The reduction in lactic acidosis following an infusion of a fish oil structured lipid in an endotoxemia model (see Fig 1) is also relevant in this context as it implies improved oxygen delivery, and presumably flow, to the tissues.
The data suggest that if an increase in flow can be induced, some compensation of the relative cellular tissue ischemia is possible. Once the more vasodilated circulation has been created, the ability of the myocyte to deliver the extra flow will be decisive. It is well established that the heart is compromised in septic shock, which militates against survival. A correlation coefficient of 0.86 between cardiac output and survival was reported by Nishijima et al in 1973, and an increase in cardiac output was observed as a factor in surviving patients by Abraham et al in 1984. The nutrient support for the myocyte is clearly important to ensure optimum performance. Again, a more vasodilated circulation will facilitate oxygen delivery to the heart and ensure adequate supply of free fatty acid, the main energy substrate for the myocardium.
Equally as important as the type of nutrients to administer is the route of delivery. When possible, nutrients should be delivered via the gastrointestinal tract, since the complications of parenteral nutrition are avoided and the normal liver first-pass effect is achieved.
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