Immunonutrition and critical illness: an update.

Dietary supplementation with nutrients that have physiologic effects on immune function has been shown to be beneficial in subsets of patients with surgical and medical critical illness. However, several meta-analyses have suggested potential harm when immune nutrients are used inappropriately. This has led to concern among clinicians that in turn has curtailed the more widespread use of immunonutrition as a therapeutic modality.

Risk of aspiration in patients on enteral nutrition: frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction.

Upper digestive feeding intolerance, as evidenced by high gastric residual volume and vomiting, is the most common complication among hospitalized patients receiving enteral nutrition. These patients are at high risk of developing aspiration pneumonia, which in turn is associated with prolonged hospital stay and increased mortality. Most episodes of aspiration are small in volume and do not lead to pneumonia.

The acute respiratory distress syndrome: role of nutritional modulation of inflammation through dietary lipids.

The acute respiratory distress syndrome (ARDS) is the most serious form of acute hypoxic respiratory failure. ARDS represents the expression of an acute, diffuse, inflammatory process in the lungs consequent to a variety of infectious and noninfectious conditions. It is characterized pathologically by damage to pulmonary epithelial and endothelial cells, with subsequent alveolar-capillary leak and exudative pulmonary edema.

Unexplained metabolic acidosis in critically ill patients: the role of pyroglutamic acid.

Objective: To determine the role of pyroglutamic acid (PGA) in the pathogenesis of unexplained metabolic acidosis in critically ill patients.

Design And Setting: Case series in the medical ICU of an urban hospital.

Patients: 23 patients admitted to the medical ICU with acidemia (pH <7.