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抗生素的经验治疗（英文PPT）A Randomized Trial of Empiric Antibiotics and Invasive Diagnostic课件
* * * * Berg et al, Clin Nutr 2008 (in press) Brain Glutamine Levels Brain Glutamate Levels Safety of Glutamine in Head Injury? Yang Chinese Journal of Traumatology 2007; 10:145 Efficacy of Glutamine in Head Injury? 46 patient with severe TBI randomized to IV ala-gln vs standard care ?dose All patients fed PN on day 3 with EN to follow P<0.05 What about Glutamine in Pancreatitis? Efficacy of Glutamine in Pancreatitis? 4 RCTs of IV Glutamine supplemented PN ? relevance when EN standard of care What about Glutamine in Shock? JPEN 2008;32:28 20 severely traumatized patients RCT Enteral glut 0.5 gm/kg/day vs control All patients rec’d Impact Started within 24 hrs and continued for 10 days Canadian Critical Care Nutrition Clinical Practice Guidelines “If using parental nutrition, we strongly recommend supplementing with parenteral glutamine.” “Enteral Glutamine should be considered for Burns and Trauma Patients.” “There are insufficient data to support the routine use of enteral glutamine in other critically ill patients.” Benefit of Parenteral Glutamine in Patients on EN? JPEN 2003;27:355 see for current version What about dose of Glutamine? RCT 368 heterogeneous critically ill patients Double-blind Enteral nutrition supplemented glutamine: 20 grams/L Control: Glycine 20g/L Well matched groups Glutamine group rec’d average 19 g/day of glutamine Hall Intensive Care Med 2003;29:1710 Inadequate Dose and Wrong Patient Population? No differences noted Normal Healthy range Tjader ICM 2004 Optimal Dose? REDOXS Dosing Study High dose appears safe High dose associated with no worsening of SOFA Scores greater resolution of oxidative stress greater preservation of glutathione Improved mitochondrial function Heyland JPEN Mar 2007 Parenterally Enterally Glutamine/day 0.35 gms/kg 30 gms Antioxidants per day 500 mcg Selenium Vit C 1500 mg Vit E 500 mg B carotene 10 mg Zinc 20 mg Se 300 ug Glutamine loss in the filtration fluid during CRRT in ICU patients. Berg et al, ICM
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