Pharmaconutrition Review

Pierre, Joseph F.; Heneghan, Aaron F.; Lawson, Christy M.; Wischmeyer, Paul E.; Kozar, Rosemary A.; Kudsk, Kenneth A.

doi:10.1177/0148607113493326

Cited by 43 publications

(3 citation statements)

References 216 publications

(254 reference statements)

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“…Pharmaco-nutrition refers to the addition of nutrients with specific beneficial actions (e.g., antioxidant effects) to standard feeding, and specifically aims to invigorate gut mucosal and systemic immune defense mechanisms, and to shackle an excessive pro-inflammatory response during the catabolic phase of illness [42,43]. The most relevant "pharmaco-nutrients" in septic patients are the amino-acids glutamine and arginine, omega-3 fatty acids, selenium, and vitamin C.…”

Section: Pharmaco-nutritionmentioning

confidence: 99%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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Nutrition therapy in sepsis is challenging and differs from the standard feeding approach in critically ill patients. The dysregulated host response caused by infection induces progressive physiologic alterations, which may limit metabolic capacity by impairing mitochondrial function. Hence, early artificial nutrition should be ramped-up and emphasis laid on the post-acute phase of critical illness. Caloric dosing is ideally guided by indirect calorimetry, and endogenous energy production should be considered. Proteins should initially be delivered at low volume and progressively increased to 1.3 g/kg/day following shock symptoms wane. Both the enteral and parenteral route can be (simultaneously) used to cover caloric and protein targets. Regarding pharmaconutrition, a low dose glutamine seems appropriate in patients receiving parenteral nutrition. Supplementing arginine or selenium is not recommended. High-dose vitamin C administration may offer substantial benefit, but actual evidence is too limited for advocating its routine use in sepsis. Omega-3 polyunsaturated fatty acids to modulate metabolic processes can be safely used, but non-inferiority to other intravenous lipid emulsions remains unproven in septic patients. Nutrition stewardship, defined as the whole of interventions to optimize nutritional approach and treatment, should be pursued in all septic patients but may be difficult to accomplish within a context of profoundly altered cellular metabolic processes and organ dysfunction caused by time-bound excessive inflammation and/or immune suppression. This review aims to provide an overview and practical recommendations of all aspects of nutritional therapy in the setting of sepsis.

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Section: Pharmaco-nutritionmentioning

confidence: 99%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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“…Recently, the pharmaconutrition concept involve nutrients studied as therapeutic components administered in pharmacological doses and focused on specialized nutritional support to a study active therapeutics on immune function [46]. However, there are no specific diets designed for different physiological conditions.…”

Section: Effects Of Malnutrition and Refeeding On Antibody Immune Res...mentioning

confidence: 99%

Oral administration of an aqueous extract from the oyster mushroom Pleurotus ostreatus enhances the immunonutritional recovery of malnourished mice

Llauradó

Morris

Lebeque

et al. 2016

Biomedicine & Pharmacotherapy

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Mushroom nutriceutical components have lately attracted interest for developing immunonutritional support. However, there is relatively little information pertaining to the use of mushroom preparations for modulating the metabolic and immunological disorders associated to malnutrition. This study was aimed to evaluate the effects of oral administration of an aqueous extract (CW-P) from Pleurotus ostreatus on the recovery of biochemical and immunological functions of malnourished mice. 8-week old female BALB/c mice were starved for 3days and then refed with commercial diet supplemented with or without CW-P (100mg/kg) for 8days. Regardless of the diet used during refeeding, animal body weights and serum protein concentrations did not differ between groups. Oral treatment with CW-P normalized haemoglobin levels, liver arginase and gut mucosal weight. CW-P increased total liver proteins and also DNA and protein contents in gut mucosa. Pleurotus extract provided benefits in terms of macrophages activation as well as in haemopoiesis, as judged by the recovery of bone marrow cells and leukocyte counts. Moreover, CW-P stimulated humoral immunity (T-dependent and T non-dependent antibodies responses) compared to non-supplemented mice. CW-P extract from the oyster mushroom can be used to develop specific food or nutritional supplement formulations with potential clinical applications in the immunotherapy.

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“…The most relevant pharmaconutrients in septic patients are the amino acids glutamine and arginine, omega-3 fatty acids, selenium, and vitamin C [99].…”

mentioning

confidence: 99%

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Ramasco,

Nieves-Alonso,

García-Villabona

et al. 2024

JPM

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Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., “Sepsis Code” programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock.

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Pharmaconutrition Review

Cited by 43 publications

References 216 publications

Nutrition in Sepsis: A Bench-to-Bedside Review

Nutrition in Sepsis: A Bench-to-Bedside Review

Oral administration of an aqueous extract from the oyster mushroom Pleurotus ostreatus enhances the immunonutritional recovery of malnourished mice

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

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