pectins and Critical-Illness

Maintenance of the gut environment is a key factor in determining outcome in the care of critically ill and postoperative patients. It is especially important to maintain both gastrointestinal secretions, full of anti-infectious and anti-inflammatory compounds, and the gut flora. Prebiotics, usually polysaccharides, exhibit strong bio-activity and the ingestion of prebiotics has been shown to reduce the rate of infection and restore health in sick and postoperative patients. Probiotics may have at least five functions, all of great importance to the sick patients: the reduction or elimination of potentially pathogenic micro-organisms of various kinds; the reduction or elimination of various toxins, mutagens, carcinogens, etc.; modulation of the innate and adaptive immune defence mechanisms; the promotion of apoptosis; and the release of numerous nutrient, antioxidant, growth, coagulation and other factors necessary for recovery. A combination of pre- and probiotics is referred to as 'synbiotics'. Our experience of synbiotic treatment in critically ill patients is limited, but cutting-edge results from studies of severe acute pancreatitis, chronic hepatitis and liver transplantation offer great hope for the future. This is especially important as pharmaceutical treatment, including the use of antibiotics, has largely failed, and the medical world is in much need of new treatment paradigms.

Topics: Critical Illness; Dietary Fiber; Dietary Supplements; Enteral Nutrition; Humans; Lactobacillus; Pectins; Probiotics

Anaerobic colonic flora are necessary for the fermentation of fiber into short-chain fatty acids and constitute the bulk of fecal mass. Lack of dietary fiber in most enteral feedings, compounded by antibiotic therapy, suppresses normal colonic metabolism, resulting in diarrhea. Pectin, a water-soluble fiber, stimulates epithelial growth in the colon and thus reduces diarrhea.. Forty-four critically ill patients receiving enteral nutrition and antibiotic therapy were randomized to receive fiber-containing or fiber-free tube feedings and pectin or placebo. Data on frequency, consistency, and volume of fecal output; energy (caloric) intake; and administration of specific medications were collected for 9 days. Diarrhea was defined as 2 or more days with scores of 12 or higher on the Hart and Dobb diarrhea scale.. Subjects in the 4 groups did not differ significantly in age, sex, severity of illness, or energy intake. Twelve subjects (27.3%) experienced diarrhea. Significantly fewer subjects in the fiber-free/placebo and fiber/pectin groups experienced diarrhea than did subjects in the fiber/placebo group (P = .02). On the basis of repeated-measures analysis of variance of daily mean scores, the severity of diarrhea did not differ significantly among the study groups over time (P = .16).. The reduced rate of diarrhea found in this study may be related to the stringent definition of diarrhea used. The therapeutic dose of pectin for reducing diarrhea needs further exploration. The trend was toward less diarrhea in the fiber/pectin group, but the study needs to be replicated with a larger sample.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Combined Modality Therapy; Critical Illness; Diarrhea; Dietary Fiber; Double-Blind Method; Energy Intake; Enteral Nutrition; Food Additives; Food, Formulated; Humans; Length of Stay; Male; Middle Aged; Pectins; Severity of Illness Index

Pectin-containing liquid enteral nutrition (PCLEN) contains pectin, which becomes solid in the stomach and therefore mitigates vomiting and diarrhea. Its efficacy for use in critical care medicine was evaluated.. We used liquid enteral nutrition (LEN) (traditional LEN (TLEN)) as the primary LEN at the emergency and critical care center. We adopted PCLEN as the primary LEN from 2014. During 2012-2016, 954 patients admitted to intensive care units and emergency wards were given PCLEN or TLEN. We conducted propensity score matching for 693 eligible patients for age, sex, and organ dysfunctions for six organs.. We included 199 PCLEN patients and 199 TLEN patients. Severity was higher in the PCLEN group. The enteral nutrition failure rate was significantly lower for PCLEN than for TLEN. The diarrhea incidence rates were 28.1% vs 38.2% (p=0.033), and the incidence rates of nosocomial pneumonia were 4.5% and 9.6% (p=0.048). For PCLEN, the enteral nutrition failure rates were not different for patients with gastric acid inhibitors and without them.. PCLEN can be used effectively for critically ill patients irrespective of the use of gastric acid inhibitors. It can decrease the incidence of enteral nutrition failure and diarrhea.

Topics: Aged; Aged, 80 and over; Case-Control Studies; Critical Care; Critical Illness; Diarrhea; Enteral Nutrition; Female; Humans; Intensive Care Units; Male; Middle Aged; Pectins; Retrospective Studies