic activity in the maintenance of gastrointestinal epithelial integrity after mucosal injury. This multifunctional cytokine may prove beneficial in a variety of pathologic states in clinical medicine. Recombinant human interleukin-11 is beneficial in the prevention and treatment of mucosal injury in experimental models of immunologic, cytotoxic, ischemic, and oxidant injury. In addition, IL-11 has growth potential activity for enterocytes and is beneficial in short bowel syndrome after massive intestinal resections in animals; IL-11 also prevents mucosal ulceration, enterocyte apoptosis, and gut translocation of bacterial endotoxin and enteric pathogens after irradiation or cytoreductive chemotherapy. Interleukin-11 may provide a much-needed treatment strategy to preserve the gastrointestinal epithelium in critically ill patients.

ISSN:1070-5295    

出版商:OVID    

年代:2000

数据来源: OVID