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Biomedical subjects

G Grimble

Publications and source records attributed to G Grimble.

12 recordsLinked to original sources
PubMed2003

Nutritional support in critically ill children.

BACKGROUND & AIMS: Enteral nutrition is the feeding method of choice during critical illness, but in some cases as few as 25% are fed appropriately. The aim was to retrospectively review the administration of nutrition to critically ill children. METHODS: The notes of 95 children over the age of 1 year who were in PICU>or=3 days were reviewed and information related to the delivery of nutrition was obtained. RESULTS: Fifty-nine per cent were fed within 24h of admission. Enteral nutrition was administered 54% of the time, 10% required parenteral nutrition and 9.5% received no nutritional support. Children only received a median 58.8 (range 0-277)% of their energy requirements, which could not be optimised until the 10th intensive care day. Energy intake was greater when supplemented with parenteral nutrition. Parenteral nutrition administration was interrupted 3 times while enteral nutrition was stopped 264 times, mainly to allow other clinical procedures to take place. For 75% of the study time, children had abnormal bowel patterns. Seventy-nine per cent were constipated for 3-21 days and 43% had diarrhoea of unknown aetiology. CONCLUSION: This was a retrospective study to describe the efficiency of nutritional support in critically ill children. We have shown that it is possible to administer enteral nutrition safely. However, the difference between desirable intake and actual intake achieved suggests that a more pro-active approach should be adopted.

Adolescent↗
PubMed1999

Enteral nutrition in intensive care patients: a practical approach.

Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of these patient's management. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decision-making when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.

Contraindications↗
PubMed1998

Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine.

Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.

Cost-Benefit Analysis↗
PubMed1994

Possible role of short-term parenteral nutrition with fat emulsions for development of haemophagocytosis with multiple organ failure in a patient with traumatic brain injury Roth B, Grande PO, Nillson-Ehle P and Eliasson I. Intensive Care Med 1993; 19: 111-114.

This paper describes a case-report of a 21-year-old woman who sustained an isolated traumatic brain injury following a road traffic accident. After a 3-day period of parenteral nutrition including fat (Intralipid 20%) she developed hypertriglyceridaemia and 'creaming plasma', with a rash, high fever, hypertension, raised inracranial pressure, hepatic and renal failure, haemolysis, marked thrombocytopenia, and leucopenia, coagulation disorder and pulmonary failure, suggestive of hyperactivation of the monocyte-macrophage system. Treatment involved cessation of the lipid emulsion infusion and steroids. 6 months after the accident, the patient was well recovered with only minor neurological sequelae.

Journal Article↗
PubMed1994

Can daily dietary arginine supplement affect the function and subpopulation of lymphocytes in patients with advanced gastric cancer? Wu C-W, Chi C-W, Chiu C-C, Liu W-Y, P'eng F-K and Wang S-R. Digestion 1993; 54: 118-124.

The effect of arginine on lymphocyte proliferation in vitro was studied in patients with advanced gastric cancer. Patients who were ambulatory, normally nourished and consuming a normal diet, received a daily supplement of 30 g arginine for 7 days. There was no change in total lymphocyte count, T B cell ratio in peripheral blood, or an enhancement of lymphocyte proliferation in response to mitogen stimulation. Arginine ingestion did not impair liver function and had no detectable side effects except transient nausea in one patient. An in vitro study on the effect of arginine on phytohaemagglutination-stimulated lymphocyte proliferation showed that lymphocytes from gastric cancer patients had poorer responses than obtained from normal subjects despite the supplement in the culture medium with normal serum, patient serum, or fetal bovine serum. These results indicate that dietary arginine supplementation appears safe but does not stimulate lymphocyte function in these advanced gastric cancer patients. The suppressed immune function may be the results of their intrinsic lymphocyte defect.

Journal Article↗
PubMed1990

Nutritional support in hospitals in the United Kingdom: national survey 1988.

The increasing sophistication of enteral and total parenteral nutritional support techniques has resulted in improvements in the clinical practice of such support in recent years. This survey was designed to establish current clinical practice in the management of nutritionally-compromised hospital patients in 206 districts in the United Kingdom. However, despite recent developments in these techniques, the response revealed a wide variation in the practice of clinical nutritional support. The results also indicate that in each district there should be a group of people, with an interest in clinical nutrition, to monitor and advise on nutritional support. It is suggested that, a national multidisciplinary group should be formed, similar to the American and European Societies of Parenteral and Enteral Nutrition. The group would promote the appropriate use of, and research into, nutritional support specifically for the nutritionally compromised patient in the United Kingdom.

Dietary Services↗
PubMedDate not supplied

Enteral nutrition in malnourished patients with hepatic cirrhosis and acute encephalopathy.

Ten patients with histologically proven cirrhosis, admitted in grade I to II acute hepatic coma, received in addition to a standard dietary protein free "anticoma" regime, a continuous nasogastric infusion of a branched-chain amino acid enriched chemically defined enteral diet (Hepaticaid) containing an equivalent of 70 g protein/day for a mean of 7.3 days (range 3-23). No complications of therapy were observed and, specifically, the use of fine bore tubes did not provoke variceal hemorrhage. Overall positive nitrogen balance (4.3 +/- 1.7 g N/day) was observed in patients fed 7 or more days. Improvement to coma grade 0 was seen in all patients save one, who died from hepatorenal failure. While serum ammonia levels remained elevated during the study period, there was a significant increase in the branched-chain/aromatic ratio (p less than 0.01) as plasma branched-chain amino acids rose (p less than 0.05) and tyrosine levels fell (p less than 0.05).

Adult↗