Abstract
Glutamine-enriched total parenteral nutrition (TPN) is beneficial in reducing both infective complications and mortality of critically ill patients. Similar results were observed in bone marrow transplant patients, as well as increased circulating numbers of lymphocytes, in particular T-cell subsets. An increase was observed in T-cell DNA synthesis in colorectal cancer patients receiving glutamine-enriched TPN. However, TPN is associated with complications such as intestinal atrophy, and enteral nutrition is now the preferred route. The present study assessed the effects of feeding glutamine enterally in 14 intensive care patients who were not immunosuppressed. Blood samples were analysed for plasma glutamine concentration (enzymatically), lymphocyte proliferation via 3H thymidine incorporation into DNA (counts per minute — CPM) with and without mitogenic stimulation (Concanavalin-A), neutrophil activity (using an oxidative burst technique) and cytokine production in culture medium (IL-2 and IL-8). Patients were randomly divided into two groups and fed 15-g bolus doses in water of either glutamine (n = 7; 60 ± 8 years) or placebo (n = 7; 60 ± 6 years) for 5 days. Nasogastric nutrition was discontinued daily at midday and a blood sample was taken; 1 hour later, a bolus dose of glutamine/placebo was administered via the tube; 2 hours later total nutrition was started again. Lymphocyte proliferation increased in the glutamine group (P < 0.04) compared with the placebo, as measured by CPM and the stimulation index. IL-2 production increased in culture medium from Day 0 to Day 5 for patients receiving glutamine (P < 0.02) compared with the placebo group. IL-8 production, neutrophil numbers or activity, and plasma glutamine did not change. Our results suggest that glutamine is able to induce an IL-2 mediated increase in the proliferative ability of T-cells, and we hypothesise that these changes may underlie previously observed clinical benefits from glutamine administration in critically ill patients.
Highlights
In our experience, very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient
TMSORG for R, C, N and Re were significantly associated with HM
P109 How we reduce allogenic blood transfusions in the patients undergoing surgery of ascending aorta D Radojevic, Z Jankovic, B Calija, M Jovic, B Djukanovic
Summary
Very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient. There is evidence that increasing the dose of continuous renal replacement therapy (CRRT) is associated with improved survival in critically ill patients with acute renal failure (ARF) [1]. The aim of this study is to investigate if there is any difference in patients’ characteristics in ICU between COPD and nonCOPD diseases caused chronic respiratory failure and require mechanical ventilation during acute exacerbations. Noninvasive positive pressure ventilation (NPPV) has been reported to be beneficial in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), and to facilitate weaning In this trial we assessed the possible benefit of early NPPV in patients with blunt chest trauma and acute respiratory failure. The aim of this study was to compare the pharmacokinetic and pharmacodynamic parameters and the clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in critically ill adults patients with gram negative bacilli infection. The purpose of the study is to identify the factors associated with DNR status in our institution
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