Effects of intravenous fat emulsions on lung function in patients with acute respiratory distress syndrome or sepsis.
ABSTRACT To investigate whether rapid or slowly infused intravenous fat emulsions affect the ratio of prostaglandin I2/thromboxane A2 in arterial blood, pulmonary hemodynamics, and gas exchange.
Prospective, controlled, randomized, crossover study.
Operative intensive care unit of a university hospital.
Eighteen critically ill patients. Ten patients were stratified with severe sepsis, and eight patients had acute respiratory distress syndrome (ARDS).
Patients were assigned randomly to receive intravenous fat emulsions (0.4 x resting energy expenditure) over 6 hrs (rapid fat infusion) or 24 hrs (slow fat infusion) along with a routine parenteral nutrition regimen, by using a crossover study design.
Systemic and pulmonary hemodynamics as well as gas exchange measurements were recorded via respective indwelling catheters. Arterial thromboxane B2 and 6-keto-prostaglandin-F1alpha plasma concentrations were obtained by radioimmunoassay, and 6-keto-prostaglandin-F1alpha/thromboxane B2 ratios (P/T ratios) were calculated. Data were collected immediately before and 6, 12, 18, and 24 hrs after onset of fat infusion. In the ARDS group, P/T ratio increased by rapid fat infusion. Concomitantly, pulmonary shunt fraction, alveolar-arterial oxygen tension difference [P(a-a)o2]/Pao2, and cardiac index increased as well, whereas pulmonary vascular resistance and Pao2/Fio2 declined. After slow fat infusion, a decreased P/T ratio was revealed. This was accompanied by decreased pulmonary shunt fraction, lowered P(a-a)o2/Pao2, and increased Pao2/Fio2. Correlations between plasma concentrations of 6-keto-prostaglandin-F1alpha or thromboxane B2 and measures of respiratory performance could be shown during rapid and slow fat infusion, respectively. In the sepsis group, the P/T ratio remained unchanged at either infusion rate, but pulmonary shunt fraction and P(a-a)o2/Pao2 decreased after rapid fat infusion, whereas Pao2/Fio2 increased.
Pulmonary hemodynamics and gas exchange are related to changes of arterial prostanoid levels in ARDS patients, depending on the rate of fat infusion. In ARDS but not in sepsis patients clear of pulmonary organ failure, a changing balance of prostaglandin I2 and thromboxane A2 may modulate gas exchange, presumably via interference with hypoxic pulmonary vasoconstriction.
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ABSTRACT: Therapy of intensive care patients is often complicated by co-morbidities or complex systemic disorders such as sepsis. The necessity to generate an individualized nutritional regime has gained in importance in recent years as this essential part of supportive care has a direct impact on the prognosis of the patient. In the present article a special focus is put on particular questions of nutritional aspects of intensive care patients. The current guidelines and study data on disorders relevant in intensive care medicine, such as acute or chronic renal and liver failure, acute respiratory distress syndrome and sepsis are presented and discussed. Another focus is the establishment of an adequate nutritional regime for patients after operations or suffering from multiple trauma.Der Anaesthesist 03/2013; · 0.85 Impact Factor
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ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.Regional Anesthesia and Pain Medicine 04/2011; 36(3):310-311. · 3.46 Impact Factor
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ABSTRACT: It is increasingly recognized that the nutrition of critically ill patients is a highly complex activity with many unanswered questions. Much research has been performed showing that early enteral nutrition helps to avoid complications. In addition, it has already been shown that the calorie goal as the sole diet goal rather plays a minor role, if one pays attention to sufficient supply of proteins. The diet of the different patient groups with their very individual physiological conditions and their very different diseases are another difficile question in nutritional therapy. The question about the best access path currently appears clearly to be the way of enteral nutrition. Although there seems to be no clear advantage to the gastric or jejunal route, the gastric tube is apparently used more often in clinical practice due to the ease of placement. Reflux control is also currently controversially discussed. To assess the intestinal transport capacity, control of reflux is inevitable, but the amount of reflux that should be considered as cut-off criteria is still unclear. The field of immunonutrition or the substitution of selenium, glutamine, and other substances requires further research. The goal of this article is to provide the reader with a review of the current literature concerning nutritional needs of intensive care patients.Medizinische Klinik, Intensivmedizin und Notfallmedizin. 01/2014;