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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

More than one thousand publications have demonstrated the safety and efficacy of today's lipid emulsions including long chain fatty acids under experimental and clinical conditions. This has resulted in a general acceptance of a dual energy system comprising both carbohydrates and lipids as non-protein calories in total parenteral nutrition. Non-carnitine-dependent fatty acid has been suggested as a superior energy source in clinical situations where carnitine may be in the subnormal range. A medium chain triglyceride (MCT) emulsion would provide an energy source with a more readily oxidizable substrate. The tolerance of MCT is less than that of long chain triglyceride (LCT), whereby only physical mixtures of these emulsions will be used in humans. A structured lipid (SL) is a triglyceride which includes both medium and long chained fatty acids within the same triglyceride. Emulsions including SL have demonstrated a decreased protein energy expenditure and increased serum albumin in burned animal. The SL has also been superior to LCT emulsions in stimulating muscle protein synthesis and maintaining body weight in hepatectomized animals. These positive effects on protein kinetics have been concomitant with a lower RES involvement during septicemia in burned guinea pigs. Emulsions including fatty acids with odd-number carbons give a possibility to provide a fat emulsion which also could contribute positively to the glucose homeostasis. The omega-3 family of fatty acids has demonstrated a potential pharmacologic effect with regard to their ability to decrease blood viscosity and improve survival rate in endotoxin shock in an experimental model. These observations have been ascribed to changes in thromboxin A2 levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New developments in lipid emulsions for parenteral nutrition. 311 89

In order to assess the significance of malnutrition in determining surgical complications and the possibility of their reduction by preoperative nutritional support (PNS), a randomized controlled trial is being performed at our institution. The results relative to 100 patients who underwent major surgery for gastrointestinal disease, are presented here. In the treatment group 49 patients received 30 kcal/kg/day and 200 mg/kg/day of nitrogen for at least 7 days in the immediate preoperative period (nine patients were excluded from this group due to early surgery--seven cases; or refusal to accept PNS--two cases. Data analysis with their inclusion or exclusion showed similar results.) Fifty-one patients constituted the control group. The observed septic complication rate was, respectively, 30 and 35.3% (p:NS). When the analysis was restricted to the patients with abnormal instant nutritional assessment (INA), as defined by Seltzer et al (serum albumin less than 3.5 g/dl and/or total lymphocyte count less than 1500 cells/mm3), a statistically significant difference was observed in the incidence of sepsis between the two subgroups (21% vs 53.3%, p less than 0.05). Analogous results were obtained from the patients who underwent gastrectomy for gastric cancer: 16.7% of septic complications in the malnourished treated patients and 100% in the malnourished control ones (p less than 0.05). The occurrence of serious sepsis (sepsis score greater than or equal to 10, according to the scoring system developed by Elebute and Stoner) in the malnourished subgroups was 5.2% and 26.7%, respectively, (p = 0.09). The postoperative mortality rate was not significantly changed by the PNS (reduction from 3.9% to 2.5%, p:NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preoperative parenteral nutrition in the high risk surgical patient. 312 96

The United Kingdom and Ireland Register of Home Parenteral Nutrition (HPN) contains details on 237 cases treated between 1977 and 1987. One hundred courses of HPN were given to 89 patients for complications of Crohn's disease. Six registering centers provided 87 percent of the courses of treatment. The short-bowel syndrome was a factor in 60 patients, fistulas in 29 patients, and exacerbation of the disease in 41 patients. Thirty patients had more than one complication. The age distribution of patients with Crohn's disease was the same as for all HPN patients. Nine patients have died and eight have ceased HPN because of complications from the treatment. Fifty two percent of the patients had no complications. Patients with Crohn's disease on HPN had a significantly better lifestyle than the group as a whole (P less than .05) and had lower sepsis and complication rates (P less than .01 and 0.001, respectively). The 60 Crohn's patients with short-bowel syndrome spent a significantly longer time on HPN than Crohn's patients overall (P less than .05). Only 15 of these have been able to cease treatment and resume enteral feeding, compared with 23 of the other 40 patients who were able to resume enteral nutrition after a median of three months. Analysis of the authors' group of 35 patients included in the 100 showed that the only nutritional parameters of use in monitoring the patients' well-being were weight and serum albumin. Eighty percent of the patients with Crohn's disease who were treated by HPN have either successfully resumed enteral feeding or are successfully managing their own HPN. HPN is a safe and effective treatment for patients with acute or chronic intestinal failure from Crohn's disease.
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PMID:How do patients with Crohn's disease fare on home parenteral nutrition? 313 56

Because several studies have shown a significant inverse correlation between depressed serum concentrations of albumin and hospital morbidity, a study with central total parenteral nutrition (TPN) with normal serum albumin (NSA) in hypoalbuminemic patients was conducted. Sixty-one patients who required central TPN were randomized into one of two groups: group 1 (n = 31) received TPN plus NSA (25 to 37.5 g/day) until their measured serum albumin was greater than 3 g/dl, and group 2 (n = 30), who received TPN alone. All patients were followed for hospital complications until discharge or death. The groups were well matched for age, sex, major diagnoses, initial serum albumin concentrations, hospital complications before TPN, and number of operative procedures. Both groups received comparable doses of energy (37.2 +/- 89 vs. 3.30 +/- 6.2 kcal/kg.day) and protein (1.6 +/- 0.4 vs. 1.6 +/- 0.3 g/kg.day). After initiation of TPN, there were significantly more hospital complications in group 2 (1 = 1.1 +/- 1.4, n = 33; 2 = 2.6 +/- 3.0, n = 80, p less than .01). When complications in the patient groups were stratified, significantly more patients in group 2 developed pneumonia (18 vs. 9, p less than .05) and septicemia (11 vs. 2, p less than .05). Increasing serum albumin concentrations with NSA in hypoalbuminemic patients receiving central TPN appears to be associated with a reduction in hospital morbidity.
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PMID:Effect of albumin supplementation during parenteral nutrition on hospital morbidity. 314 19

Nutritional indices (percentage ideal body weight [IBW], serum albumin, serum transferrin, total lymphocyte count [TLC] and delayed cutaneous hypersensitivity [DH] response) were assessed in 80 consecutive patients (aged 85-100 y) within 24 h of admission to determine their predictive value for mortality. Nine patients died. Pearson correlation analysis demonstrated that death was significantly (p less than 0.05 to less than 0.01) associated with sepsis, serum albumin less than 30 g/L, TLC less than or equal to 1500 cells/mm3, and percentage IBW less than or equal to 90%. However, when serum albumin was controlled for, logit regression analyses demonstrated that the impact of other nutritional indices on death was insignificant. The effect of serum albumin remained significant (p less than 0.05 to less than 0.01) even when age and physician's diagnosis were held constant. With the logit model, serum albumin greater than or equal to 30 g/L had a sensitivity of 0.33, specificity of 0.99, and overall predictive power of 0.91. Serum albumin is thus the simplest and best single predictor of mortality and can provide early identification of elderly people at increased risk of death.
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PMID:Predictive ability of various nutritional variables for mortality in elderly people. 272 72

The pathophysiological changes occurring with increasing grade of encephalopathy were examined in 93 consecutive episodes in 44 patients with liver cirrhosis (37 posthepatic). The incidence of gastrointestinal bleeding and leukocytosis increased significantly when the grade advanced from 1 to 5. The following variables showed a trend for change that did not reach statistical significance: rising serum bilirubin, SGOT, and BUN levels; decreasing serum sodium and chloride levels; and increased incidence of infection. The mean values of the following variables were significantly different in 25 fatal episodes and 68 survivors, implicating a bad prognosis: high serum bilirubin, alkaline phosphatase, and BUN levels; low serum albumin, sodium, and chloride levels; and a higher incidence of severe infections (sepsis, infected ascitic fluid). Because increasing grade of encephalopathy is the most important factor in determining the prognosis of hepatic encephalopathy (mortality 0, 10, 5, 19, and 85 percent in grades 1 to 5, respectively), more efforts should be made to understand and prevent the pathophysiological changes associated with advancing grades of encephalopathy.
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PMID:Pathophysiological changes associated with increasing grade of hepatic encephalopathy. 324 14

DTH skin reactions can identify a population of surgical patients at increased risk for sepsis and related mortality. The usefulness of the technique is increased by repeating the test during the hospital course and by calculating a DTH score, which is the sum of the diameter of induration of all five or six tests expressed in millimeters. Regression analysis of factors that could possibly indicate development of sepsis and death after surgical treatment reveals that the most powerful predictors are serum albumin, DTH score and age of the patient. The population of patients who are anergic are more frequently malnourished than reactive patients, but the DTH response cannot be used to determine the malnourished state in individual patients. The lack of a DTH reaction (anergy) identifies an immune defect characterized by a failure of release of lymphokines in vivo. Lymphokines from normal individuals can restore to normal the absent response of anergic patients to specific antigens. In experimental animals made anergic by a heat injury, the mortality rate from bacterial peritonitis can be significantly lowered by lymphokines. Immunomodulation of demonstrated defects in host resistance is an exciting prospect for the future of surgical patients.
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PMID:Delayed type hypersensitivity testing in surgical patients. 327 96

In a historical cohort study, acute renal failure developed in 16.5% of 157 patients with rhabdomyolysis over a two-year study period. Underlying clinical, laboratory, and causative factors associated with the development of acute renal failure were examined. Factors predictive of renal failure in this setting, determined by multiple logistic regression analysis, included the degree of serum creatine kinase, serum potassium, and serum phosphorus level elevation; the degree of depression of serum albumin level; and the presence of dehydration at presentation or sepsis as the underlying cause. The predictive model that was developed correctly classified 93% of subjects and was statistically validated.
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PMID:Factors predictive of acute renal failure in rhabdomyolysis. 338 1

The incidence and the clinical implications of hypocalcemia were evaluated in acutely ill patients admitted to the Medical Intensive Care Unit of the Detroit Receiving Hospital. Total and ionized calcium levels were prospectively evaluated upon admission for all patients over a three-month interval. A high proportion of patients (62 of 88, 70 percent) were found to have decreased levels of both total and ionized calcium. Known causes of hypocalcemia could be identified in only 28 patients (45 percent). These included hypomagnesemia (17, 28 percent), renal insufficiency (five, 8 percent), alkalosis (four, 6 percent), and acute pancreatitis (two, 3 percent). In the remaining 34 patients (55 percent), no readily identifiable cause could be found. These 34 patients had a lower mean albumin level than did the 23 normocalcemic patients (p less than 0.01), but there were no differences in age, pH, serum creatinine, magnesium, or phosphate between the two groups. Serum albumin correlated directly with ionized calcium levels (n = 82, r = 0.33, p less than 0.01), as well as with total calcium levels (n = 76, r = 0.70, p less than 0.01). There was a strong association between sepsis and hypocalcemia. Patients who survived the hospitalization had higher mean ionized calcium, total calcium, and albumin values than did nonsurvivors, but there were no differences in age, serum creatinine, magnesium, and phosphate between the two groups. The mortality of the hypocalcemic patients (44 percent) was significantly greater (p less than 0.05) than the mortality of the normocalcemic patients (17 percent). These findings suggest that hypocalcemia is a very common abnormality in acutely ill patients and is associated with a poor prognosis.
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PMID:Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. 340 50

The nutritional status was analyzed in 37 patients being treated with staged anterior and posterior spinal reconstructive procedures. Using stringent criteria for nutritional and immunologic incompetency, 31 patients (84%) became malnourished during hospitalization. Although the serum albumin on admission had been normal for all patients, it became significantly depressed in 77% following anterior and posterior spinal procedures. In a similar fashion, the total lymphocyte count became significantly depressed in 92%. The postoperative complications were clearly more extensive in patients who were malnourished and immune-deficient using these criteria--15 patients with urinary tract infections, four patients with bacterial sepsis, four patients with wound infections, and four patients with pneumonia (vs. one with a wound infection in the adequately nourished group). The length of hospitalization following the second operative procedure was significantly longer in the malnourished group: 16.2 days versus 12.4 days (p less than 0.05). The main purpose of this study is to create awareness of the ongoing nutritional demands placed on patients treated by two-stage spinal reconstruction surgical procedures. More aggressive nutritional intervention can reduce postoperative complications and length of hospital stay and improve the speed of functional recovery.
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PMID:Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery. 340 99


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