Abstract:
OBJECTIVE:To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. DESIGN:Prospective, randomized clinical trial. SETTING:Department of surgery in a university hospital. PATIENTS:Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. MEASUREMENTS:Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. MAIN RESULTS:The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p =.52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 +/- 5 mm Hg vs. 31 +/- 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). CONCLUSION:EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Braga M,Gianotti L,Gentilini O,Parisi V,Salis C,Di Carlo Vdoi
10.1097/00003246-200102000-00003subject
Has Abstractpub_date
2001-02-01 00:00:00pages
242-8issue
2eissn
0090-3493issn
1530-0293journal_volume
29pub_type
临床试验,杂志文章,随机对照试验abstract::The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their ren...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198705000-00013
更新日期:1987-05-01 00:00:00
abstract::We developed a method to measure accurately pressures at the airway opening (Pao) and in the trachea (Ptr) in neonates during high frequency oscillatory ventilation (HFOV) from 15-30 Hz. All component parts of the pressure-measuring system were tested as a unit against a reference transducer in a closed chamber in whi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198401000-00011
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To appraise the literature on the effect of initial renal replacement therapy (RRT) modality on clinical outcomes. DESIGN:Systematic review and meta-analysis. SETTING:Academic medical center. PATIENTS AND PARTICIPANTS:Adult critically ill patients with acute kidney injury. INTERVENTIONS:Continuous vs. int...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/01.CCM.0B013E3181611F552
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To describe three female patients of one family with different phenotypes of the same mutation of the ornithine transcarbamylase gene. X-linked inherited ornithine transcarbamylase deficiency is the most frequent urea cycle disorder. Many of the hemizygous males die during the neonatal period. Women, who are ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200201000-00035
更新日期:2002-01-01 00:00:00
abstract::A survey of acute care/blood gas laboratories was conducted through the memberships of the Society of Critical Care Medicine ( SCCM ) and the National Association of Medical Directors of Respiratory Care ( NAMDRC ). Data were obtained from 227 laboratories and analyzed for operational characteristics, personnel, analy...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198406000-00014
更新日期:1984-06-01 00:00:00
abstract:OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002772
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS:Objective testing ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000183157.15533.4c
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:Life-threatening conditions cause severe changes in the organization and conformation of macromolecules, creating urgent requirements for protein repair to ensure survival. As molecular chaperones, heat shock proteins (HSP) that have specialized functions in protein folding are now well established to restore...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVES:To assess the reversibility of acute kidney injury-induced neutrophil dysfunction and to identify involved mechanisms. DESIGN:Controlled laboratory experiment and prospective observational clinical study. SETTING:University laboratory and hospital. SUBJECTS:C57BL/6 wild-type mice. PATIENTS:Patients with ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001472
更新日期:2016-07-01 00:00:00
abstract:OBJECTIVE:To assess clinician perceptions of a machine learning-based early warning system to predict severe sepsis and septic shock (Early Warning System 2.0). DESIGN:Prospective observational study. SETTING:Tertiary teaching hospital in Philadelphia, PA. PATIENTS:Non-ICU admissions November-December 2016. INTERVE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003803
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:To determine whether chest wall vibration with tracheal gas insufflation during bronchoconstriction maintains gas exchange at lower airway and intrathoracic pressures than those that occur during positive pressure ventilation. DESIGN:Prospective study. SETTING:Experimental laboratory. SUBJECTS:Six anesthet...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00057
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To describe the philosophy and approach to patient care called evidence based medicine, and to highlight how it can enhance the practice of intensive care. DATA SOURCES:We searched MEDLINE, reference lists, and our personal files to identify relevant literature. STUDY SELECTION:Articles on intensive care pr...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199602000-00025
更新日期:1996-02-01 00:00:00
abstract::Vecuronium's short half-life and minimal cardiopulmonary side-effects make it a suitable drug for continuous infusion. Vecuronium is used frequently in critically ill patients to increase their total compliance and to minimize the adverse effects of mechanical ventilation. This crossover, prospective study evaluates t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198910000-00004
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr c...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000297887.84347.85
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVES:The relationship between respiratory mechanical parameters and hemodynamic variables remains unclear. This study was performed to determine whether mean airway pressure and central venous pressure in the first day of mechanical ventilation are associated with patient outcomes. DESIGN:Retrospective first 24-...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002290
更新日期:2017-05-01 00:00:00
abstract::This study was performed to determine if particulate material within the pulmonary vascular bed could be sampled by aspirating blood from a wedged pulmonary artery catheter. 99mTechnetium-labeled albumin microspheres (20 micrometers) were injected and embolized into the precapillary pulmonary vasculature of 6 critical...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198304000-00001
更新日期:1983-04-01 00:00:00
abstract:OBJECTIVE:To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. DESIGN:Controlled, animal study using an ex vivo lung preparation. SETTING:A research laboratory at a university medical center. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199602000-00015
更新日期:1996-02-01 00:00:00
abstract:OBJECTIVE:Cytokine response after cardiac surgery may be genetically influenced. A study was carried out to investigate the relation between cytokine gene expression in peripheral blood mononuclear cells, genotype, and clinical events after cardiac surgery. DESIGN:A case-control study was performed. SETTING:Cardiac i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000227647.77356.AB
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVES:Neurologic damage following cardiac arrest remains a major burden for modern resuscitation medicine. Cardiopulmonary resuscitation with extracorporeal circulatory support holds the potential to reduce morbidity and mortality. Furthermore, the endogenous gasotransmitter carbon monoxide attracts attention in r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004242
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVES:To determine whether excessive alcohol consumption increases the risk for intensive care unit (ICU)-acquired bacterial infection, especially ventilator-associated pneumonia (VAP), in nontrauma patients. DESIGN:Prospective observational cohort study. SETTING:A 21-bed polyvalent ICU in a university hospital....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318174dd75
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-199507000-00021
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:To determine whether partial liquid ventilation (PLV) affects the risk of nosocomial pneumonia. STUDY DESIGN:To assess in vitro bacterial adhesion and viability after liquid perfluorocarbon exposure and to assess bacterial recovery after partial liquid ventilation in vivo in rabbits. SETTING:University anim...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199912000-00023
更新日期:1999-12-01 00:00:00
abstract::To achieve normocarbia during conventional mechanical ventilation, ventilator settings are determined initially on the basis of body weight. The best ventilator settings for CO2 elimination during high-frequency jet ventilation (HFJV) have not been so clearly defined. A recent study has suggested that eucarbia will be...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198801000-00012
更新日期:1988-01-01 00:00:00
abstract::Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and servi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181aa6288
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures. DESIGN:Prospective study. SETTING:Heart surgery intensive care ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000084807.15352.93
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVES:We sought to review findings from recent literature on the postresuscitation care of cardiac arrest patients using therapeutic hypothermia as part of nontrial treatment. DESIGN:Literature review. SETTING:Hospital-based environment. SUBJECTS:Patients initially resuscitated from cardiac arrest who underwent...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181aa5c7c
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVES:To investigate pharmacokinetics and metabolism of sodium citrate in critically ill patients. To determine the risk of citrate accumulation in the setting of liver dysfunction (cirrhosis, hepatorenal syndrome). DESIGN:Prospective cohort study. SETTING:Intensive Care Unit, Department of Medicine IV, Universi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084871.76568.E6
更新日期:2003-10-01 00:00:00
abstract::The hemodynamic response to a dopamine HCl infusion (10 microgram/kg per min) was measured in 25 adult patients with severe sepsis: there were 6 patients with circulatory hyperdynamic states, 9 patients with myocardial failure, and 10 with hypovolemia. Each patient also had acute respiratory failure. Changes of intrap...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197906000-00004
更新日期:1979-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of lorazepam and midazolam for long-term sedation of critically ill, mechanically ventilated patients. DESIGN:Double-blind, randomized, controlled study. SETTING:Medical intensive care unit in a university teaching hospital. PATIENTS:Sixty-four evaluable adult patients admitte...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199908000-00009
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. DESIGN:A single-group descriptive longitudinal cor...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000934
更新日期:2015-06-01 00:00:00