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John A Stroster, Selman Uranues, Rifat Latifi
PURPOSE OF REVIEW: This article examines some of the articles that inspired recent changes to critical care guidelines related to glutamine in enteral nutrition. RECENT FINDINGS: Two recent multicenter randomized controlled trials involving enteral glutamine have reported increased mortality rates in groups of mechanically ventilated adult patients, while demonstrating no additional benefits to other outcomes, such as nosocomial infections. SUMMARY: Recent studies suggest that enteral glutamine supplementation may not provide significant clinical benefits to adult patients on mechanical ventilation with multiple organ failure, but more information is still needed when attempting to apply these results to other groups of critical care patients...
December 2015: Current Opinion in Critical Care
Gaël Piton, Gilles Capellier
PURPOSE OF REVIEW: Gut barrier failure is associated with bacterial translocation, systemic inflammation, and is presumed to be associated with the development of multiple organ dysfunction syndrome. As the gut barrier function is carried out by a monolayer of enterocytes, a minimum requirement is the integrity of the enterocytes, and controlled paracellular permeability between adjacent enterocytes. Many factors can cause critically ill patients to lose gut barrier function by a mechanism of enterocyte damage; for example, small bowel ischemia or hypoxia, sepsis, systemic inflammatory response syndrome, or absence of enteral feeding...
April 2016: Current Opinion in Critical Care
Annika Reintam Blaser, Stephan M Jakob, Joel Starkopf
PURPOSE OF REVIEW: The current review summarizes different aspects of assessment of gastrointestinal function and provides a practical approach to management of adult patients with gastrointestinal dysfunction in the ICU. RECENT FINDINGS: Different ways to define gastrointestinal failure have been used in the past. Recently, the term 'acute gastrointestinal injury (AGI)' has been proposed to specifically describe gastrointestinal dysfunction as a part of multiple organ dysfunction syndrome...
April 2016: Current Opinion in Critical Care
Taku Oshima, Pierre Singer, Claude Pichard
PURPOSE OF REVIEW: The review focuses on the use of parenteral nutrition and enteral nutrition in critically ill patients to optimize the nutrition care throughout the ICU stay. The key message is: you have the choice! RECENT FINDINGS: Enteral nutrition has been recommended for critically ill patients, whereas parenteral nutrition has been considered harmful and to be avoided. However, recent studies have challenged this theory. They demonstrated that enteral nutrition is frequently associated with energy and protein undernutrition, whereas parenteral nutrition becomes deleterious only if overfeeding is induced...
August 2016: Current Opinion in Critical Care
William Manzanares, Pascal L Langlois, Gil Hardy
PURPOSE OF REVIEW: Purpose of the review is to summarize recent research addressing the role of intravenous lipid emulsions (IVLEs) in the critically ill. RECENT FINDINGS: Soybean oil-based IVLEs, which are high in the omega-6 polyunsaturated fatty acids, have been largely used in parenteral nutrition over the last several decades. However, it is now generally accepted that the higher content of phytosterols and polyunsaturated fatty acids in soybean oil IVLE may adversely affect the immunological and inflammatory status of the critically ill...
August 2016: Current Opinion in Critical Care
Peter J M Weijs
PURPOSE OF REVIEW: Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill. RECENT FINDINGS: Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children...
August 2016: Current Opinion in Critical Care
Fiona Simpson, Gordon S Doig
PURPOSE OF REVIEW: The purpose of this review is to highlight emerging techniques used to determine body composition early in ICU stay, their prediction of poor outcome, and what is required before they can be more widely used. RECENT FINDINGS: Opportunistic use of imaging techniques to assess muscle mass shows promise with regard to predicting patient outcomes; however, some of these techniques are expensive. Mid-arm muscle circumference and physical assessments of muscle wasting and subcutaneous fat loss using the subjective global assessment (SGA) are simple cheap tools that can be undertaken at the ICU patient bedside...
August 2016: Current Opinion in Critical Care
Enid E Martinez, Nilesh M Mehta
PURPOSE OF REVIEW: Nutritional status and nutrient delivery during critical illness impact clinical outcomes. We have reviewed recent studies that may guide best practices regarding nutrition therapy in critically ill children. RECENT FINDINGS: Malnutrition is prevalent in the pediatric ICU population, and is associated with worse outcomes. Nutrition support teams, dedicated dietitians, and educational programs facilitate surveillance for existing malnutrition and nutrition risk, but specific tools for the pediatric ICU population are lacking...
August 2016: Current Opinion in Critical Care
Yaseen M Arabi, Abdulaziz S Aldawood, Hasan M Al-Dorzi, Hani M Tamim, Samir H Haddad, Gwynne Jones, Lauralyn McIntyre, Othman Solaiman, Maram H Sakkijha, Musharaf Sadat, Shihab Mundekkadan, Anand Kumar, Sean M Bagshaw, Sangeeta Mehta
RATIONALE: The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear. OBJECTIVE: In patients with different baseline nutritional risk, we examined the effect of permissive underfeeding with full protein intake compared to standard feeding on 90-day mortality. METHODS: This is a post-hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial...
September 2, 2016: American Journal of Respiratory and Critical Care Medicine
Brandon P Lucke-Wold, Aric F Logsdon, Linda Nguyen, Ahmed Eltanahay, Ryan C Turner, Patrick Bonasso, Chelsea Knotts, Adam Moeck, Joseph C Maroon, Julian E Bailes, Charles L Rosen
Studies using traditional treatment strategies for mild traumatic brain injury (TBI) have produced limited clinical success. Interest in treatment for mild TBI is at an all time high due to its association with the development of chronic traumatic encephalopathy and other neurodegenerative diseases, yet therapeutic options remain limited. Traditional pharmaceutical interventions have failed to transition to the clinic for the treatment of mild TBI. As such, many pre-clinical studies are now implementing non-pharmaceutical therapies for TBI...
October 5, 2016: Nutritional Neuroscience
Jan Wernerman
PURPOSE OF REVIEW: To review the literature on feeding critically ill patients with special emphasis on the intestine. RECENT FINDINGS: Many dogmas have been questioned in the past few years. In particular, the absence of evidence for impact on outcomes in critically ill patients has been highlighted. So 'early enteral feeding', the trophic effect on intestinal mucosa in humans, 'pharmaco-nutrition', postpyloric feeding and prokinetic drugs have all been found to lack proper evidence to affect outcomes...
April 2014: Current Opinion in Critical Care
Michael P Casaer, Dieter Mesotten, Greet Hermans, Pieter J Wouters, Miet Schetz, Geert Meyfroidt, Sophie Van Cromphaut, Catherine Ingels, Philippe Meersseman, Jan Muller, Dirk Vlasselaers, Yves Debaveye, Lars Desmet, Jasperina Dubois, Aime Van Assche, Simon Vanderheyden, Alexander Wilmer, Greet Van den Berghe
BACKGROUND: Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone. METHODS: In this randomized, multicenter trial, we compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group)...
August 11, 2011: New England Journal of Medicine
Ari Joffe, Natalie Anton, Laurance Lequier, Ben Vandermeer, Lisa Tjosvold, Bodil Larsen, Lisa Hartling
BACKGROUND: Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children. This is an update of a review that was originally published in 2009. . OBJECTIVES: The objective of this review was to assess the impact of enteral and parenteral nutrition given in the first week of illness on clinically important outcomes in critically ill children...
2016: Cochrane Database of Systematic Reviews
B L Fang, S Y Qian, X L Jia, Z Li, J Liu
OBJECTIVE: To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU). METHOD: Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013. Clinical prognosis was compared between children with and without EN interruptions by t, rank-sum and χ(2) tests...
September 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Jan Hau Lee, Elizabeth Rogers, Yek Kee Chor, Rujipat Samransamruajkit, Pei Lin Koh, Mohamad Miqdady, Ali Ibrahim Al-Mehaidib, Antonius Pudjiadi, Sunit Singhi, Nilesh M Mehta
BACKGROUND AND OBJECTIVES: Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the Paediatric Critical Care Environment...
December 2016: Asia Pacific Journal of Clinical Nutrition
Cristian Merchan, Diana Altshuler, Caitlin Aberle, John Papadopoulos, David Schwartz
PURPOSE: Enteral nutrition (EN) is often held in patients receiving vasopressor support for septic shock. The rationale for this practice is to avoid mesenteric ischemia. The objective of this study is to evaluate the tolerability of EN in patients with septic shock who require vasopressor support and determine factors associated with tolerance of EN. MATERIALS AND METHODS: This was a single-center retrospective review of adult patients admitted to the intensive care unit with a diagnosis of septic shock and an order for EN...
July 3, 2016: Journal of Intensive Care Medicine
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