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Protein catabolism intensive care

Rojan Radpay, Mahtab Poor Zamany Nejat Kermany, Badiozaman Radpay
BACKGROUND: Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the benefits and compare their adverse effects of each method...
2016: Tanaffos
Kittrawee Kritmetapak, Sadudee Peerapornratana, Nattachai Srisawat, Nicha Somlaw, Narisorn Lakananurak, Thasinas Dissayabutra, Chayanat Phonork, Asada Leelahavanichkul, Khajohn Tiranathanagul, Paweena Susantithapong, Passisd Loaveeravat, Nattachai Suwachittanont, Thaksa-On Wirotwan, Kearkiat Praditpornsilpa, Kriang Tungsanga, Somchai Eiam-Ong, Piyawan Kittiskulnam
Critically ill patients with acute kidney injury (AKI) who receive renal replacement therapy (RRT) have very high mortality rate. During RRT, there are markedly loss of macro- and micronutrients which may cause malnutrition and result in impaired renal recovery and patient survival. We aimed to examine the predictive role of macro- and micronutrients on survival and renal outcomes in critically ill patients undergoing continuous RRT (CRRT). This prospective observational study enrolled critically ill patients requiring CRRT at Intensive Care Unit of King Chulalongkorn Memorial Hospital from November 2012 until November 2013...
2016: PloS One
Mile Stanojcic, Celeste C Finnerty, Marc G Jeschke
PURPOSE OF REVIEW: A complex network of hormones and other effectors characterize the hypermetabolic response in critical illness; these mediators work together to induce numerous pathophysiologic alterations. Increased incidence of infection, multiorgan failure, long-term debilitation, delays in rehabilitation, and death result from an inability to meet the prohibitively elevated protein and energy requirements, which occur during illness and can persist for several years. Pharmacologic interventions have been successfully utilized to attenuate particular aspects of the hypermetabolic response; these modalities are a component of managing critically ill patients - including those patients with severe burns...
August 2016: Current Opinion in Critical Care
Shinji Kume, Daisuke Koya
Diabetic nephropathy is a leading cause of end stage renal disease and its occurance is increasing worldwide. The most effective treatment strategy for the condition is intensive treatment to strictly control glycemia and blood pressure using renin-angiotensin system inhibitors. However, a fraction of patients still go on to reach end stage renal disease even under such intensive care. New therapeutic targets for diabetic nephropathy are, therefore, urgently needed. Autophagy is a major catabolic pathway by which mammalian cells degrade macromolecules and organelles to maintain intracellular homeostasis...
December 2015: Diabetes & Metabolism Journal
Erin L MacLeod, Kevin D Hall, Peter J McGuire
Nutritional management of acute metabolic decompensation in amino acid inborn errors of metabolism (AA IEM) aims to restore nitrogen balance. While nutritional recommendations have been published, they have never been rigorously evaluated. Furthermore, despite these recommendations, there is a wide variation in the nutritional strategies employed amongst providers, particularly regarding the inclusion of parenteral lipids for protein-free caloric support. Since randomized clinical trials during acute metabolic decompensation are difficult and potentially dangerous, mathematical modeling of metabolism can serve as a surrogate for the preclinical evaluation of nutritional interventions aimed at restoring nitrogen balance during acute decompensation in AA IEM...
January 2016: Journal of Inherited Metabolic Disease
F Donatelli, M Nafi, M Di Nicola, V Macchitelli, C Mirabile, L Lorini, F Carli
BACKGROUND: Critically ill patients often suffer from a protein catabolic state. The aim of this study was to demonstrate that nitrogen balance (NB) in cardiac patients admitted to the intensive care unit (ICU) is related to their insulin sensitivity level and that supraphysiologic doses of insulin can restore anabolism. MATERIALS AND METHODS: Twenty-eight patients that were admitted to ICU in enteral and/or parenteral nutrition have been enrolled in this study...
July 2015: Acta Anaesthesiologica Scandinavica
Felix Liebau, Jan Wernerman, Luc J C van Loon, Olav Rooyackers
BACKGROUND: Critically ill patients are susceptible to protein catabolism. Enteral feeding may ameliorate protein loss, but its effect is not well characterized in terms of protein kinetics. OBJECTIVE: We established a method of quantifying the effect of enteral protein feeding on whole-body protein turnover and studied critically ill patients receiving early enteral nutrition. DESIGN: In a proof-of-concept study, we established, in healthy subjects (n = 6), a method of measuring the effect of continuous enteral protein feeding on whole-body protein turnover by using ¹³C-phenylalanine (¹³C-Phe) intrinsically labeled casein by a nasogastric feeding tube and an intravenous ²H₅-Phe tracer...
March 2015: American Journal of Clinical Nutrition
Muhammad Rafique
OBJETIVO: To evaluate the therapeutic agents used during metabolic crises and in long-term management of patients with propionic acidemia (PA). MATERIALS AND METHODS: The records of PA patients were retrospectively evaluated. RESULTS: The study group consisted of 30 patients with 141 admissions. During metabolic crises, hyperammonemia was found in 130 (92%) admissions and almost all patients were managed with normal saline, ≥ 10% dextrose, and restriction of protein intake...
April 2014: Arquivos Brasileiros de Endocrinologia e Metabologia
Vinicius F Cruzat, Lucas C Pantaleão, José Donato, Paulo Ivo Homem de Bittencourt, Julio Tirapegui
Sepsis is a leading cause of death in intensive care units worldwide. Low availability of glutamine contributes to the catabolic state of sepsis. L-Glutamine supplementation has antioxidant properties and modulates the expression of heat shock proteins (HSPs). This study investigated the effects of oral supplementation with L-glutamine plus L-alanine (GLN+ALA), both in the free form and L-alanyl-L-glutamine dipeptide (DIP), on glutamine-glutathione (GSH) axis and HSPs expression in endotoxemic mice. B6.129F2/J mice were subjected to endotoxemia (lipopolysaccharides from Escherichia coli, 5 mg...
March 2014: Journal of Nutritional Biochemistry
Lori F Gentile, Lyle L Moldawer
Morbidity and mortality from severe sepsis remain high, despite decades of research and improvements in intensive care unit (ICU) care. There have been over 100 failed clinical trials of biological response modifiers aimed at single therapeutic targets, mostly to suppress the early pro-inflammatory responses. In the last decade, extracellular HMGB1 has emerged as a late mediator of sepsis in murine sepsis models, whose blockade improves mortality and has a wider therapeutic window than previous efforts. Although this review promulgates the use of HMGB1 inhibitor as a therapeutic target, it should be recognized that it may not be an optimal approach to the early systemic inflammatory response syndrome (SIRS) response and cytokine storm, but rather for those patients who survive their cytokine storm and present with a persistent inflammatory, immunosuppressive and catabolism response (PICS)...
March 2014: Expert Opinion on Therapeutic Targets
Pierre Singer, Michael Hiesmayr, Gianni Biolo, Thomas W Felbinger, Mette M Berger, Christiane Goeters, Jens Kondrup, Christian Wunder, Claude Pichard
BACKGROUND & AIMS: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary...
April 2014: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Paul E Wischmeyer
Critical care is a very recent advance in the history of human evolution. Prior to the existence of ICU care, when the saber-tooth tiger attacked you had but a few critical hours to recover or you died. Mother Nature, and her survival of the fittest mentality, would never have favored the survival of the modern ICU patient. We now support ICU patients for weeks, or even months. During this period, patients appear to undergo phases of critical illness. A simplification of this concept would include an acute phase, a chronic phase, and a recovery phase...
2013: Critical Care: the Official Journal of the Critical Care Forum
L D Plank
Critical illness is characterised by catabolism of the skeletal muscle that releases amino acids for protein synthesis to support tissue repair, immune defence and inflammatory and acute-phase responses. Protein requirements for these patients have generally been based on levels that result in the lowest catabolic rates or most favourable nitrogen balance. The definition of these levels, in particular, in relation to indexing to a measure of patient weight or lean body mass, is controversial. Furthermore, optimal nitrogen balance may not necessarily equate to best clinical outcome...
May 2013: European Journal of Clinical Nutrition
C Pichot, D Longrois, M Ghignone, L Quintin
Alpha-2 adrenergic agonists ("alpha-2 agonists") present multiple pharmacodynamic effects: rousable sedation, decreased incidence of delirium in the setting of critical care, preservation of respiratory drive, decreased whole body oxygen consumption, decreased systemic and pulmonary arterial impedance, improved left ventricular systolic and diastolic function, preserved vascular reactivity to exogenous catecholamines, preserved vasomotor baroreflex with lowered set point, preserved kidney function, decreased protein catabolism...
November 2012: Annales Françaises D'anesthèsie et de Rèanimation
Gianni Biolo
Skeletal muscle adaptation to critical illness includes insulin resistance, accelerated proteolysis, and increased release of glutamine and the other amino acids. Such amino acid efflux from skeletal muscle provides precursors for protein synthesis and energy fuel to the liver and to the rapidly dividing cells of the intestinal mucosa and the immune system. From these adaptation mechanisms, severe muscle wasting, glutamine depletion, and hyperglycemia, with increased patient morbidity and mortality, may ensue...
2013: World Review of Nutrition and Dietetics
Roland N Dickerson, Stefanie L Pitts, George O Maish, Thomas J Schroeppel, Louis J Magnotti, Martin A Croce, Gayle Minard, Rex O Brown
BACKGROUND: Studies regarding protein requirements for patients with critical illness are inconclusive owing to small sample size and population heterogeneity. The primary objectives of this study were to determine the amount of protein required to achieve nitrogen equilibrium or a positive nitrogen balance (NB, -4 g/d or better) and ascertain whether patients with traumatic brain injury (TBI) exhibit greater protein catabolism than those without TBI. METHODS: Adult patients admitted to the trauma center, given specialized nutrition support, and had an NB determination within 5 days to 14 days after injury were evaluated...
September 2012: Journal of Trauma and Acute Care Surgery
Feria Hikmet Noraddin, Mats Flodin, Annika Fredricsson, Azita Sohrabian, Anders Larsson
BACKGROUND: Cystatin C is a low-molecular-weight protein that is freely filtered by the glomerulus and catabolized after reabsorption by the proximal tubular cells in healthy subjects. Urinary cystatin C is a potential biomarker for tubular damage including acute kidney injury (AKI) in the acute phase when patients are submitted to the intensive care unit. METHODS: The aim of this study was to perform a method validation of urinary analysis of cystatin C by particle-enhanced turbidimetric immunoassay (PETIA) on a high-throughput chemical analyzer...
September 2012: Journal of Clinical Laboratory Analysis
J Acosta Escribano, I Herrero Meseguer, R Conejero García-Quijada
Neurocritical patients require specialized nutritional support due to their intense catabolism and prolonged fasting. The preferred route of nutrient administration is the gastrointestinal route, especially the gastric route. Alternatives are the transpyloric route or mixed enteral-parenteral nutrition if an effective nutritional volume of more than 60% cannot be obtained. Total calorie intake ranges from 20-30 kcal/kg/day, depending on the period of the clinical course, with protein intake higher than 20% of total calories (hyperproteic diet)...
November 2011: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
T Grau Carmona, J López Martínez, B Vila García
Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanical ventilation...
November 2011: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
J López Martínez, J A Sánchez-Izquierdo Riera, F J Jiménez Jiménez
Nutritional support in acute renal failure must take into account the patient's catabolism and the treatment of the renal failure. Hypermetabolic failure is common in these patients, requiring continuous renal replacement therapy or daily hemodialysis. In patients with normal catabolism (urea nitrogen below 10 g/day) and preserved diuresis, conservative treatment can be attempted. In these patients, relatively hypoproteic nutritional support is essential, using proteins with high biological value and limiting fluid and electrolyte intake according to the patient's individual requirements...
November 2011: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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