NUTRITIONINICULLLcourse-FrantiekDuka.pptVIP

literární kontrola DNL je funkcí p?ívodu glukózy, a nikoli inzulinémie * * * * * * * The rate of glucose administration commonly used during TPN of critically ill patients does not suppress endogenous glucose production or net protein loss, but markedly stimulates de novo lipogenesis and CO2 production. Increasing the proportion of fat may be beneficial, provided that lipid emulsion has no adverse effects. * * * * * * Body composition in septic ICU patients receiving full nutritional support 8 ICU septic patients TPN : 31 kcal nonprotein energy + 2.3 g N /kg FFM Body composition:neutron activationanalysis Streat SJ, J. Trauma 1987;27:262 Body composition (proteins) in patients with abdominal sepsis receiving full enteral support * P 0.05 * * * Protein (kg) * * Plank, LD et al, Ann. Surg. 1998; 228: 146 total body protein visceral protein skeletal muscle protein Protein metabolism in trauma patients with or without brain injury  Petersen SR et al, J. Trauma 1993; 34: 653 G protein /kg per day Glucose vs lipid for isocaloric TPNCarbohydrate (CHO) and lipid net oxidation mg / kg per min *# 75%glucose, 10% fat,15% amino acids *# * p 0.05 vs basal# p0.05 vs fat 70% fat, 15%glucose,15% amino acids Tappy L et al, CCM 1998; 26:860 Protein breakdown net balance are improved by hypercaloric glucose supply in burns 14 severely burned children ( 40% BSA) Hypercaloric EN: 1500 kcal/m2 + 1500/m2 TBSA/day High CHO diet (82% CHO, 3% fat, 15% protein) versus high-fat diet (42% CHO, 44% fat, 14% protein), Reverse crossover design Hart DW et al, CCM 2001; 29: 1318 Conclusions: protein metabolism The negative nitrogen balance of critical illness is due to increased net protein breakdown, whilst protein synthesis is relatively maintained The resistance of the proteocatabolism to the provision of energy substrates defines ?stress starvation“ (in contrast to simple starvation) Thanks for attention! * * * * * * * * * * * * * * * * * * * * * * *