Nutrition support of the trauma patient

Hypercatabolism after trauma may lead to acute protein malnutrition, ultimately resulting in multiple organ failure. Nutrition support may prevent this sequence. This review addresses the need for early nutrition support, the preferred route of substrate delivery, and the potential advantages of "immune-enhancing" diets.     

胃肠道肿瘤病人营养支持

肿瘤是当前常见病之一，胃肠道肿瘤病人有多种原因可引起营养不良。因此有必要对胃肠道肿瘤病人营养不良进行分析、评估，以便临床治疗。有研究表明，营养支持是肿瘤综合治疗中不可缺少的一个环节。     

Nutrition and the patient requiring mechanical ventilatory support

Respiratory function in mechanically ventilated patients (VP) is adversely affected by starvation and hypermetabolic stress. These patients are more successfully managed and extubated if proper nutritional support is provided. The features of metabolism and respiratory function in VP require moderation in glucose, fat, and protein administration. In delivering energy to VP, attention must be given to nearby tracheostomy sites complicating the parenteral route and airway-cuff problems that may inhibit effective enteral feeding.     

Nutrition and the patient requiring mechanical ventilatory support.

Respiratory function in mechanically ventilated patients (VP) is adversely affected by starvation and hypermetabolic stress. These patients are more successfully managed and extubated if proper nutritional support is provided. The features of metabolism and respiratory function in VP require moderation in glucose, fat, and protein administration. In delivering energy to VP, attention must be given to nearby tracheostomy sites complicating the parenteral route and airway-cuff problems that may inhibit effective enteral feeding.     

肝移植术后合并高位肠瘘营养支持一例报告

本文报导一例“胆囊切除、脾切除、胆总管十二脂肠吻合术”后一年行肝移植术、术后合并高位肠瘘病人营养支持。术后1～3天，采用PN。此期的供热量为(930±152)kcal/d。术后第四天开始肠内营养，给低脂、低蛋白、高碳水化合物流质饮食，肠内供给热能由652Kcal/d起逐渐加至1150kcal/d，供氮量为0.24g     

Nutrition support for the patient with an open abdomen after major abdominal trauma

OBJECTIVE: Nutrition support in the severely injured trauma patient is crucial to minimize the hypermetabolic stress response. Even though enteral nutrition is the preferred method of feeding, it is not always feasible after multiple trauma. We present a complex nutritional case in a patient who sustained severe abdominal trauma with a severe liver injury, rib fractures, and pulmonary contusion. METHODS: The patient required several repeat laparotomies, abdominal packing, and temporary abdominal closure. The clinical course was complicated by hypotension requiring multiple vasopressors; coagulopathy requiring more than 35 U of packed red cells, more than 50 U of fresh frozen plasma, and more than 80 U of platelets; acute renal failure requiring dialysis; and pneumonia and acute respiratory distress syndrome requiring intricate ventilator management. Nutrition intervention began on post-trauma day 4 with total parenteral nutrition due to hypotension, resuscitation, and massive bowel edema; by post-trauma day 8. the patient was receiving goal nutrients. RESULTS: On post-trauma day 27, bowel edema was significantly less, and a nasoenteric feeding tube was placed and enteral feeding initiated. By post-trauma day 31, full enteral feeds were tolerated, and total parenteral nutrition was stopped. Nutrient provision was adjusted daily to account for organ and metabolic changes including hepatic, pulmonary, and renal dysfunction. The patient did well and was eventually extubated and eating a regular diet. CONCLUSION: With careful monitoring and adjusting of the nutritional plan, a hypermetabolic complex trauma patient with an open abdomen can be fed optimally, safely, and successfully despite increased bowel edema and multiple organ dysfunction.     

Nutrition support in the morbidly obese, critically ill patient.

Nutrition support in the critically ill patient is challenging but is even more difficult in a morbidly obese patient. This case report chronicles the care of a 6-foot-tall, 256-kg male (body mass index 76.5 kg/m(2)) who spent over a month in the intensive care unit for respiratory failure, sepsis, and acute renal failure. Parenteral nutrition was provided throughout his critical care course. One of the major difficulties encountered was determining his nutritional needs. A hypocaloric nutritional regimen was used, along with moderate protein provisions. Numerous electrolyte imbalances occurred, including hypercalcemia that did not resolve by eliminating calcium from the parenteral nutrition solution. Enteral nutrition was desired but was not used initially because of a need for vasopressors, a diagnosis of pancreatitis, difficulty in documenting feeding tube placement because of diagnostic limitations secondary to the patient's large size, and concern about managing stools. Eventually, oral intake and supplemental enteral feeding were initiated. Nutrition support team members worked closely with the interdisciplinary care team to develop strategies to manage the nutritional problems related to his obesity. A discussion of the various nutritional issues encountered in the care of this patient is provided. Reasonable nutritional status was achieved, but this case reflects some of the challenges encountered in caring for the nutritional needs of select patient populations in clinical practice and the need for increased research and guidelines in this area.     

Nutrition care of AIDS patients

Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss and protein depletion are commonly seen among the AIDS population. Though the relationship between disease progression and nutritional status has not been established, maintaining good nutritional status may support response to treatment of opportunistic infections and improve patient strength and comfort. Increased nutrient needs, decreased nutrient intake, and impaired nutrient absorption contribute to malnutrition in AIDS patients. Causes of decreased nutrient intake and absorption may be poor appetite, oral and esophageal pain, mechanical problems with eating, and gastrointestinal complications (diarrhea and malabsorption). Causes of these impediments to maintaining nutritional status are discussed, and suggestions to overcome them are given. Dietitians working with AIDS patients need to understand how the complications of the disease might affect nutritional status so that strategies for nutrition treatment can be developed. Nutrition care of AIDS patients requires that dietitians and their support personnel provide supportive, nonjudgmental care. The patients should be included in decision making regarding their nutrition care. Caring for AIDS patients in the community and through home care agencies represents an area in need of the expertise of a dietetics professional.     

心功能不全患者的临床营养支持

合理的营养支持能有效延缓心功能不全向心功能衰竭的发展过程,延长生存期,提高生活质量.本文总结了心功能不全患者的营养代谢特点、营养风险筛查与营养状态评估方法、营养素需求及营养支持的应用等方面的进展,并对急性心功能不全的营养代谢支持进行讨论.     

Nutrition support for individuals with liver failure

The prevalence of liver diseases is increasing in the United States, particularly as a result of the recent hepatitis C epidemic. In the past, patients who developed fulminant hepatic failure or cirrhosis owing to a chronic liver disease were likely to expire. During the last 15-20 years, liver transplantation has given these patients a chance at survival. Progressive nutrition deficiencies and muscle wasting are universal problems in these patients. Left untreated, the progressive wasting of liver disease leads to infection and an increased risk of death owing to infection both before and after transplantation. Aggressive nutritional support is essential to optimize the care of these patients and to enable them to obtain and survive a liver transplant and gain access to a new life following a successful liver engraftment.     

心功能不全患者的临床营养支持

合理的营养支持能有效延缓心功能不全向心功能衰竭的发展过程,延长生存期,提高生活质量.本文总结了心功能不全患者的营养代谢特点、营养风险筛查与营养状态评估方法、营养素需求及营养支持的应用等方面的进展,并对急性心功能不全的营养代谢支持进行讨论.

Abstract：

Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.