A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis

Détails

ID Serval
serval:BIB_1D238A68C2A1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis
Périodique
Clinical Nutrition
Auteur⸱e⸱s
Roulet  M., Detsky  A. S., Marliss  E. B., Todd  T. R., Mahon  W. A., Anderson  G. H., Stewart  S., Jeejeebhoy  K. N.
ISSN
0261-5614 (Print)
Statut éditorial
Publié
Date de publication
07/1983
Volume
2
Numéro
2
Pages
97-105
Notes
Journal Article --- Old month value: Jul
Résumé
Energy and protein metabolism was studied in 11 septic patients receiving ventilatory support while on three different intravenous regimens. They received 5% dextrose in water (D5W), and one of two different regimens of parenteral nutritional support (PNS); either amino acid and dextrose (PNA) or amino acid and dextrose and lipid (PNB). All patients were given D5W and PNS in random order. The energy intake was targetted to exceed by 50% the measured metabolic rate. On D5W the mean measured energy expenditure was only 15.2% above the expected energy expenditure (p<0.02). A respiratory quotient of 0.75 while on D5W showed that in the absence of PNS the major part of energy requirements came from fat oxidation. In addition, on D5W these patients were in negative nitrogen and protein (synthesis-catabolism) balance. With PNS the metabolic rate rose significantly (p<0.02). While on PNA, the CO(2) production was significantly higher than with PNB, and despite receiving all non-protein energy as glucose, the patients continued to oxidise fat to meet about 30% of their energy requirements. Continued fat oxidation was found to be associated with insulin resistance and high catecholamine levels, suggesting a cause and effect relationship. PNS caused an increase in protein (synthesis - catabolism) and nitrogen balances, and reduced leucine oxidation. The fall in leucine oxidation was greater on PNB than on PNA. Protein and nitrogen balances, expressed per gram of amino acid infused, were significantly better with PNB than PNA. It was concluded that insulin resistance may make fat an efficient source of energy.
Pubmed
Création de la notice
24/01/2008 20:33
Dernière modification de la notice
20/08/2019 12:53
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