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

Parenteral nutrition via central venous catheterization is associated with serious risks, especially that of sepsis. Lipid emulsion (Intralipid[Sweden]), which may be administered peripherally, was evaluated for its potential to support microbial growth. Washed cultures of Staphylococcus aureus, Candida albicans, and three species of Gram-negative rods were all capable of multiplying in the emulsion at room temperature. Variations in inoculum size did not affect the growth rate. Studies comparing the emulsion to amino acid-glucose solutions (total parenteral nutrition [TPN])confirmed other reports that TPN inhibits the growth of certain bacteria but merely retards fungal multiplication. When human serum was added to the lipid emulsion in an attempt to simulate in vivo conditions at the catheter tip, Escherichia coli was inhibited while the growth of S aureus and C albicians was unaltered.
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PMID:Microbiol growth in lipid emulsions used in parenteral nutrition. 0 Sep 82

Sepsis continues to be one of the most feared complications of total parenteral nutrition. Many techniques have been advocated for dressing changes, solution preparation, and evaluation of patients with fever spikes. Our technique in evaluating such a patient with suspected sepsis is to remove the tubing and solution from the pumping mechanism and place the bottle below the patient, permitting approximately 10 cc of blood to flow into the tubing. The entire set-up of solution and tubing is then quickly replaced and the infusion resumed. The removed blood is transferred to a series of three standard blood culture bottles. The first bottle will be culturing blood; the second, a mixture of blood and infusate; the third, solution alone. When performed carefully, negative culture results appear to exclude TPN as a source of spesis. Positive results are obviously helpful, but must be interpreted with caution in that the blood, catheter, tubing, filter, or solution may be suspect.
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PMID:A technique for evaluating sepsis in TPN patients. 9 53

During the five-year interval from January 1, 1971 to January 1, 1976 118 seriously ill adults received 2916 patient days of TPN therapy with an average infection rate of 7.6%. All patients received the benefit of a well-defined TPN catheter care protocol which emphasized regular (every 48 hours) catheter dressing changes. The lowest risk of infection, 2.7%, was seen in 73 patients who received an amino acid-glucose solution through a silicone elastomer catheter protected by an iodophor dressing. When catheter-related sepsis occurred, Staphlylococcus aureus and Candida albicans were the most common organisms cultured.
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PMID:Catheter infection factors affecting total parenteral nutrition. 9 66

Intravenous nutrition has become a necessary part of comprehensive critical care. The guidelines that surround the technique render it both safe and effective, but are not always practical in the patient with sepsis or multisystem failure who has a shortage of sites for catheter insertion. After an 8 year experience in a multidisciplinary ICU in which 40 per cent of patients admitted are fed parenterally, modified techniques have been developed so a more aggressive and liberal approach can be used for treating acutely ill patients. Additional crystalloid fluids and medications can be administered through the TPN catheter, high calorie levels can be used initially, and TPN can be stopped abruptly and insulin dosages as high as 28 U. per hour administered safely. When critically ill patients undergo major surgery TPN may be continued. This is made possible by a well oriented and well trained staff, competent to both follow and act on the results of very close monitoring in a special care area with efficient stat laboratory backing. Complication rates have to be kept low by rigorous supervision of both catheter insertion and aftercare. This has made frequent catheter changes a practical safety measure. Management and monitoring protocols are presented. The well established protocols for the management of TPN are adhered to for the routine support of nutrition.
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PMID:Aggressive approach to intravenous feeding of the critically ill patient. 10 64

Total parenteral nutrition TPN has been used to treat or prevent malnutrition in 65 children with a variety of solid tumors and leukemia in the past 7 years. TPN was used in 58 patients with gastrointestinal complications of surgery, chemotherapy, or radiation; in 2 patients for preoperative correction of malnutrition; and in 8 who were entered into a prospective study. During TPN, general nutrition and appearance improved in all patients. Weight gain was noted in most. Despite gastrointestinal complications, which usually require the interruption of chemotherapy and radiation, treatment could be continued at full dose in 31 children with nutritional support by TPN. TPN was discontinued in 6 patients when blood cultures became positive. Sepsis was treated successfully by removal of the central venous catheter in all 6 and administration of antibiotics in 3. TPN appears to be safe and effective means of combating malnutrition which may occur with cancer and its therapy.
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PMID:Parenteral feeding in the management of children with cancer. 10 88

A home program of total parenteral nutrition (HTPN) has been developed for managing patients with severe chronic small bowel disease who would otherwise be unable to leave the hospital. Six such children were treated by this program using a Broviac catheter to shorten hospitalization, to decrease the cost of care, and to normalize their lives as much as possible. They ranged in age from 2 1/4-17 yr and received HTPN for periods of from 1-11 mo. Criteria for instituting this therapy were the inability to maintain fluid and nutritional balance on therapeutic diet or oral formula, or a need for 30 or more days of conventional TPN. The 6 patients had a total of 1139 days on HTPN with 1 episode of catheter sepsis and 1 localized infection at the catheter site. None of the catheters clotted but 1 was accidentally dislodged. Small bowel adaptation occurred in 4 of the 6 patients. This allowed gradual discontinuous of HTPN and reinstitution of total oral alimentation.
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PMID:Home total parenteral nutrition: an alternative approach to the management of children with severe chronic small bowel disease. 40 77

Two regimens (A and B) for TPN were designed to meet the requirements of newborn infants for calories, amino acids, fatty acids, electrolytes, trace elements and vitamins. Both "A" and "B" included fat emulsion (Intralipid). "A" contained fructose and glucose, "B" glucose only. "A" provided amino acids (Vamin) in proportions similar to those of whole egg, "B" similar to those of human milk. All nutrients were given simultaneously into peripheral veins by constant infusion. Nineteen patients (11 newborns, 8 infants) were studied for 1-28 days. Twelve infants recovered, 7 died. In none could TPN be regarded as the cause of death. Treatment was complicated by sepsis in 5 infants. During the course of treatment, blood levels of substrates and insulin were measured before, during and 30 min after discontinuation of TPN. Highly raised concentrations of circulating substrates seen in 3 infants seemed to be related to a poor clinical condition rather than to the regimen used. Infants in good condition tolerated TPN well. Low levels of branch-chained amino acids and tendency to ketonemia, when infusion was stopped, suggested that minimal rather than optimal supply of energy and of amino acids in relation to energy was provided with both regimens. Low insulin levels associated with elevated blood levels of substrates suggested that insulin administration to selected cases might be indicated. Fructose (0.30 g/kg X hour-1) given with regimen A increased blood lactate concentrations. Homocystinaemia appeared in 2 cases; disappearance after excess vitamin B6 administration indicated increased B6 requirement.
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PMID:Total parenteral nutrition in infants. Blood levels of glucose, lactate, pyruvate, free fatty acids, glycerol, d-beta-hydroxybutyrate, triglycerides, free amino acids and insulin. 40 94

We analyzed the course of 186 patients with external gastrointestinal fistulas treated at the University of California Medical Center, San Francisco from 1968 to 1977. There were 82 patients in the earlier group (1968-1971) and 104 patients in the later group (1972-1977). The groups differed in that 35% of patients in the earlier group received TPN, but 71% of patients in the later group received TPN. Of the patients who did not receive TPN, 93% had been adequately nourished using tube feeding methods. The two groups were otherwise similar. The fistula-related mortality (11%) and the spontaneous closure rate of the fistulas (32%) was unchanged over the ten year period. Thus, the principal impact of TPN was to simplify the nutritional management rather than to alter the outcome. When malignancy, previous abdominal irradiation, Crohn's disease, or a short (<2 cm) fistula tract were present, spontaneous closure was less likely than when none of these factors were present (20% versus 47%). Sixty-eight per cent of the deaths occurred in patients with uncontrolled sepsis. Fifty per cent of the deaths were due to the primary disease and were unrelated to the fistula. Spontaneous closure could not be expected to start until sepsis was controlled. Because over 90% of patients whose fistulas closed spontaneously did so within one month after infection was eradicated, we recommend operative closure for most fistulas that persist beyond that time. The most reliable operation is excision of the bowel from which the fistula arises with end-to-end anastomosis. Fistulas not amenable to excision should be managed by bypass.
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PMID:Management of external gastrointestinal fistulas. 69 30

1. The effect of total parenteral nutrition with or without glutamine enrichment was studied in septic rats after 4 days of treatment. 2. Septic rats treated with glutamine-enriched total parenteral nutrition survived sepsis significantly better than other TPN-treated septic rats: the cumulative percentage of deaths over 4 days in septic rats treated with glutamine-enriched total parenteral nutrition was 25% compared with 55% in septic rats given total parenteral nutrition without glutamine and 70% in septic rats given glucose. 3. Glutamine-enriched total parenteral nutrition resulted in improved nitrogen balance in septic rats: the cumulative nitrogen balance over the 4 days of treatment was the least negative as compared with other groups of septic rats. 4. The rate of loss of intracellular glutamine in skeletal muscle was markedly decreased (P less than 0.001) in response to glutamine-enriched total parenteral nutrition in septic rats. 5. The rate of protein synthesis was increased (21.2%) and the rate of protein degradation was decreased (35.5%) in response to glutamine-enriched total parenteral nutrition in septic rats. 6. It is concluded that the administration of glutamine-enriched total parenteral nutrition is beneficial to septic rats and possibly to septic patients.
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PMID:Effect of glutamine-enriched total parenteral nutrition on septic rats. 165 66

Wistar rats were divided into two groups, intraperitoneal sepsis group (group IS) and total parenteral nutrition group (group TPN), to evaluate the characteristics of pathologic alterations in rats with cholestasis. Biochemical assay showed that cholestasis developed in both groups after 10 days. Light microscopic examination of liver specimens revealed that the degeneration in the intermediate and external zone of hepatolobules was the major alteration in group IS, and group TPN showed characteristic dilation of central veins and hepatic sinuses and the proliferation of Kupffer cells with marked phagocytosis. Electron microscopic pictures presented the enlargement of bile canaliculi with altered microvilli in group IS and many highly electron-dense bile particles within cytoplasm and secondary lysosomes near dilated bile canaliculi in group TPN. It is concluded that there were different histopathologic alterations of liver specimens in TPN-supported animals and septic animals when cholestasis developed. It is unsuitable to take intraperitoneal sepsis as a unique factor of cholestasis in TPN-supported rats. Bile stasis is only one sign of TPN-induced hepatic lesion, which needs further exploration to determine its causes and mechanisms.
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PMID:Histopathologic study of cholestasis induced by total parenteral nutrition or intraperitoneal sepsis in rats. 176 53


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