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An acute decrease in precursor availability does not affect mucosal concentrations of serotonergic metabolites, in contrast with systemic concentrations. ATD alters biochemical responses to acute stress from the endoscopic examination reflected by lower 5-HT concentrations. Changes in 5-HT concentrations were paralleled by alterations in KA concentrations, which suggest competition between the 2 metabolic pathways for the mutual precursor.

Does acute tryptophan depletion affect peripheral serotonin metabolism in the intestine

Keszthelyi D,et al.Am J Clin Nutr. 2012 Mar;95(3):603-8.

There are wide variations in prescribing practices with regard to stress ulcer prophylaxis, although such prophylaxis is used in the majority of ICU patients. Histamine-2- antagonists, sucralfate, and proton pump inhibitors are commonly used agents, with histamine-2-antagonists being the most commonly preferred agent among the institutions surveyed. Published literature and available guidelines should be used as a template for institutions that are constructing their own guidelines.

Survey of stress ulcer prophylaxis

Erstad BL,et al.Crit Care 1999, 3:145–149

Nutritional management of patients with respiratory failure can be a model of Îl1.1trinonal management inchrönically critically ill patients.. This model requires recognition of the differing metabolic states of starvation and hypermetabolism. Starvation can result .in malnutrition, with adverse effect on respiratory rnusc1estrength, ventilatory drive, and immune defense mechanisms. General nutritional goals inClude preservation of lean body mass by providing adequate energy .and positive nitrogen balançe. General nutritional prescriptions for both states include a substrate mix of200/oprptein, 600/0 to 700/0 carbphy.. drates, and 200/0 to 3Qo/ofat. Positive nitrogen balanc~ is difficult to attain b1 hypermetabolic pa~ientsandenergy requirements are increased compared with starved patients. En:- teral' nutrition should be the mode of initial nutrient delivery unless the gastrointestinal tract is nonfunctional. Monitoring of nutd... tional .support is essential.Cornplicatio11$ of nutritional support are multiple"Nutritional hypercapnia is an important complication in a chronically critiçallyill patient. Outcom~s of selected long-term acute patients are poor, with only 80/0 of patients fully functional 1 year after discharge.17 Appropriate nutritional therapy is one a.spectof management of these patients that has the possibility of optimizing function and survival.

Nutrition in chronic critical illness

Pingleton SK.Clin Chest Med. 2001 Mar;22(1):149-63

由于肠IR 所引起炎症介质与细胞因子 的大量释放、自由基损伤、细胞凋亡、钙超载以及肠 源性细菌/内毒素经淋巴移位, 在肠缺血- 再灌注 致多器官功能障碍与衰竭的发病学中发挥着重要 作用, 以这些发病环节为靶点, 可能为防治肠IR 损 伤导致的多器官功能障碍与衰竭开辟新的防治 途径。

肠缺血-再灌注致多器官损伤发病机制的研究进展

张春晖,et al.中国微循环.2008;12(6):389-92

accurate nutrition assessment, timely and effective nutrition interventions, and careful monitoring will help patients meet their medical and nutrition accurate nutrition assessment, timely and effective nutrition interventions, and careful monitoring will help patients meet their medical and nutrition goals.

Nutrition management for the patient requiring prolonged mechanicalventilation

Doley J,et al.Nutr Clin Pract. 2011 Jun;26(3):232-41.

Bacteremia, infected necrosis, organ failure, and mortality were all associated with intestinalbarrier dysfunction early in the course of acute pancreatitis. Overall, prophylaxis with this specific combination of probiotic strains reduced bacterial translocation, but was associated with increased bacterial translocation and enterocyte damage in patients with organ failure.

Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis

Besselink MG,et al.Ann Surg. 2009 Nov;250(5):712-9

surgical patients receiving a normocaloric formula exhibited decreased length of stay, ventilator days, and average daily glucose levels , and were more likely to be directly discharged home compared with those receiving a calorically dense dietary formula.trauma patients receiving a normocaloric formula exhibited decreased length of stay and a greater likelihood of direct discharge home.

Effect of calorically dense enteral nutrition formulas on outcome incritically ill trauma and surgical patients

Bryk J,et al.JPEN J Parenter Enteral Nutr. 2008;32(1):6-11.

Early enteral nutrition (EN) is recommended because it is associated with decreased infectious complications and use of EN is associated with decreased mortality and infections compared with parenteral nutrition (PN). EN is not without risks, such as diarrhea or aspiration, but use of prokinetic agents, head of bed elevation, and use of feeding protocols can maximize benefits and minimize risks. In obese patients, use of hypocaloric feedings with increased protein has been demonstrated to promote weight loss and improved glucose management. In nonobese patients, small studies have demonstrated that providing more than 70% or less than 30% of goal caloric intake may be associated with worse outcomes, but more studies are needed.

An update on nutrition support in the critically ill

Gerlach AT,et al.J Pharm Pract.2011;24(1):70-7.

The EN supplemented with glutamine increased the lymphocyte count and helped to decrease lipid peroxidation but presented no effect on the antioxidant glutathione capacity and on cytokine concentrations or glycolytic parameters.

"Enteral nutrition supplemented with L-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection.

Cavalcante AA,et al.Nutrition. 2012 Apr;28(4):397-402.

Neurologic prognostication for patients in coma from nontraumatic causes remains complex and problematic. We have provided a modernization of the landmark Levy et al study performed in the 1970s, and we have attempted to illustrate the importance of continued aggressive investigation of this population, with an eye toward implementing more modern techniques for treatment and diagnoses. Future studies are clearly needed to further our understanding of coma outcome, with obvious implications not only for the financial burden to society but also, more importantly, for making the correct prognostic decision for the benefit of patients and their families. These studies should remain strict to the definition of coma, collect examination and ancillary data systematically and consistently, and allow sufficient time for potential recovery, particularly in cases of uncertainty, to minimize the self-fulfilling prophesy bias introduced by early withdrawal of care. Specific aspects of the brain stem examination, including pupillary, corneal, and oculocephalic reflexes, merit specific attention, because these appear to strongly correlate with prognosis, whereas the motor response appears to have a less robust correlation.

"Clinical examination for outcome prediction in nontraumatic coma.

"Greer DM,et al.Crit Care Med. 2012 Apr;40(4):1150-6.

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