RESUMO
Intestinal barrier function impairment can lead to bacterial and toxin translocation in critically ill patients and is an important factor in gut-derived infections and even multiple organ failure. Early enteral nutrition (EEN) can nourish the intestine, prevent bacterial translocation, effectively maintain intestinal barrier function and immune function and provide metabolic substrates for the body, bringing clinical benefits. For critically ill patients such as those with severe acute pancreatitis, severe burns and severe traumatic brain injury and those after major abdominal surgery, there is evidence-based proof supporting EEN while in patients with uncontrolled shock and severe hypoxemia and acidosis, the initiation of EEN should be delayed. EEN in critically ill patients can be applied orally or through nasogastric tube. Dietary fiber-free intact protein preparations are recommended at initiation and administration via continuous pumping can improve EEN gastrointestinal tolerability.
RESUMO
Currently,the popular notions on the mechanisms of gut-derived-infection are described as follows.The stress may cause the damage of intestinal mucosal barrier and dysfunction of intestinal immune response,which leads to the alteration of intestinal flora,abnormal proliferation of opportunistic pathogen as well as the translocation of alive bacteria and their toxin into systemic compartment.As a result,the proinflammatory cytokines are released to induce the outbreak of intestinal inflammation or systemic inflammatory response syndrome,even the MODS.This review focuses on the relationship between biological behavior of intestinal bacteria and gut-derived-infection.