Evolución de los pacientes graves con ventilación mecánica invasiva según el catabolismo proteico / Evolution of severe patients with invasive mechanical ventilation according to protein catabolism

Introducción: el catabolismo proteico es un indicador de la respuesta metabólica a la agresión. Objetivo: determinar la evolución de los pacientes con ventilación mecánica invasiva y su posible asociación con el catabolismo proteico, por categorías diagnósticas. Método: se realizó un estudio observacional, analítico y prospectivo, conto dos los pacientes sometidos a ventilación mecánica invasiva, ingresados en cuidados intensivos desde el 2001 hasta el 2007 y fueron clasificaron según la categoría diagnóstica (trauma, clínico y quirúrgico). Se midió el peso corporal al ingreso. Se evaluó el catabolismo proteico durante los primeros 3 días del ingreso, con la urea plasmática, la creatininuria y el nitrógeno ureico urinario. Se contrastaron con las variables dependientes: mortalidad, morbilidad y el tiempo de ventilación mecánica. Resultados: se estudiaron 262 pacientes; 88 presentaban trauma, 89 afecciones clínicas y 85 afecciones quirúrgicas. El catabolismo proteico fue alto en el trauma y se asoció a la mortalidad, a la disfunción múltiple de órganos y al tiempo prolongado de ventilación mecánica; en los pacientes quirúrgicos se asoció a la morbilidad. Los valores bajos de creatininuria, evidenciaron asociación con la mayor mortalidad, morbilidad y el tiempo prolongado de ventilación mecánica. Conclusiones: el catabolismo proteico se asoció a la evolución del paciente con ventilación mecánica invasiva, en las categorías trauma y quirúrgicos. No se evidenció asociación en la categoría clínica(AU)

Introduction: Protein catabolism is an indicator of the metabolic response to injury. Objective: To determine the evolution of patients with mechanical invasive ventilation and its possible association with protein catabolism by diagnostic category. Method: An observational, analytical and prospective study was performed with all patients undergoing mechanical invasive ventilation admitted to Intensive Care from 2001 to 2007 and classified according to the diagnostic category (trauma, clinical and surgical). Body weight was measured at admission. Protein catabolism was evaluated during the first 3 days of admission, with plasma urea, creatinine and urinary urea nitrogen. They were contrasted with the dependent variables: mortality, morbidity and time of mechanical ventilation. Results: We studied 262 patients; 88 presented trauma, 89 clinical conditions and 85 surgical conditions. Protein catabolism was high in trauma and associated with mortality, multiple organ dysfunction and prolonged mechanical ventilation; in surgical patients was associated with morbidity. The low values of urine creatinine,were associated with the greater mortality, morbidity and the prolonged time of mechanical ventilation. Conclusions: Protein catabolism was associated with the evolution of the patient with mechanical invasive ventilation, in the trauma and surgical categories. There was no evidence of association in the clinical category(AU)

The influence of indomethacin on TNFα and skeletal muscle protein catabolism in chronic obstructive pulmonary disease rat model / 中华内科杂志

Objective To observe the influence of tumor necrosis factor-alpha(TNFα) on skeletal muscle protein catabolism in rats with chronic obstructive pulmonary disease (COPD) and the effects of indomethacin (IND) on it. Methods Duplicated COPD model rats were divided into two groups: the malnutrition group and the normal nutrition group. The malnutrition group were further divided by randomized block design into four groups. Isotonic physiologic saline was administered to group A, the control and the normal nutrition group, and different doses of oral IND were administered to groups B, C, and D weight, concentrations of TNFα, contents of 3-methyl-histidine ( 3- M H ) and tyrosine (Tyr) in the diaphragm and extensor digitorum longus muscle homogenates were measured before and after the intervention. Results Before the intervention, the concentrations of TNFα in the serum of malnutrition groups were all significantly higher than those of normal nutrition group and the control group. After the intervention: (1) The concentrations of TNFα in the serum of the rats of group B, C and D were significantly lower than the group A, especially in group C. The levels of TNFα in serum and body weight of model group rats were negatively correlated ( r = -0. 846, P ＜0. 01 ), as well as the diaphragm and extensor digitorum longus muscle weights ( r = - 0. 778, P ＜ 0. 01; r = - 0. 772, P ＜ 0. 01 ). (2) The levels of 3-methyl-histidine in the diaphragm and extensor digitorum longus muscles of the intervention group C was lower than the COPD normal nutrition group, as well as the intervention groups B and D. The contents of tyrosine in the diaphragm and extensor digitorum longus muscles of the intervention group C was lower than that of the COPD normal nutrition group,as well as the groups B and D. The body weight growth value of the intervention group B were slightly higher than the group A, without significant difference( P ＞ 0. 05 ), while the group C was significantly higher than the group A ( P ＜ 0. 01 ). Conclusions TNFα is involved in the occurrence of COPD malnutrition and skeletal muscle amyotrophy. IND can reduce the TNFα levels in the serum and the catabolic rates of the skeletal muscle proteins in malnutrition rats with COPD, so as to improve partly the skeletal muscle atrophy.