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Many surgical diseases are treated with bowel rest including ileus, pancreatitis, intestinal ischemia, and intra- abdominal infections, which greatly limits the intake of substrate at a time of elevated catabolism.
Lastly, patients on moderate to high doses of vasopressors should not receive enteral nutrition because of the rare complication of bowel necrosis from the increased intestinal oxygen demand induced by feeding in the setting of splanchnic ischemia.
Diuretics and resins such as sodium polystyrene that pull electrolytes from the gastrointestinal tract have a limited role in the treatment of hyperkalemia because diuretics may worsen AKI, whereas resins with sorbitol have been associated with colonic ischemia and necrosis.
Multiple factors contribute to postoperative liver failure, but the basic physiology is driven by ischemia of the hepatocytes.
In 1999, the TRICC trial, a landmark ran- domized trial that examined transfusion requirements in critical care, showed decreased mortality when a restrictive transfusion practice was compared with a liberal transfusion practice. ftis study established hemoglobin less than 7 mg/dL as a "transfusion trigger" for most patients, and the mortality benefit was still observed in patients with preexisting cardiac disease.33 Additional research confirmed that hemoglobin levels of 7 mg/dL are well tolerated by ICU patients, and the only patients who benefit from more liberal transfusion are patients who are actively bleeding or manifesting acute coronary ischemia.
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