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Parenteral nutrition for critically ill patients

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https://www.readbyqxmd.com/read/28627189/-nitrogenous-content-in-parenteral-nutrition-a-four-year-experience-in-a-general-hospital-critically-ill-patient-specificity
#1
Juan Luis Villalobos-Gámez, Carlos Lara-Ramos, Yolanda Domínguez-Rivas, Antonio Vallejo-Báez, Francisco Cota-Delgado, Efrén Márquez-Fernández, José Manuel García-Almeida, José Antonio López-Medina, Rosalía Rioja-Vázquez, Albert Santacreu-Regí, Francisca Rius-Díaz, Alfredo Mínguez-Mañanes
INTRODUCTION: There have been several studies focusing on caloric intake during the last years, while protein content relevance has been underestimated. Some recent evidence has shown that protein deficiency has also an impact on patient outcomes. We have studied the nitrogen (N) content in parenteral nutrition (PN) bags administered to adult patients in a Spanish tertiary level hospital for four years. MATERIAL AND METHODS: Patients who received parenteral nutrition in the general ward and Intensive Care Unit (ICU) were recorded...
June 5, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/28627187/-is-plasma-selenium-correlated-to-transthyretin-levels-in-critically-ill-patients
#2
Renata G B O N Freitas, Roberto Jose Negrão Nogueira, Silvia Maria Franciscato Cozzolino, Ana Carolina Junqueira Vasques, Matthew Thomas Ferreira, Gabriel Hessel
BACKGROUND: Selenium is an essential trace element, but critically ill patients using total parenteral nutrition (PN) do not receive selenium because this mineral is not commonly offered. Threfore, the eval uation of plasma selenium levels is very important for treating or preventing this deficiency. Recent studies have shown that transthyretin may reflect the selenium intake and could be considered a biomarker. However, this issue is still little explored in the literature. OBJECTIVE: This study aims to investigate the correlation of transthyretin with the plasma selenium of critically ill patients receiving PN...
June 5, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/28599676/a-randomized-trial-of-supplemental-parenteral-nutrition-in-underweight-and-overweight-critically-ill-patients-the-top-up-pilot-trial
#3
Paul E Wischmeyer, Michel Hasselmann, Christine Kummerlen, Rosemary Kozar, Demetrios James Kutsogiannis, Constantine J Karvellas, Beth Besecker, David K Evans, Jean-Charles Preiser, Leah Gramlich, Khursheed Jeejeebhoy, Rupinder Dhaliwal, Xuran Jiang, Andrew G Day, Daren K Heyland
BACKGROUND: Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit (ICU) affect patient mortality, particularly for inadequate nutrition intake in patients with body mass indices (BMIs) of <25 or >35. Thus, we hypothesized increased nutrition delivery via supplemental PN (SPN) + enteral nutrition (EN) to underweight and obese ICU patients would improve 60-day survival and quality of life (QoL) versus usual care (EN alone)...
June 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28585162/omega-3-supplementation-in-patients-with-sepsis-a-systematic-review-and-meta-analysis-of-randomized-trials
#4
Clara Lu, Sunjay Sharma, Lauralyn McIntyre, Andrew Rhodes, Laura Evans, Saleh Almenawer, Lori Leduc, Derek C Angus, Waleed Alhazzani
BACKGROUND: Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. METHODS: We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28584925/peripherally-inserted-central-catheters-are-associated-with-lower-risk-of-bloodstream-infection-compared-with-central-venous-catheters-in-paediatric-intensive-care-patients-a-propensity-adjusted-analysis
#5
Ricardo Silveira Yamaguchi, Danilo Teixeira Noritomi, Natalia Viu Degaspare, Gabriela Ortega Cisternas Muñoz, Ana Paula Matos Porto, Silvia Figueiredo Costa, Otavio T Ranzani
PURPOSE: Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. METHODS: We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil...
June 5, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28574294/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
#6
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...
May 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28522351/effect-of-early-supplemental-parenteral-nutrition-in-the-paediatric-icu-a-preplanned-observational-study-of-post-randomisation-treatments-in-the-pepanic-trial
#7
Ilse Vanhorebeek, Sascha Verbruggen, Michaël P Casaer, Jan Gunst, Pieter J Wouters, Jan Hanot, Gonzalo Garcia Guerra, Dirk Vlasselaers, Koen Joosten, Greet Van den Berghe
BACKGROUND: Large randomised controlled trials have shown that early supplemental parenteral nutrition in patients admitted to adult and paediatric intensive care units (PICUs) is harmful. Overdosing of energy with too little protein was suggested as a potential reason for this. This study analysed which macronutrient was associated with harm caused by early supplemental parenteral nutrition in the Paediatric Early versus Late Parenteral Nutrition In Critical Illness (PEPaNIC) randomised trial...
May 15, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28481068/-early-parenteral-nutrition-in-complex-post-operative-periods
#8
A I Molina Caballero, A Pérez Martínez, S Hernández Martín, N González Temprano, L Ayuso González, J Pisón Chacón
OBJECTIVE: The protein hypercatabolic state in critically ill pediatric patients can be minimized by an effective nutrition therapy. We conducted a study to evaluate the benefits of early parenteral nutrition (EPN) assessing its effect on nutritional parameters and clinical relevance after complex surgical procedures. METHODS: Prospective randomized study in patients undergoing abdominal surgery in which nothing by mouth is anticipated for a period ≥ 3 days, between 2012 and 2014...
October 10, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
https://www.readbyqxmd.com/read/28388376/how-much-and-what-type-of-protein-should-a-critically-ill-patient-receive
#9
Juan B Ochoa Gautier, Robert G Martindale, Saúl J Rugeles, Ryan T Hurt, Beth Taylor, Daren K Heyland, Stephen A McClave
Protein loss, manifested as loss of muscle mass, is observed universally in all critically ill patients. Depletion of muscle mass is associated with impaired function and poor outcomes. In extreme cases, protein malnutrition is manifested by respiratory failure, lack of wound healing, and immune dysfunction. Protecting muscle loss focused initially on meeting energy requirements. The assumption was that protein was being used (through oxidation) as an energy source. In healthy individuals, small amounts of glucose (approximately 400 calories) protect muscle loss and decrease amino acid oxidation (protein-sparing effect of glucose)...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28361751/glutamine-dipeptide-supplemented-parenteral-nutrition-improves-the-clinical-outcomes-of-critically-ill-patients-a-systematic-evaluation-of-randomised-controlled-trials
#10
Peter Stehle, Björn Ellger, Dubravka Kojic, Astrid Feuersenger, Christina Schneid, John Stover, Daniela Scheiner, Martin Westphal
BACKGROUND & AIMS: Early randomised controlled trials (RCTs) testing whether parenteral nutrition regimens that include glutamine dipeptides improves the outcomes of critically ill patients demonstrated convincingly that this regimen associates with reduced mortality, infections, and hospital stays. However, several new RCTs on the same question challenged this. To resolve this controversy, the present meta-analysis was performed. Stringent eligibility criteria were used to select only those RCTs that tested the outcomes of critically ill adult patients without hepatic and/or renal failure who were haemodynamically and metabolically stabilised and who were administered glutamine dipeptide strictly according to current clinical guidelines (via the parenteral route at 0...
February 2017: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/28353418/factors-associated-with-the-development-of-tertiary-peritonitis-in-critically-ill-patients
#11
Josep Ballus, Juan C Lopez-Delgado, Joan Sabater-Riera, Xose L Perez-Fernandez, Antoni J Betbese, Joan A Roncal
BACKGROUND: Critically ill surgical patients remain at a high risk of adverse outcomes as a result of secondary peritonitis (SP). The risk is even higher if tertiary peritonitis (TP) develops. Factors related to the development of TP, however, are scarce in the literature. The main aim of our study was to identify factors associated with the development of TP in patients with SP in the intensive care unit (ICU), and also to report differences in microbiologic patterns and antibiotic therapy in patients with the two conditions...
March 29, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28284302/critical-care-nutrition-where-s-the-evidence
#12
REVIEW
Jayshil J Patel, Ryan T Hurt, Stephen A McClave, Robert G Martindale
The surgical critically ill patient is subject to a variable and complex metabolic response, which has detrimental effects on immunity, wound healing, and preservation of lean body muscle. The concept of nutrition support has evolved into nutrition therapy, whereby the primary objectives are to prevent oxidative cell injury, modulate the immune response, and attenuate the metabolic response. This review outlines the metabolic response to critical illness, describes nutritional risk; reviews the evidence for the role, dose, and timing of enteral and parenteral nutrition, and reviews the evidence for immunonutrition in the surgical intensive care unit...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28224103/management-of-parenteral-nutrition-in-critically-ill-patients
#13
REVIEW
Paolo Cotogni
Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28179737/updates-in-nutrition-support-for-critically-ill-adult-patients
#14
Diana Wells Mulherin, Sarah V Cogle
Specialized nutrition support is often employed in critically ill patients who are unable to maintain volitional intake. The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently updated guidelines for the provision of nutrition support in critically ill patients. The purpose of this review is to summarize key changes from the previous guidelines as they relate to recently published literature, which will aid the hospital pharmacist in optimizing nutrition support therapies in the critical care setting...
January 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28169021/supplemental-parenteral-nutrition-in-intensive-care-patients-a-cost-saving-strategy
#15
Lorenzo Pradelli, Séverine Graf, Claude Pichard, Mette M Berger
BACKGROUND & AIMS: The Swiss supplemental parenteral nutrition (SPN) study demonstrated that optimised energy provision combining enteral nutrition (EN) and SPN reduces nosocomial infections in critically ill adults who fail to achieve targeted energy delivery with EN alone. To assess the economic impact of this strategy, we performed a cost-effectiveness analysis using data from the SPN study. METHODS: Multivariable regression analyses were performed to characterise the relationships between SPN, cumulative energy deficit, nosocomial infection, and resource consumption...
January 25, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28168570/early-enteral-nutrition-in-critically-ill-patients-esicm-clinical-practice-guidelines
#16
REVIEW
Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M Berger, Michael P Casaer, Adam M Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M Jakob, Cecilia I Loudet, Manu L N G Malbrain, Juan C Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean-Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia Wendon, Jan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M Oudemans-van Straaten
PURPOSE: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS: We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion...
March 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28151828/nutrition-in-the-critically-ill-patient
#17
REVIEW
Kristine W A C Koekkoek, Arthur R H van Zanten
PURPOSE OF REVIEW: To summarize recent relevant studies regarding nutrition during critical illness and provide recommendations for clinical practice. RECENT FINDINGS: Recently acquired knowledge regarding nutritional status and risk assessment, body composition, gastric residual volume, prokinetics, tube positioning, enteral vs parenteral nutrition, nutritional dose and timing of initiation, pharmaconutrition, dysbiosis and probiotics are discussed. SUMMARY: Body composition especially lean body mass is associated with clinical outcomes...
April 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28129265/parenteral-and-enteral-nutrition-in-surgical-critical-care-plasma-metabolomics-demonstrates-divergent-effects-on-nitrogen-fatty-acid-ribonucleotide-and-oxidative-metabolism
#18
Brodie A Parent, Max Seaton, Danijel Djukovic, Haiwei Gu, Brittany Wheelock, Sandi L Navarro, Daniel Raftery, Grant E O'Keefe
BACKGROUND: Artificial nutrition support is central to the care of critically ill patients and is primarily provided enterally (EN). There are circumstances when parenteral nutrition (PN) is considered necessary. We are uncertain how each of these approaches confer clinical benefits beyond simply providing calories. We sought to better understand how each of these techniques influence metabolism in critically ill patients using a broad-based metabolomics approach. Metabolic responses to EN and PN may differ in ways that could help us understand how to optimize use of these therapies...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28102514/carbapenemase-producing-klebsiella-pneumoniae-bloodstream-infection-in-critically-ill-patients-risk-factors-and-predictors-of-mortality
#19
M Papadimitriou-Olivgeris, F Fligou, C Bartzavali, A Zotou, A Spyropoulou, K Koutsileou, S Vamvakopoulou, N Sioulas, V Karamouzos, E D Anastassiou, I Spiliopoulou, M Christofidou, M Marangos
A significant increase in carbapenemase-producing Klebsiella pneumoniae (CP-Kp) bacteraemias has been observed worldwide. The objective of the present work was to study the risk factors and predictors of mortality of CP-Kp bacteraemias among critically ill patients. During a 4-year period (2012-3015), a matched 1:2 case-control study was conducted. Klebsiella pneumoniae was identified by Vitek 2 technology. Antibiotic susceptibility was performed by the agar disc diffusion method and Etest. The presence of the bla KPC, bla VIM and bla NDM genes was confirmed by polymerase chain reaction (PCR)...
January 19, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28049258/the-impact-of-implementation-of-an-enteral-feeding-protocol-on-the-improvement-of-enteral-nutrition-in-critically-ill-adults
#20
REVIEW
Seoung-Hyun Kim, Chi-Min Park, Jeong-Meen Seo, Mingew Choi, Dae-Sang Lee, Dong Kyung Chang, Miyong Rha, Soyoung Yu, Seonhye Lee, Eunmee Kim, Young Yun Cho
BACKGROUND AND OBJECTIVES: The optimal delivery of enteral nutrition (EN) may improve clinical outcomes in critically ill patients; thus, optimal EN protocols should be developed. The purpose of this study was to evaluate the impact of implementing an EN protocol on the improvement of EN practices and on the clinical outcomes of critically ill patients. METHODS AND STUDY DESIGN: This was a retrospective study with prospectively collected data. Multidisciplinary working group developed an evidence-based EN protocol based on an extensive review of literature and existing guidelines...
January 2017: Asia Pacific Journal of Clinical Nutrition
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