Total parenteral nutrition, bacterial translocation, and host immune function

Shou, Jian; Lappin, Jacqueline; Minnard, Emery A.; Daly, J.M.

doi:10.1016/0002-9610(94)90065-5

Cited by 120 publications

(40 citation statements)

References 21 publications

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“…Long-term parenteral feeding-induced liver steatosis may be attenuated by L-NAME administration. 15) The deleterious effects, such as hypertension, 23) caused by nonselective NOS inhibitors have been reported and mainly attributed to the inability to discriminate between the constitutive and inducible isoforms of NOS. 24) In this study, we did not measure the blood pressure of these animals.…”

Section: Discussionmentioning

confidence: 99%

“…Administration of total parenteral nutrition solution is an efficient method to supply all daily nutrition requirements; however, it is associated with occurrence of increased complicated infections. 15) Zheng et al 16) indicated that long-term parenteral nutrition-induced liver steatosis may be attenuated by L-NAME administration. Up to now, only few reports have described the long-term application of L-NAME for subacute peritonitis.…”

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confidence: 99%

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Dose Effects of Chronically Infused Nitric Oxide Synthase Inhibitor NG-Nitro-L-arginine Methyl Ester on Anabolic Response and Arginine Metabolism in Rats with Subacute Peritonitis

Hsiao

Lee

Tsao

et al. 2011

Biological & Pharmaceutical Bulletin

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Patients with peritonitis develop arginine deficiency due to decreased consumption, impaired absorption, and increased utilization of arginine.1,2) Arginine, a precursor for the synthesis of nitric oxide (NO), urea, creatinine, glutamate, proline, and polyamines, is a conditionally essential amino acid in stressed conditions, especially in inflammation. 1,3,4) Green et al. 5) was the first research group to show that nitrate/nitrite concentrations and the severity of infection are closely correlated. Subsequent studies showed that patients with peritonitis have uncontrolled activation of inducible nitric oxide synthase (NOS), which results in NO overproduction and the following sepsis.6) Therefore, inhibition of NOS might be a useful strategy to treat arginine deficiency and inhibit excess NO production. 6,7) In animal and human studies, the results of NOS inhibition in inflammation have been ambiguous. For example, N G -nitro-L-arginine methyl ester (L-NAME), a nonselective NOS inhibitor which inhibits both constitutive and inducible NOS, effectively ameliorated the inflammatory lesions in the skin of zinc-deficient rats, 8) improved the myocardial function in sepsis, 9) and attenuated the lipopolysaccharide-induced peritoneal permeability and NO release in mice.10) On the contrary, some studies have shown that L-NAME may cause hypertension, augment the expressions of interferon (IFN)-g and interleukin (IL)-2, and result in markedly severe disease in rats with T cell-dependent autoimmune interstitial nephritis.11) The adverse effects of NOS inhibitors have also been observed in subjects with hemodynamic instability and sepsis. [12][13][14] Evidence suggests that the therapeutic effects of NOS inhibitors may depend on the dose, timing, and the severity and category of diseases.In clinical practice, a number of in hospital patients with subacute peritonitis developed chronic malnutrition and inflammation. Administration of total parenteral nutrition solution is an efficient method to supply all daily nutrition requirements; however, it is associated with occurrence of increased complicated infections.15) Zheng et al. 16) indicated that long-term parenteral nutrition-induced liver steatosis may be attenuated by L-NAME administration. Up to now, only few reports have described the long-term application of L-NAME for subacute peritonitis. Additionally, no study has ever addressed the effects of L-NAME on the inflammatory response and amino acid metabolism in subjects administered parenteral nutrition. In our study, we used a rat model with subacute peritonitis induced by cecal puncture and administered total parenteral nutrition solution to provide adequate nutrition, and we investigated the dose effects of parenterally supplemented L-NAME on the anabolism, inflammatory response, and arginine-derived metabolites such as the intermediates of the urea cycle, circulating profile of amino acids, NO, and cytokines. MATERIALS AND METHODS Animals and Experimental DesignMale Wistar rats (8-9 weeks old), initially weighi...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Dose Effects of Chronically Infused Nitric Oxide Synthase Inhibitor NG-Nitro-L-arginine Methyl Ester on Anabolic Response and Arginine Metabolism in Rats with Subacute Peritonitis

Hsiao

Lee

Tsao

et al. 2011

Biological & Pharmaceutical Bulletin

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“…7 Other favorable effects of enteral nutrition include better substrate utilization, prevention of mucosal atrophy, preservation of the integrity of gut flora, and preservation of immunocompetence. [8][9][10][11][12][13][14][15][16] Early enteral feeding can also ameliorate oxidative stress after surgery 17 and can decrease postoperative mortality in patients who have gastrointestinal surgery. 18 Therefore, physicians have become interested in feeding patients as soon as possible.…”

Section: Methodsmentioning

confidence: 99%

Early Enteral Nutrition and Outcomes of Critically Ill Patients Treated With Vasopressors and Mechanical Ventilation

Khalid¹,

Doshi²,

DiGiovine³

2010

American Journal of Critical Care

262

154

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Objective To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable. Methods Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure. The patients were divided into 2 groups: those who received enteral nutrition (n = 707) within 48 hours of the start of mechanical ventilation, termed the early enteral nutrition group, and those who did not (n = 467), termed the late enteral nutrition group. The primary end points were overall intensive care unit and hospital mortality. Subgroup analyses were used to evaluate potential confounding variables. The data were also analyzed after adjustments for confounding by matching for propensity score. Results Intensive care unit and hospital mortality were lower in the early enteral nutrition group than in the late enteral group: 22.5% vs 28.3%; P = 03; and 34.0% vs 44.0%; P < .001, respectively. The beneficial effect of early feeding was more evident in the sickest patients, that is, those treated with multiple vasopressors (odds ratio, 0.36; 95% confidence interval, 0.15-0.85) and those without early improvement (odds ratio, 0.59; 95% confidence interval, 0.39-0.90). When adjustments were made for confounding by matching for propensity score, early feeding was associated with decreased hospital mortality. Conclusion Early enteral nutrition may be associated with reduced intensive care unit and hospital mortality in patients whose hemodynamic condition is unstable.

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“…Return of gut motility is required to clear overgrowth of AGNB (Vantrappen et al, 1977). There appears to be good evidence that enteral nutrition significantly reduces the incidence of infection (Minard & Kudsk, 1994) following the reversal of gut leakage (Mainous et al, 1991) and of defective macrophage function (Shou et al, 1994;Okada et al, 1998). Until the patient is able to tolerate enteral feeds, protection can be directed towards both gut and flora.…”

Section: Discussionmentioning

confidence: 99%

Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates

et al. 2003

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Background and aims: Patients receiving parenteral nutrition are at risk of septicaemia. Intestinal dysmotility and impaired gut immunity due to parenteral nutrition promote bacterial overgrowth. Gut overgrowth with aerobic Gram-negative bacilli (AGNB) impairs systemic immunity. The aim of this study was to determine the potential role of gut overgrowth with AGNB in the pathogenesis of septicaemia related to parenteral nutrition. Methods: A prospective 5 y study of surgical infants less than 6 months of age was undertaken. Surveillance samples of the oropharynx and gut were obtained at the start of parenteral nutrition and thereafter twice weekly, to detect AGNB carriage. Blood cultures were taken on clinical indication only. Results: Two-hundred and eight infants received parenteral nutrition for 6271 days (median 13 days, range 1 -512 days). The incidence of AGNB carriage was 42%, whilst the septicaemia rate was 15%. Eighty-four percent of septicaemic infants carried AGNB, whilst 16% never carried AGNB (P < 0.005). Carriage developed significantly earlier than septicaemia. Conclusions: The incidence of septicaemia was significantly greater in the subset of abnormal carriers. Although gut overgrowth with abnormal flora reflects illness severity, the fact that it preceded septicaemia implicates AGNB overgrowth, per se, as a contributory factor in the development of septicaemia related to parenteral nutrition. Prevention is unlikely to be successful if it ignores the abnormal flora.

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Total parenteral nutrition, bacterial translocation, and host immune function

Cited by 120 publications

References 21 publications

Dose Effects of Chronically Infused Nitric Oxide Synthase Inhibitor NG-Nitro-L-arginine Methyl Ester on Anabolic Response and Arginine Metabolism in Rats with Subacute Peritonitis

Dose Effects of Chronically Infused Nitric Oxide Synthase Inhibitor NG-Nitro-L-arginine Methyl Ester on Anabolic Response and Arginine Metabolism in Rats with Subacute Peritonitis

Early Enteral Nutrition and Outcomes of Critically Ill Patients Treated With Vasopressors and Mechanical Ventilation

Gut overgrowth with abnormal flora: the missing link in parenteral nutrition-related sepsis in surgical neonates

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