Specialized Nutrition in Critically Ill Patients

Sherry A. Brown, PharmD, BCPS


November 30, 2001

In This Article


What have we learned about oxidative stress and injury in critically ill patients? These patients become catabolic and hypermetabolic, and a proinflammatory state is induced where there is an increase in free radical production and a decrease in plasma antioxidant concentrations. Many factors can affect the outcomes in these patients, such as the appropriate time within the disease course to administer these agents, as alluded to earlier. Also, these agents may work better if given in concert with each other for a "synergistic" or "cooperative" effect. Outside of demonstrating benefit for thermally injured and trauma patients, much of the data available for specialized nutritional supplementation are lacking and inconclusive. Larger-scale trials assessing clinical outcomes are greatly needed. Even though most of the compounds studied are endogenous, they are not inert and still carry the risk for adverse effects. Some studies have noted an increase in the production of reactive oxygen species, or "pro-oxidant" effect, with the use of these agents as demonstrated in the Cancer Prevention Study. Also, there is the potential for drug interactions, as these agents have been shown to alter cytochrome P450 enzymatic activity.


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