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https://www.readbyqxmd.com/read/28428012/-retrospective-study-of-children-referred-from-paediatric-intensive-care-to-palliative-care-why-and-for-what
#1
Alberto García-Salido, Paula Santos-Herranz, Verónica Puertas-Martín, María Ángeles García-Teresa, Ricardo Martino-Alba, Ana Serrano-González
INTRODUCTION: The creation of paediatric palliative care units (PPCU) could optimise the management of children with palliative focus after admission to a paediatric intensive care unit (PICU). This study describes the clinical and epidemiological characteristics of children referred from PICU to the UCPP of the Autonomous Community of Madrid (CAM). The overall treatment, relapses, re-admissions, and deaths, if occurred, are described. PATIENTS AND METHOD: A retrospective review was performed using the medical records from children transferred from the CAM paediatric intensive care units to the paediatric palliative care unit (1 March 2008-31 January 2015)...
April 17, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28401123/setting-an-implementation-research-agenda-for-canadian-investments-in-global-maternal-newborn-child-and-adolescent-health-a-research-prioritization-exercise
#2
Renee Sharma, Matthew Buccioni, Michelle F Gaffey, Omair Mansoor, Helen Scott, Zulfiqar A Bhutta
BACKGROUND: Improving global maternal, newborn, child and adolescent health (MNCAH) is a top development priority in Canada, as shown by the $6.35 billion in pledges toward the Muskoka Initiative since 2010. To guide Canadian research investments, we aimed to systematically identify a set of implementation research priorities for MNCAH in low- and middle-income countries. METHODS: We adapted the Child Health and Nutrition Research Initiative method. We scanned the Child Health and Nutrition Research Initiative literature and extracted research questions pertaining to delivery of interventions, inviting Canadian experts on MNCAH to generate additional questions...
January 2017: CMAJ Open
https://www.readbyqxmd.com/read/28388380/acquired-amino-acid-deficiencies-a-focus-on-arginine-and-glutamine
#3
Claudia R Morris, Jill Hamilton-Reeves, Robert G Martindale, Menaka Sarav, Juan B Ochoa Gautier
Nonessential amino acids are synthesized de novo and therefore not diet dependent. In contrast, essential amino acids must be obtained through nutrition since they cannot be synthesized internally. Several nonessential amino acids may become essential under conditions of stress and catabolic states when the capacity of endogenous amino acid synthesis is exceeded. Arginine and glutamine are 2 such conditionally essential amino acids and are the focus of this review. Low arginine bioavailability plays a pivotal role in the pathogenesis of a growing number of varied diseases, including sickle cell disease, thalassemia, malaria, acute asthma, cystic fibrosis, pulmonary hypertension, cardiovascular disease, certain cancers, and trauma, among others...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388377/how-many-nonprotein-calories-does-a-critically-ill-patient-require-a-case-for-hypocaloric-nutrition-in-the-critically-ill-patient
#4
Saúl J Rugeles, Juan B Ochoa Gautier, Roland N Dickerson, Jorge A Coss-Bu, Jan Wernerman, Douglas Paddon-Jones
Calculation of energy and protein doses for critically ill patients is still a matter of controversy. For more than 40 years of nutrition support, the total amount of nutrients to be delivered to these patients has been calculated based on expert recommendations, and this calculation is based on the administration of nonprotein calories in one attempt to ameliorate catabolic response and avoid the weight loss. New evidence suggests protein delivery is the most important intervention to improve clinical and metabolic outcomes...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388376/how-much-and-what-type-of-protein-should-a-critically-ill-patient-receive
#5
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/28388374/summary-points-and-consensus-recommendations-from-the-international-protein-summit
#6
Ryan T Hurt, Stephen A McClave, Robert G Martindale, Juan B Ochoa Gautier, Jorge A Coss-Bu, Roland N Dickerson, Daren K Heyland, L John Hoffer, Frederick A Moore, Claudia R Morris, Douglas Paddon-Jones, Jayshil J Patel, Stuart M Phillips, Saúl J Rugeles, Menaka Sarav Md, Peter J M Weijs, Jan Wernerman, Jill Hamilton-Reeves, Craig J McClain, Beth Taylor
The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388373/protein-kinetics-and-metabolic-effects-related-to-disease-states-in-the-intensive-care-unit
#7
Robert G Martindale, Daren K Heyland, Saúl J Rugeles, Jan Wernerman, Peter J M Weijs, Jayshil J Patel, Stephen A McClave
Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388372/protein-delivery-in-the-intensive-care-unit-optimal-or-suboptimal
#8
Daren K Heyland, Peter J M Weijs, Jorge A Coss-Bu, Beth Taylor, Arnold S Kristof, Grant E O'Keefe, Robert G Martindale
Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388371/experimental-and-outcome-based-approaches-to-protein-requirements-in-the-intensive-care-unit
#9
Peter J M Weijs, Roland N Dickerson, Daren K Heyland, Frederick A Moore, Saúl J Rugeles, Stephen A McClave
Insight into protein requirements of intensive care unit (ICU) patients is urgently needed, but at present, it is unrealistic to define protein requirements for different diagnostic groups of critical illness or at different stages of illness. No large randomized controlled trials have randomized protein delivery, adequately addressed energy intake, and evaluated relevant clinical outcomes. As a pragmatic approach, experimental studies have focused on protein requirements of heterogeneous ICU patients. Data are scarce and the absolute value of protein requirements therefore is an approximation...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388370/will-we-ever-agree-on-protein-requirements-in-the-intensive-care-unit
#10
L John Hoffer, Roland N Dickerson, Robert G Martindale, Stephen A McClave, Juan B Ochoa Gautier
The precise value of the normal adult protein requirement has long been debated. For many reasons-one of them being the difficulty of carrying out long-term nutrition experiments in free-living people-uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388369/protein-and-calorie-requirements-associated-with-the-presence-of-obesity
#11
Roland N Dickerson, Jayshil J Patel, Craig J McClain
Obesity compounds the metabolic response to critical illness and increases the risk for overfeeding complications due to its comorbidities. Hypocaloric, high-protein nutrition therapy affords the hospitalized patient with obesity the opportunity to achieve net protein anabolism with a reduced risk of overfeeding complications. The intent of this review is to provide the theoretical framework for development of a hypocaloric high-protein regimen, scientific evidence to support this mode of therapy, and unique considerations for its use in specialized subpopulations...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28386479/bedside-ultrasound-measurement-of-rectus-femoris-a-tutorial-for-the-nutrition-support-clinician
#12
Carlos Alfredo Galindo Martín, Enrique Monares Zepeda, Octavio Augusto Lescas Méndez
Intensive care unit acquired weakness is a long-term consequence after critical illness; it has been related to muscle atrophy and can be considered as one of the main nutritional support challenges at the intensive care unit. Measuring muscle mass by image techniques has become a new area of research for the nutritional support field, extending our knowledge about muscle wasting and the impact of nutritional approaches in the critical care setting, although currently there is no universally accepted technique to perform muscle measurements by ultrasound...
2017: Journal of Nutrition and Metabolism
https://www.readbyqxmd.com/read/28382850/are-predictive-energy-expenditure-equations-in-ventilated-surgery-patients-accurate
#13
Christopher J Tignanelli, Allan G Andrews, Kurt M Sieloff, Melissa R Pleva, Heidi A Reichert, Jennifer A Wooley, Lena M Napolitano, Jill R Cherry-Bukowiec
BACKGROUND: While indirect calorimetry (IC) is the gold standard used to calculate specific calorie needs in the critically ill, predictive equations are frequently utilized at many institutions for various reasons. Prior studies suggest these equations frequently misjudge actual resting energy expenditure (REE) in medical and mixed intensive care unit (ICU) patients; however, their utility for surgical ICU (SICU) patients has not been fully evaluated. Therefore, the objective of this study was to compare the REE measured by IC with REE calculated using specific calorie goals or predictive equations for nutritional support in ventilated adult SICU patients...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28380152/incontinence-associated-dermatitis-a-cohort-study-in-critically-ill-patients
#14
Tânia Couto Machado Chianca, Paula Caroline Gonçales, Patrícia Oliveira Salgado, Beatriz de Oliveira Machado, Gilmara Lopes Amorim, Carla Lúcia Goulart Constant Alcoforado
Objectives: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis...
March 30, 2017: Revista Gaúcha de Enfermagem
https://www.readbyqxmd.com/read/28376054/timing-of-the-initiation-of-parenteral-nutrition-in-critically-ill-children
#15
Lissette Jimenez, Nilesh M Mehta, Christopher P Duggan
PURPOSE OF REVIEW: To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. RECENT FINDINGS: Nutritional management remains an important aspect of care among the critically ill, with enteral nutrition generally preferred. However, inability to advance enteral feeds to caloric goals and contraindications to enteral nutrition often leads to reliance on parenteral nutrition. The timing of parenteral nutrition initiation is varied among critically ill children, and derives from an assessment of nutritional status, energy requirements, and physiologic differences between adults and children, including higher nutrient needs and lower body reserves...
May 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/28374096/the-intensive-care-medicine-research-agenda-in-nutrition-and-metabolism
#16
REVIEW
Yaseen M Arabi, Michael P Casaer, Marianne Chapman, Daren K Heyland, Carole Ichai, Paul E Marik, Robert G Martindale, Stephen A McClave, Jean-Charles Preiser, Jean Reignier, Todd W Rice, Greet Van den Berghe, Arthur R H van Zanten, Peter J M Weijs
PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years. METHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism...
April 3, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28367176/therapeutic-efficacy-of-nutritional-support-by-percutaneous-endoscopic-gastrostomy-in-critically-ill-patients-a-self-control-clinical-trial
#17
Fei Zhou, Ya-Ling Gao, Zheng-Jin Liu, Yi-Qun Hu
BACKGROUND & OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) is a procedure to provide enteral nutrition for critically ill patients. It is commonly used in clinical practice; however, the widespread use of PEG is controversial. Our objective was to evaluate the therapeutic effect of nutritional support by PEG in these critically ill patients. METHODS: A total of 64 critically ill patients including 41 males and 23 females (aged 23-84) were identified by the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system during September 2004 to June 2012...
January 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28365665/nutrition-support-protocols-enhancing-delivery-of-enteral-nutrition
#18
Colleen O'Leary-Kelley, Karen Bawel-Brinkley
In critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients...
April 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28364397/superior-mesenteric-artery-syndrome-after-lung-transplantation-a-rare-early-gastrointestinal-complication-of-lung-transplantation
#19
Hidenao Kayawake, Toyofumi F Chen-Yoshikawa, Akihiro Aoyama, Jitian Zhang, Hiroshi Date
Gastrointestinal complications sometimes occur after lung transplantation and remain a cause of postoperative morbidity. Superior mesenteric artery syndrome is caused by the compression of the duodenum by the superior mesenteric artery, but few reports have described superior mesenteric artery syndrome after lung transplantation. We herein report two cases of superior mesenteric artery syndrome as an early complication after lung transplantation. Both patients were emaciated and had lost weight before transplantation...
March 31, 2017: Surgery Today
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
#20
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
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