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Parenteral nutrition for critically ill patients

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https://www.readbyqxmd.com/read/29335014/cost-effectiveness-study-of-early-versus-late-parenteral-nutrition-in-critically-ill-children-pepanic-preplanned-secondary-analysis-of-a-multicentre-randomised-controlled-trial
#1
Esther van Puffelen, Suzanne Polinder, Ilse Vanhorebeek, Pieter Jozef Wouters, Niek Bossche, Guido Peers, Sören Verstraete, Koen Felix Maria Joosten, Greet Van den Berghe, Sascha Cornelis Antonius Theodorus Verbruggen, Dieter Mesotten
BACKGROUND: The multicentre randomised controlled PEPaNIC trial showed that withholding parenteral nutrition (PN) during the first week of critical illness in children was clinically superior to providing early PN. This study describes the cost-effectiveness of this new nutritional strategy. METHODS: Direct medical costs were calculated with use of a micro-costing approach. We compared the costs of late versus early initiation of PN (n = 673 versus n = 670 patients) in the Belgian and Dutch study populations from a hospital perspective, using Student's t test with bootstrapping...
January 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29308749/-2017-clinical-breakthroughs-in-critical-care-medicine
#2
Wei Huang
New achievements in critical care medicine 2017 may include updating of "Surviving Sepsis Campaign" international guideline. Comparing evaluation of sequential (sepsis-related) organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA), combination therapies with steroid, vitamin B1 and vitamin C in patients with sepsis, identification of endophenotype of sepsis, as well phenotype of acute respiratory distress syndrome (ARDS). However, it is also need to mention some of negative trials, such as levosimendan in patients undergoing cardiac surgery, low-dose immunoglobulin G and polymyxin B hemoperfusion for patient with septic shock, and enteral versus parenteral early nutrition in ventilated adults with shock...
January 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29297385/tailoring-nutrition-therapy-to-illness-and-recovery
#3
REVIEW
Paul E Wischmeyer
Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness? We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called "hypermetabolism" of critical illness. What if this is incorrect? Recent data indicate that early underfeeding of calories (trophic feeding) may have benefits and may require consideration in well-nourished patients...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29273366/effects-of-semielemental-diet-containing-whey-peptides-on-peyer-s-patch-lymphocyte-number-immunoglobulin-a-levels-and-intestinal-morphology-in-mice
#4
Tomoyuki Moriya, Kazuhiko Fukatsu, Midori Noguchi, Makoto Nishikawa, Hiromi Miyazaki, Daizoh Saitoh, Hideki Ueno, Junji Yamamoto
BACKGROUND: Enteral nutrition (EN) is the gold standard of nutritional therapy for critically ill or severely injured patients, because EN promotes gut and hepatic immunity, thereby preventing infectious complications as compared with parenteral nutrition. However, there are many EN formulas with different protein and fat contents. Their effects on gut-associated lymphoid tissue remain unclear. Recently, semielemental diets (SEDs) containing whey peptides as a nitrogen source have been found to be beneficial in patients with malabsorption or pancreatitis...
February 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29232262/intermittent-versus-continuous-feeding-in-critically-ill-adults
#5
Jayshil J Patel, Martin D Rosenthal, Daren K Heyland
PURPOSE OF REVIEW: Early enteral nutrition is recommended in critically ill adult patients. The optimal method of administering enteral nutrition remains unknown. Continuous enteral nutrition administration in critically ill patients remains the most common practice worldwide; however, its practice has recently been called into question in favor of intermittent enteral nutrition administration, where volume is infused multiple times per day. This review will outline the key differences between continuous and intermittent enteral nutrition, describe the metabolic responses to continuous and intermittent enteral nutrition administration and outline recent studies comparing continuous with intermittent enteral nutrition administration on outcomes in critically ill adults...
December 11, 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/29149943/endocrine-and-metabolic-alterations-in-sepsis-and-implications-for-treatment
#6
REVIEW
Catherine Ingels, Jan Gunst, Greet Van den Berghe
Sepsis induces profound neuroendocrine and metabolic alterations. During the acute phase, the neuroendocrine changes are directed toward restoration of homeostasis, and also limit unnecessary energy consumption in the setting of restricted nutrient availability. Such changes are probably adaptive. In patients not recovering quickly, a prolonged critically ill phase may ensue, with different neuroendocrine changes, which may represent a maladaptive response. Whether stress hyperglycemia should be aggressively treated or tolerated remains a matter of debate...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29128300/enteral-versus-parenteral-early-nutrition-in-ventilated-adults-with-shock-a-randomised-controlled-multicentre-open-label-parallel-group-study-nutrirea-2
#7
Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation...
November 8, 2017: Lancet
https://www.readbyqxmd.com/read/29061391/delivery-of-full-predicted-energy-from-nutrition-and-the-effect-on-mortality-in-critically-ill-adults-a-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#8
Emma J Ridley, Andrew R Davies, Carol L Hodgson, Adam Deane, Michael Bailey, D Jamie Cooper
BACKGROUND: The amount of energy required to improve clinical outcomes in critically ill adults is unknown. OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the impact of near target energy delivery to critically ill adults on mortality and other clinically relevant outcomes. DESIGN: Following PRISMA guidelines, MEDLINE, EMBASE, CINHAL and the Cochrane Library were searched for randomised controlled trials evaluating nutrition interventions in adult critical care populations...
October 9, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28933744/energy-and-protein-in-critically-ill-patients-with-aki-a-prospective-multicenter-observational-study-using-indirect-calorimetry-and-protein-catabolic-rate
#9
Alice Sabatino, Miriam Theilla, Moran Hellerman, Pierre Singer, Umberto Maggiore, Maria Barbagallo, Giuseppe Regolisti, Enrico Fiaccadori
The optimal nutritional support in Acute Kidney Injury (AKI) still remains an open issue. The present study was aimed at evaluating the validity of conventional predictive formulas for the calculation of both energy expenditure and protein needs in critically ill patients with AKI. A prospective, multicenter, observational study was conducted on adult patients hospitalized with AKI in three different intensive care units (ICU). Nutrient needs were estimated by different methods: the Guidelines of the European Society of Parenteral and Enteral Nutrition (ESPEN) for both calories and proteins, the Harris-Benedict equation, the Penn-State and Faisy-Fagon equations for energy...
July 26, 2017: Nutrients
https://www.readbyqxmd.com/read/28917227/pharmacoeconomics-of-parenteral-nutrition-in-surgical-and-critically-ill-patients-receiving-structured-triglycerides-in-china
#10
Guo Hao Wu, Alexandra Ehm, Marco Bellone, Lorenzo Pradelli
BACKGROUND AND OBJECTIVES: A prior meta-analysis showed favorable metabolic effects of structured triglyceride (STG) lipid emulsions in surgical and critically ill patients compared with mixed medium-chain/long-chain triglycerides (MCT/LCT) emulsions. Limited data on clinical outcomes precluded pharmacoeconomic analysis. We performed an updated meta-analysis and developed a cost model to compare overall costs for STGs vs MCT/LCTs in Chinese hospitals. METHODS AND STUDY DESIGN: We searched Medline, Embase, Wanfang Data, the China Hospital Knowledge Database, and Google Scholar for clinical trials comparing STGs to mixed MCT/LCTs in surgical or critically ill adults published between October 10, 2013 and September 19, 2015...
2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28917226/energy-intake-in-the-first-week-in-an-emergency-intensive-care-unit-may-not-influence-clinical-outcomes-in-critically-ill-overweight-japanese-patients
#11
Satomi Ichimaru, Maren Sono, Ryutaro Seo, Koichi Ariyoshi, Teruyoshi Amagai
BACKGROUND AND OBJECTIVES: The American Society for Parenteral and Enteral Nutrition recommends hypocaloric feeding for critically ill patients with a BMI of >=30.0 kg/m2. However, the cut-off value of obesity in Japan is BMI >25.0 kg/m2, due to the higher prevalence of type 2 diabetes mellitus, and cardiovascular risk factors, even at a lower BMI than in Western populations. Thus, the optimal energy intake for critically ill, overweight Asian patients is unknown. METHODS AND STUDY DESIGN: A retrospective chart review was conducted in patients with BMI of >=25...
2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28901335/enteral-versus-parenteral-nutrition-in-critically-ill-patients-with-severe-pancreatitis-a-meta-analysis
#12
REVIEW
H Yao, C He, L Deng, G Liao
Whether enteral nutrition (EN) is superior to parenteral nutrition (PN) in critically ill patients with severe acute pancreatitis remains unknown. The objective of this meta-analysis was to assess the effects of EN versus PN on clinical outcomes in a subgroup of pancreatitis patients. Relevant randomized controlled trials (RCTs) were searched in Scopus, PubMed and Web of Science from inception to August 2016. Ultimately, five RCTs including 348 patients were enrolled in this analysis. Compared with PN, EN was associated with a significant reduction in overall mortality (risk ratio (RR)=0...
September 13, 2017: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28841885/current-clinical-nutrition-practices-in-critically-ill-patients-in-latin-america-a-multinational-observational-study
#13
Karin Papapietro Vallejo, Carolina Méndez Martínez, Alfredo A Matos Adames, Vanessa Fuchs-Tarlovsky, Guillermo Carlos Contreras Nogales, Roger Enrique Riofrio Paz, Mario Ignacio Perman, Maria Isabel Toulson Davisson Correia, Dan Linetzky Waitzberg
BACKGROUND: Malnutrition in critically ill adults in the intensive care unit (ICU) is associated with a significantly elevated risk of mortality. Adequate nutrition therapy is crucial to optimise outcomes. Currently, there is a paucity of such data in Latin America. Our aims were to characterise current clinical nutrition practices in the ICU setting in Latin America and evaluate whether current practices meet caloric and protein requirements in critically ill patients receiving nutrition therapy...
August 25, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28828964/clinical-nutrition-and-gastrointestinal-dysfunction-in-critically-ill-stroke-patients
#14
Robert Patejdl, Matthias Kästner, Stephan Kolbaske, Matthias Wittstock
Background Data on the epidemiology and risk factors of altered gastrointestinal motility (AGIM) is virtually lacking for patients suffering from non-traumatic neurologic diseases and stroke. This study investigated whether patterns of AGIM differ between patients with stroke and other severe acute brain diseases. Methods Clinical records of stroke and non-stroke patients treated at a neurological intensive care unit (ICU) were reviewed at day 1-5 and at day 10 after admission. The data was analyzed for the course of enteral/parenteral nutrition and for and for signs and symptoms of gastrointestinal dysfunction...
August 22, 2017: Neurological Research
https://www.readbyqxmd.com/read/28779878/adult-classical-homocystinuria-requiring-parenteral-nutrition-pitfalls-and-management
#15
REVIEW
Christel Tran, Luisa Bonafé, Jean-Marc Nuoffer, Julie Rieger, Mette M Berger
BACKGROUND: Homocystinuria due to cystathionine beta synthase (CBS) deficiency presents with a wide clinical spectrum. Treatment by the enteral route aims at reducing homocysteine levels by using vitamin B6, possibly methionine-restricted diet, betaine and/or folate and vitamin B12 supplementation. Currently no nutritional guidelines exist regarding parenteral nutrition (PN) under acute conditions. METHODS: Exhaustive literature search was performed, in order to identify the relevant studies describing the pathogenesis and nutritional intervention of adult classical homocystinuria requiring PN...
July 25, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28710148/energy-protein-carbohydrate-and-lipid-intakes-and-their-effects-on-morbidity-and-mortality-in-critically-ill-adult-patients-a-systematic-review
#16
REVIEW
Anna Patkova, Vera Joskova, Eduard Havel, Miroslav Kovarik, Monika Kucharova, Zdenek Zadak, Miloslav Hronek
The guidelines for nutritional support in critically ill adult patients differ in various aspects. The optimal amount of energy and nutritional substrates supplied is important for reducing morbidity and mortality, but unfortunately this is not well known, because the topic is complex and every patient is individual. The aim of this review was to gather recent pertinent information concerning the nutritional support of critically ill patients in the intensive care unit (ICU) with respect to the energy, protein, carbohydrate, and lipid intakes and the effect of their specific utilization on morbidity and mortality...
July 2017: Advances in Nutrition
https://www.readbyqxmd.com/read/28699602/importance-of-target-calorie-intake-in-hospitalized-patients
#17
Ferda Akbay Harmandar, Ismail Gömceli, Başak Oğuz Yolcular, Ayhan Hilmi Çekin
BACKGROUND/AIMS: To evaluate the feasibility and clinical outcome of a nutritional algorithm based on target calorie intake commenced as enteral nutrition (EN) alone or in combination with supplemental parenteral nutrition (SPN) among hospitalized patients. MATERIALS AND METHODS: In total, 301 hospitalized patients who were provided with nutritional support, including EN (n=125) or EN+SPN (n=176), due to various medical conditions during their hospitalization were included in this study conducted at Antalya Training and Research Hospital...
July 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/28691958/guidelines-for-the-provision-and-assessment-of-nutrition-support-therapy-in-the-pediatric-critically-ill-patient-society-of-critical-care-medicine-and-american-society-for-parenteral-and-enteral-nutrition
#18
Nilesh M Mehta, Heather E Skillman, Sharon Y Irving, Jorge A Coss-Bu, Sarah Vermilyea, Elizabeth Anne Farrington, Liam McKeever, Amber M Hall, Praveen S Goday, Carol Braunschweig
This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance...
July 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28686844/guidelines-for-the-provision-and-assessment-of-nutrition-support-therapy-in-the-pediatric-critically-ill-patient-society-of-critical-care-medicine-and-american-society-for-parenteral-and-enteral-nutrition
#19
Nilesh M Mehta, Heather E Skillman, Sharon Y Irving, Jorge A Coss-Bu, Sarah Vermilyea, Elizabeth Anne Farrington, Liam McKeever, Amber M Hall, Praveen S Goday, Carol Braunschweig
This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance...
July 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28671616/incidence-of-ventilator-associated-pneumonia-in-critically-ill-children-undergoing-mechanical-ventilation-in-pediatric-intensive-care-unit
#20
Ali Amanati, Abdollah Karimi, Alireza Fahimzad, Ahmad Reza Shamshiri, Fatemeh Fallah, Alireza Mahdavi, Mahshid Talebian
BACKGROUND: Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient's outcome in Pediatric Intensive Care Units (PICU). OBJECTIVES: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications...
July 3, 2017: Children
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