Sepsis Support Research Articles

Proline, lactate and cholesterol metabolism during high-dose branched chain amino acid (BC) support in sepsis : [formula omitted], I. Giovannini, J.H. Siegel, G. Boldrini, W.P. Cole man, M. Castagneto. MIEMSS: University of Maryland, Baltimore, USA, and Centro di Studio per la Fisiopatologia dello Shock, CNR, Catholic University, Rome, Italy

Proline, lactate and cholesterol metabolism during high-dose branched chain amino acid (BC) support in sepsis : [formula omitted], I. Giovannini, J.H. Siegel, G. Boldrini, W.P. Cole man, M. Castagneto. MIEMSS: University of Maryland, Baltimore, USA, and Centro di Studio per la Fisiopatologia dello Shock, CNR, Catholic University, Rome, Italy

Infusion of branched chain-enriched amino acid solutions in sepsis

The goal of nutritional support in sepsis is, as in other conditions, to prevent the use of endogenous protein as an energy substrate and, ideally, to promote the synthesis of proteins specifically required in responding to the particular insult or stress at hand. This entails provision of an utilizable fuel, in sufficient quantity, that does not inhibit the use of endogenous nonprotein sources; preservation of the existing protein mass by minimizing skeletal muscle and visceral proteolysis; provision of amino acids in sufficient quantity and in the appropriate proportions such that protein synthesis is optimized. Specifically, this includes the synthesis of those proteins required to maintain hyperdynamic function of the essential organs as well as the hepatic and leukocytic synthesis of proteins required in immunologic defense. This study has assessed one aspect of this goal during the administration of nutrient solutions differing primarily in branched chain amino add content We conclude that leucine is fundamental among the branched chain amino acids for reducing skeletal muscle proteolysis. Solutions designed for sepsis or stress should, therefore, contain adequate amounts of this amino acid.

Nutritional Support in Sepsis

Sepsis induces a complex series of host metabolic adjustments, involving muscle proteolysis and hepatic gluconeogenesis. Successful hemodynamic management of the initial phase of shock has lead to survivors who face the prospect of eventual mortality (50 per cent) from this septic episode one to two weeks later. Surgery and use of antibiotics may minimize the invasive infection and eradicate the source. Continued support in the form of cardiorespiratory, renal, and nutritional support provide time, but these measures are only supportive. Nutrition does allow for important protein synthesis. Essential to eventual survival is the ability of the host to contain and resolve the infective microorganism.