Santiago, Chile. Stress hyperglycemia is frequently diagnosed in septic patients in critical care units ICU and it is associated with greater illness severity and higher morbimortality rates. In response to an acute injury, high levels of counterregulatory hormones such as glucocorticoids and catecholamines are released causing increased hepatic gluconeogenesis and insulin resistance. Furthermore, during sepsis, proinflammatory cytokines also participate in the pathogenesis of this phenomenon. Septic patients represent a subtype of the critical ill patients in the ICU: this metabolic disarrangement management strategies and insulin therapy recommendations had been inconsistent. In this article, we describe the pathophysiological mechanisms of stress hyperglycemia in critical patients including the action of hormones, inflammatory cytokines and tissue resistance to insulin.
|Genre:||Health and Food|
|Published (Last):||16 March 2004|
|PDF File Size:||8.56 Mb|
|ePub File Size:||16.18 Mb|
|Price:||Free* [*Free Regsitration Required]|
Nutritional metabolic management, together with other treatment and support measures used, is one of the mainstays of the treatment of septic patients. Nutritional support should be started early, after initial life support measures, to avoid the consequences of malnutrition, to provide adequate nutritional intake and to prevent the development of secondary complications such as superinfection or multiorgan failure..
As in other critically-ill patients, when the enteral route cannot be used to ensure calorie-protein requirements, the association of parenteral nutrition has been shown to be safe in this subgroup of patients.
Studies evaluating the effect of specific pharmaconutrients in septic patients are scarce and are insufficient to allow recommendations to be made.. To date, enteral diets with a mixture of substrates with distinct pharmaconutrient properties do not seem to be superior to standard diets in altering the course of sepsis, although equally there is no evidence that these diets are harmful..
There is insufficient evidence to recommend the use of glutamine in septic patients receiving parenteral nutrition.
However, given the good results and absence of glutamine-related adverse effects in the various studies performed in the general population of critically-ill patients, these patients could benefit from the use of this substance. Routine use of omega-3 fatty acids cannot be recommended until further evidence has been gathered, although the use of lipid emulsions with a high omega-6 fatty acid content should be avoided. Septic patients should receive an adequate supply of essential trace elements and vitamins.
Further studies are required before the use of high-dose selenium can be recommended.. ISSN: Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Descargar PDF. Ortiz Leyba a ,?? Autor para correspondencia. Palabras clave:. Nutritional support should be started early, after initial life support measures, to avoid the consequences of malnutrition, to provide adequate nutritional intake and to prevent the development of secondary complications such as superinfection or multiorgan failure.
Studies evaluating the effect of specific pharmaconutrients in septic patients are scarce and are insufficient to allow recommendations to be made. To date, enteral diets with a mixture of substrates with distinct pharmaconutrient properties do not seem to be superior to standard diets in altering the course of sepsis, although equally there is no evidence that these diets are harmful.
Further studies are required before the use of high-dose selenium can be recommended. Dellinger, M. Levy, J. Carlet, J. Bion, M. Parker, R. Jaeschke, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: Crit Care Med, 36 , pp. Ortiz Leyba, M. Planas, J. Montejo, R. Parenteral administration of different amounts of branch-chain amino acids in septic patients: clinical and metabolic aspects. Crit Care Med, 25 , pp.
Montejo, A. Mesejo, P. Marco, S. Celaya, J. An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med, 28 , pp. Pontes-Arruda, A. Aragao, J. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock.
Crit Care Med, 34 , pp. B6 Medline. Schunn, J. Small bowel necrosis associated with postoperative jejunal tube feeding. J Am Coll Surg, , pp. Frey, J. Takala, L. Non-occlusive small bowel necrosis during gastric tube feeding: A case report. Intensive Care Med, 27 , pp. McClave, W. Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel?. Nutr Clin Pract, 18 , pp.
Elke, D. Engel, H. Bogatsch, I. Frerichs, M. Ragaller, et al. German Competence Network Sepsis SepNet Current practice in nutritional support and its association with mortality in septic patients--results from a national, prospective, multicenter study. Ortiz-Leyba, J. Garnacho-Montero, A. Sepsis, mortality, and parenteral nutrition: the risk of dualism on nutritional support.
Crit Care Med, 37 , pp. Bertolini, G. Lapichino, D. Radrizzani, R. Facchini, B. Simini, P. Bruzzone, et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med, 29 , pp. Kieft, A. Roos, J. Van Drunen, A. Bindels, J. Bindels, Z. Clinical outcome of immunonutrition in a heterogeneous intensive care population. Intensive Care Med, 31 , pp. Heyland, F. Novak, J. Drover, M. Jain, X. Su, U. Should immunonutrition become routine in critically ill patients: a systematic review of the evidence.
JAMA, , pp. Zarazaga, J. Urrutia, M. Blesa, et al. A systematic review and consensus statement. Clin Nutr, 22 , pp. Marik, G. Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med, 34 , pp. Grau Carmona, V. Heras de la Calle, B. Quesada Bellver, J. Effect of an enteral diet enriched with eicosapentaenoic acid, gammalinolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr, ,.
Fisiopatologia: papel dos mediadores e do agente bacteriano. O papel do agente bacteriano. The host response to sepsis and developmental impact. Blood cytokines during the perinatal period in very preterm infants: relationship of inflammatory response and bronchopulmonary dysplasia.
Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Joseph A. Carcillo, MD, Alan I. A fisiopatologia do choque e a resposta a terapias variam de acordo com a idade do paciente. Background: the Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. Objective: to provide American College of Critical Care Medicine clinical guidelines for hemodynamic support of neonates and children with septic shock. Setting: individual members of the Society of Critical Care Medicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia
To describe abnormalities in coagulation and fibrinolysis in septic shock with purpura and to assess the relationship between plasma plasminogen activator inhibitor-1 PAI-1 concentrations and multiple organ system failure MOSF.. Observational study in the pediatric intensive care unit of a tertiary care hospital. The presence of early MOSF was assessed at admission in 15 children with septic shock and purpura consecutively admitted to the pediatric intensive care unit. Blood samples were taken to determine coagulation and fibrinolysis parameters.. At admission, MOSF was diagnosed in 7 patients Coagulation parameters were generally affected but statistically significant differences were found only in concentrations of fibrinogen and antithrombin III, which were lower in patients with MOSF than in those without organ dysfunction.
Le pressioni ventricolari di riempimento e i volumi risultano aumentati e la pressione arteriosa media ridotta: ad una diminuzione della gittata cardiaca segue ipotensione che porta ad una diminuita perfusione ai tessuti e ad anossia cerebrale . Le cause di disfunzione cardiaca che possono esitare in shock sono  :. Avviatosi il processo scatenante la sindrome, l'ipoperfusione dei tessuti porta ad una disfunzione multi-organo, che aumenta e peggiora lo stato di shock: diverse sostanze vengono riversate nel torrente circolatorio dai vasocostrittori come le catecolamine , a varie chinine , istamina , serotonina , prostaglandine , radicali liberi , attivazione del sistema del complemento e fattore di necrosi tumorale. Tutte queste sostanze non fanno altro che danneggiare gli organi vitali come rene , cuore , fegato , polmone , intestino , pancreas e cervello . Gli esami per la diagnosi differenziale delle diverse sindrome da shock, utilizzano il semplice prelievo del sangue sino a metodiche molto sofisticate  :. I pazienti con shock cardiogeno evidente richiedono un trattamento complesso e spesso un approccio multidisciplinare  .