(精编)【持续性肾脏替代治疗CRRT英文精品课件】Glutamine therapy.pptVIP

Glutamine Therapy: What does the evidence show?;The First Ever Recorded Clinical Trial;11 Then said Daniel to Melzar, whom the prince of the eunuchs had set over Daniel, 12 Prove thy servants, I beseech thee, ten days; and let them give us pulse to eat, and water to drink. 13 Then let our countenances be looked upon before thee, and the countenance of the children that eat of the portion of the kings meat: and as thou seest, deal with thy servants. 14 So he consented to them in this matter, 15 And at the end of ten days their countenances appeared fairer and fatter in flesh than all the children which did eat the portion of the kings meat. ;16 [from all the children of Israel in the King’s Court] Thus Melzar took away the portion of their meat, and the wine that they should drink; and gave them pulse. ;Prolonged ICU stay, discharged weak and debilitated. Dies on day 43 in hospital from massive PE;Why such poor adoption?;Information Overload;Impractical for individual clinicians to assimilate massive amounts of information to make unaided judgments about complex decisions;Clinical Practice Guidelines; Development of CPGs;; Guidelines: Topics;Nutrients vs. Nutrition;Overall Effect of Glutamine supplementation;Effect of Glutamine: A Systematic Review of the Literature;Effect of Glutamine: A Systematic Review of the Literature;Effect of Glutamine: A Systematic Review of the Literature;Enteral vs ParenteralGlutamine supplementation?;Why Parenteral Glutamine;Why Enteral Glutamine?;Enteral v Parenteral Glutamine Supplementation;Results of Subgroup Analysis;;Concealed randomization Double-blind 72 Trauma (ISS20) Reported on 60 successful feed patients (non-ITT) Gln added to EN vs isonitrogenous control (12 days) Results Less pneumonia, bacteremia, and sepsis (majority in first week) Plasma glutamine levels elevated in Gln group in first week Lower levels of p55 and p75 soluble TNF receptors No difference in mech ventilation, LOS, mortality ;Effect of Enteral Glu