Glutamine supplemented parenteral nutrition to prevent ventilator-associated pneumonia in the intensive care unit.

OBJECTIVE: Ventilator-associated pneumonia (VAP) is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN). We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU). MATERIAL AND METHODS: With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20), and the second was prescribed TPN (n=20) while the third group was given glutamine-supplemented TPN (n=20). C-reactive protein (CRP), sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs. RESULTS: No statistically significant difference was found among groups in terms of development of VAP (p=0.622). CONCLUSION: Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP.

Analysis of the effect of perioperative magnesium sulphate on minimal alveolar concentration of desflurane using bispectral index monitoring.

BACKGROUND: In this study we aimed to analyze the effect of perioperative magnesium sulphate (MgSO(4)) on minimal alveolar concentration (MAC) of desflurane using bispectral index (BIS) monitoring. PATIENTS AND METHODS: Sixty patients undergoing abdominal surgery under general anesthesia were randomized into two groups: Mg - receiving perioperative MgSO(4) supplementation and C - control. Anesthesia was titrated to maintain the BIS value between 45-55. RESULTS: MAC values, tachycardia and hypertension during intubation was found to be lower in group Mg compared to group C (p<0.001). Time to extubation, verbal cooperation and eye opening was longer in patients receiving infusion of MgSO(4) (p<0.001). CONCLUSION: We concluded that perioperative MgSO(4) infusion may be used as an adjunct as it decreases MAC of desflurane and suppresses the hemodynamic response to intubation.

A new agent for treatment of acute respiratory distress syndrome: thymoquinone. An experimental study in a rat model.

OBJECTIVE: Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are important clinical problems in thoracic surgery and critical care medicine. Most of the treatment methods are still supportive. Thymoquinone has anti-inflammatory, spasmolytic, bronchodilator and antibacterial effects. We studied its effects on ALI/ARDS in a rat model. METHODS: ALI/ARDS was developed in 40 Sprague-Dawley male rats (200-250 g in weight) by intratracheal instillation of human gastric juice (pH 1.2). Rats were treated with mechanic ventilator for 3h. There were five groups: Control group (n=11); Steroid group (n=10); Ethanol group (n=5); Thymoquinone group (n=9) and Thymoquinone+Steroid group (n=5). No instillation except gastric juice was applied in the first group. Thymoquinone was given in dosage of 6 mg/kg, metilprednisolone in dosage of 10mg/kg, ethanol 0.75 ml/kg intraperitoneally (IP). Blood gas analysis and compliance measurement were done. At the end of the third hour, rats were sacrificed and their lungs were excised for histopathological examination. RESULTS: In the thymoquinone group, the ratio of arterial oxygen to the fraction of inspired oxygen (PO2/FiO2) was significantly better compared to the other groups (P=0.000-0.043). Static compliance measurements revealed higher values in thymoquinone and thymoquinone+steroid groups. Histopathological examinations showed that affected lung tissue is lower in groups 2 and 4 (P=0.000-0.027). CONCLUSIONS: This study revealed that thymoquinone improved oxygenation while both thymoquinone and steroids protect lung tissue from hazardous effects of human gastric juice (pH 1.2) histopathologically.