(BQ) Part 1 book "Nutrition support for the critically ill" presents the following contents: An introduction to malnutrition in the intensive care unit, the immunological role of nutrition in the gut, assessment of the patient, timing and indications for enteral nutrition in the critically ill,...
Because the field of nutrition is actively evolving and creating major new principles in the care of the
pediatric patient, we have embarked on the third edition of this textbook. The editors continue to support
the premise that a comprehensive text as a reference source in pediatric nutrition is essential for the proper care
of infants and children. As medical care in the twenty-first century is predicated on prevention of disease, the
discipline of pediatric nutrition becomes that much more important.
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Parenteral versus enteral nutrition: effect on serum cytokines and the hepatic expression of mRNA of suppressor of cytokine signaling proteins, insulin-like growth factor-1 and the growth hormone receptor in rodent sepsis...
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: a prospective, multi-centre, observational study...
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Rationale and design of a proof-of-concept trial investigating the effect of uninterrupted perioperative (par)enteral nutrition on amino acid profile, cardiomyocytes structure, and cardiac perfusion and metabolism of patients undergoing coronary artery bypass grafting...
MINERAL NUTRIENTS ARE ELEMENTS acquired primarily in the form of inorganic ions from the soil. Although mineral nutrients continually cycle through all organisms, they enter the biosphere predominantly through the root systems of plants, so in a sense plants act as the “miners” of Earth’s crust (Epstein 1999). The large surface area of roots and their ability to absorb inorganic ions at low concentrations from the soil solution make mineral absorption by plants a very effective process.
Harrison's Internal Medicine Part 4. Nutrition Chapter 73. Enteral and Parenteral Nutrition Therapy
Enteral and Parenteral Nutrition Therapy: Introduction
The ability to provide specialized nutritional support (SNS) represents a major advance in medical therapy.
Decision-making for the implementation of specialized nutrition support (SNS). CVC, central venous catheter; PICC, peripherally inserted central catheter. (Adapted from previous chapter by Lyn Howard, MD.)
The first step in deciding to administer SNS is to consider the nutritional implications of the disease process. Is the condition or its treatment likely to impair food intake and absorption for a prolonged period of time? For example, a well-nourished individual can tolerate approximately 7 days of starvation while experiencing a systemic response to inflammation (SRI).
Disease-Specific Nutritional Support
SNS is basically a support therapy and is primary therapy only for the treatment or prevention of malnutrition. Certain conditions require modification of nutritional support because of organ or system impairment. For instance, in nitrogen accumulation disorders, protein intake may need to be reduced. However, in renal disease, except for brief periods of several days, protein intakes should approach requirement levels of at least 0.8 g/kg or higher up to 1.2 g/kg as long as the blood urea nitrogen does not exceed 100 mg/dL.
Table 73-10 Enteral Formulas
STANDARD ENTERAL FORMULA
1. Complete dietary products (+)a
requiring tube feeding; some can be a. Caloric density 1 kcal/mL used orally b. Protein ~14% cals, caseinates,
c. CHO ~60% cals, hydrolyzed corn starch, maltodextrin, sucrose
d. Fat ~30% cals, corn, soy, safflower oils
e. Recommended daily intake of all minerals and vitamins in 1500 kcal/d
f. Osmolality (mosmol/kg): ~300
MODIFIED ENTERAL FORMULAS
1. Caloric density 1.
Although PN was initially relatively expensive, its components are often less expensive than specialty enteral formulas. Percutaneous placement of a central venous catheter into the subclavian or internal jugular vein with advancement into the superior vena cava can be accomplished at the bedside by trained personnel using sterile techniques. Peripherally inserted central catheters can also be placed within the lumen in the central vein, but this technique is usually more appropriate for non-ICU patients.
Protein or Amino Acid Requirements
Although the recommended dietary allowance for protein is 0.8 g/kg per d, maximal rates of repletion occur with 1.5 g/kg in the malnourished. In the severely catabolic patient, this higher level minimizes protein loss. In patients requiring SNS in the acute care setting, at least 1 g/kg is recommended, with greater amounts up to 1.5 g/kg as volume, renal, and hepatic tolerances allow. The standard parenteral and enteral formulas contain protein of high biologic value and meet the requirements for the eight essential amino acids.
Enteral feeding often leads to diarrhea, especially if bowel function is compromised by disease or drugs, particularly broad-spectrum antibiotics. Diarrhea may be controlled by the use of a continuous drip, with a fiber-containing formula, or by adding an antidiarrheal agent to the formula. However, Clostridium difficile, which is a common cause of diarrhea in patients being tube fed, should be ruled out before using antidiarrheal agents. H2 blockers may also assist in reducing the net fluid presented to the colon.
(BQ) Part 2 book "Nutrition support for the critically ill" presents the following contents: Access and complications of parenteral nutrition, surgical intensive care considerations, major infections and sepsis, organ failure and specialized enteral formulas, management of the obese patient
Efficacy of SNS in Different Disease States
Efficacy studies have shown that malnourished patients undergoing major thoracoabdominal surgery benefit from SNS. Critical illness requiring ICU care including major burns, major trauma, severe sepsis, closed head injury, and severe pancreatitis [positive CT scan and Acute Physiology and Chronic Health Evaluation II (APACHE II) 10] all benefit by early SNS, as indicated by reduced mortality and morbidity. In critical illness, initiation of SNS within 24 h of injury or ICU admission is associated with a ~50% reduction in mortality.
Total energy expenditure comprises resting energy expenditure (two-thirds) plus activity energy expenditure (one-third) (Chap. 72). Resting energy expenditure includes the calories necessary for basal metabolism at bed rest. Activity energy expenditure represents one-fourth to one-third of the total, and the thermal effect of feeding is about 10% of the total energy expenditure. For normally nourished healthy individuals, the total energy expenditure is about 30– 35 kcal/kg.
Mechanical The insertion of a central venous catheter should be performed by trained and experienced personnel using aseptic techniques to limit the major common complications of pneumothorax and inadvertent arterial puncture or injury. Catheter position should be radiographically confirmed to be in the superior vena cava distal to the junction with the jugular or subclavian vein and not directly against the vessel wall. Thrombosis related to the catheter may occur at the site of entry into the vein and extend to encase the catheter.