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Kenneth A Kudsk - One of the best experts on this subject based on the ideXlab platform.
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Parenteral Feeding depletes pulmonary lymphocyte populations
Journal of Parenteral and Enteral Nutrition, 2009Co-Authors: Joshua L Hermsen, Enrique F Gomez, Yoshifumi Sano, Woodae Kang, Yoshinori Maeshima, Kenneth A KudskAbstract:Background: The effect of Parenteral nutrition (PN) on lymphocyte mass in the lung is unknown, but reduced mucosal lymphocytes are hypothesized to play a role in the reduced immunoglobulin A―mediated immunity in both gut and lung. The ability to transfer and track cells between mice may allow study of diet-induced mucosal immune function. The objectives of this study are to characterize lung T-cell populations following Parenteral Feeding and to study distribution patterns of transferred donor lung T cells in recipient mice. Methods: In experiment 1, cannulated male Balb/c mice are randomized to receive chow or PN for 5 days. Lung lymphocytes are obtained via collagenase digestion, and flow cytometric analysis is used to identify total T (CD3+) and B (CD45/B220+) cells. In experiment 2, isolated lung T cells from chow-fed male Balb/c mice are pooled and labeled in vitro with a fluorescent dye (carboxyfluorescein diacetate succinimidyl ester [CFSE]), and 1.1 ×10 8 CFSE+ cells (3.1 × 10 6 T cells) are transferred to chow-fed Balb/c recipients. Cells recovered from recipient lungs and intestinal lamina propria (LP) are analyzed by flow cytometry to determine CFSE/ CD3+ T cells at 1, 2, and 7 days. In experiment 3, cells are transferred to PN-fed recipients. Results: In experiment 1, PN significantly decreases lung T- and B-cell populations compared with chow Feeding. In experiment 2, CFSE+ T-cell retention is highest on day 1 in lung and LP, and decreases on day 2. Cells are gone by day 7; 98.1% of retained donor lung T cells migrate to recipient lungs and 1.9% to the intestine on day 1. Similar results are seen in experiment 3 after transfer of cells to PN-fed recipients. Conclusions: PN reduces pulmonary lymphocyte populations consistent with impaired respiratory immunity. Transferred lung T cells preferentially localize to recipient lungs rather than intestine with maximal accumulation at 24 hours. Limited cross-talk of transferred lung T cells to the intestine indicates that mucosal lymphocyte traffic might be programmed to localize to specific effector sites.
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maintaining mucosal immunity during Parenteral Feeding with surrogates to enteral nutrition
Nutrition in Clinical Practice, 2003Co-Authors: Gordon S Sacks, Kenneth A KudskAbstract:Pneumonia and intra-abdominal abscesses are significantly lower in trauma patients receiving enteral Feeding compared with those receiving Parenteral Feeding. Extensive experimental evidence suggests that this is related to maintenance of the mucosal-associated lymphoid tissue, which provides immunologic protection for both the gastrointestinal and respiratory tracts against microbial flora and infectious pathogens. This system is exquisitely sensitive to the route and type of nutrition delivery that affects its functional effectiveness. Although Parenteral nutrition decreases the effectiveness of this extraintestinal mucosal immunity, specialty nutrients like glutamine and neuropeptides such as gastrin-releasing peptide and cholecystokinin are capable of preventing some of the immune defects associated with Parenteral nutrition. This review examines the mechanisms associated with the mucosal immunity and role of both glutamine and neuropeptides in normalizing defects induced by Parenteral Feeding. Based upon evolving data, specific nutrients and products of the enteric nervous system show promise as adjuncts to Parenteral Feeding that are capable of maintaining immune function in patients unable to be fed via the gastrointestinal tract.
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enteral versus Parenteral Feeding in critical illness
2002Co-Authors: Kenneth A KudskAbstract:Hypermetabolic, critically ill patients rapidly mobilize lean tissue, releasing large quantities of amino acids into the circulating amino acid pool for distribution to the liver, intestine, bone marrow, and injured or healing tissues. Within these sites, gluconeogenesis, immune cell proliferation, and fibroblast proliferation support the body’s attempts to seal and heal its injuries while maintaining defenses against bacterial challenges. Glutamine and alanine synthesis up-regulated through the metabolism of branched-chain amino acids by skeletal muscle provide specific fuels for enterocytes and rapidly proliferating immunocytes as well as sources of carbon skeletons for gluconeogenesis [1]. In addition, amino acids from the general amino acid pool are synthesized by the liver into acute-phase production to upregulate effectiveness of the reticuloendothelial system in clearing foreign material from the bloodstream [2]. While current opinion suggests that well-nourished patients can maintain a vigorous metabolic response for a week or perhaps longer, certain mechanisms of mucosal defenses may be influenced by nutrition support even in well-nourished patients.
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enteral versus Parenteral Feeding effects on septic morbidity after blunt and penetrating abdominal trauma
Annals of Surgery, 1992Co-Authors: Kenneth A Kudsk, Martin A Croce, Timothy C Fabian, Gayle Minard, Elizabeth A Tolley, H Poret, Melody Kuhl, Rex O BrownAbstract:To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or Parenteral Feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total Parenteral nutrition 31.%, p less than 0.02), intra-abdominal abscess (1.9% versus total Parenteral nutrition 13.3%, p less than 0.04), and line sepsis (1.9% versus total Parenteral nutrition 13.3%, p less than 0.04), and sustained significantly fewer infections per patient (p less than 0.03), as well as significantly fewer infections per infected patient (p less than 0.05). Although there were no differences in infection rates in patients with injury severity score less than 20 or abdominal trauma index less than or equal to 24, there were significantly fewer infections in patients with an injury severity score greater than 20 (p less than 0.002) and abdominal trauma index greater than 24 (p less than 0.005). Enteral Feeding produced significantly fewer infections in the penetrating group (p less than 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index greater than 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p less than 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the more severely injured patients. The authors recommend that the surgeon obtain enteral access at the time of initial celiotomy to assure an opportunity for enteral delivery of nutrients, particularly in the most severely injured patients.
R. F. Tepaev - One of the best experts on this subject based on the ideXlab platform.
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Parenteral Feeding complications in pediatrics
2020Co-Authors: Russian Federation, R. F. TepaevAbstract:Статья посвящена парентеральному питанию — проведению инфузионной терапии с целью введения воды, мак-ро- и микронутриентов в соответствии с потребностями организма. Описаны различные виды парентерального питания: полное, частичное и дополнительное. Показано, что сбалансированное парентеральное питание позволяет в достаточной мере обеспечить организм ребенка аминокислотами, углеводами, жирами, энергией, необходимой для поддержания базового энергетического уровня и коррекции предшествующей нутритивной недостаточности. Белково-энергетический гомеостаз служит основой жизнедеятельности организма, определяющей активность вос-палительного ответа, адекватность иммунного статуса, длительность, тяжесть и в значительной степени — прогноз заболевания. Длительное парентеральное питание ассоциируется с различными по степени тяжести осложнениями: от транзиторных и легких, до тяжелых, требующих оперативного вмешательства, трансплантации печени. Знание современных рекомендаций позволяет практикующему врачу успешно преодолевать проблемы, ассоциированные с длительным парентеральным питанием. В работе представлены современные данные о диагностике, профилактике и лечении осложнений парентерального питания.Ключевые слова: парентеральное питание, осложнения, дети, инфузионная терапия, нутриенты.(Педиатрическая фармакология. 2013; 10 (3): 26–31)
J M D Nightingale - One of the best experts on this subject based on the ideXlab platform.
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reFeeding hypophosphataemia is more common in enteral than Parenteral Feeding in adult in patients
Clinical Nutrition, 2011Co-Authors: Sebastian Zeki, A Culkin, S M Gabe, J M D NightingaleAbstract:Summary Background & aims ReFeedinghypophosphataemia (RH) can result in sudden death. This study aimed to compare the incidence of RH between patients fed enterally and those fed Parenterally. Methods The risk of RH in adult patients fed Parenterally (PN) or nasogastrically (NG) was assessed by comparison of patient records with the UK NICE guidelines for reFeeding syndrome, between December 2007 and December 2008. A fall in serum phosphate to less than 0.6 mmol/L was indicative of RH. Results Of 321 patients,92 were at risk of RH. Of these, 23 (25%) patients developed RH ( p = 0.003). 18 (33%) of NG fed, ‘at-risk’ patients developed RH vs 5 (13%) fed Parenterally ( p = 0.03). Death within 7 days and RH were not associated. The sensitivity and specificity of the NICE criteria for defining patient’s risk of RH was calculated: 0.76 and 0.50 respectively for NG Feeding; 0.73 and 0.38 respectively for Parenteral Feeding. Conclusion Patients fed by NG tube and deemed at risk of RH are more likely to develop RH than patients fed by PN. The higher risk with NG Feeding may be due to the incretin effect from absorption of glucose. The UK guidelines lack specificity.
Rex O Brown - One of the best experts on this subject based on the ideXlab platform.
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enteral versus Parenteral Feeding effects on septic morbidity after blunt and penetrating abdominal trauma
Annals of Surgery, 1992Co-Authors: Kenneth A Kudsk, Martin A Croce, Timothy C Fabian, Gayle Minard, Elizabeth A Tolley, H Poret, Melody Kuhl, Rex O BrownAbstract:To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or Parenteral Feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total Parenteral nutrition 31.%, p less than 0.02), intra-abdominal abscess (1.9% versus total Parenteral nutrition 13.3%, p less than 0.04), and line sepsis (1.9% versus total Parenteral nutrition 13.3%, p less than 0.04), and sustained significantly fewer infections per patient (p less than 0.03), as well as significantly fewer infections per infected patient (p less than 0.05). Although there were no differences in infection rates in patients with injury severity score less than 20 or abdominal trauma index less than or equal to 24, there were significantly fewer infections in patients with an injury severity score greater than 20 (p less than 0.002) and abdominal trauma index greater than 24 (p less than 0.005). Enteral Feeding produced significantly fewer infections in the penetrating group (p less than 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index greater than 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p less than 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the more severely injured patients. The authors recommend that the surgeon obtain enteral access at the time of initial celiotomy to assure an opportunity for enteral delivery of nutrients, particularly in the most severely injured patients.
Stephen J Okeefe - One of the best experts on this subject based on the ideXlab platform.
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physiological response of the human pancreas to enteral and Parenteral Feeding
Current Opinion in Clinical Nutrition and Metabolic Care, 2006Co-Authors: Stephen J OkeefeAbstract:Purpose of ReviewNormal digestive physiology is a highly orchestrated process, integrating the mechanical breakdown of food, the secretion of digestive juices, the control of motility, and the efficient absorption of nutrients. As enteral and Parenteral Feeding techniques bypass many of these contro
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physiological effects of enteral and Parenteral Feeding on pancreaticobiliary secretion in humans
American Journal of Physiology-gastrointestinal and Liver Physiology, 2003Co-Authors: Stephen J Okeefe, Frank P Anderson, Chris Gennings, Souheil G Abouassi, John N Clore, Douglas M Heuman, William Y CheyAbstract:In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and Parenteral Feeding. Twenty-seven healthy volunteers were ...
