Pharmaconutrition in PICU. Gan Chin Seng Paediatric Intensivist UMMC
|
|
- Jasmine James
- 5 years ago
- Views:
Transcription
1 Pharmaconutrition in PICU Gan Chin Seng Paediatric Intensivist UMMC
2 Pharmaconutrition in Critical Care Unit Gan Chin Seng Paediatric Intensivist UMMC
3 Definition New concept Treatment with specific nutrients to improve host defences and improve the outcome of critically ill patients E.g. glutamine, arginine, omega-3 fatty acids, selenium Less about energy requirements or nitrogen balance Pharmacological nutrition, Nutritional pharmacology
4 Background Critical illness causes systemic inflammation, altered immunity, & metabolic changes resulting in hypermetabolism Inability to maintain adequate nutrition leads to nutrient deficiencies, which may in turn increase the risk for infection, organ failure, & mortality
5 Artificial Nutrition Enteral (EN)/ parenteral (PN) ADJUNCTIVE support Debates on energy requirements & protein losses in past 40 years Early EN once haemodynamically stable within 3 days to avoid mucosal atrophy No immediate benefit with supplemented PN when intolerant to early EN in the absence of malnutrition ESPEN 2009: early ASPEN 2009: 7-10 days (Heidegger et al. Lancet. 2012; )
6 Immunonutrition Immune- enhancing diet (IED) Past 3 decades Enteral formulations or cocktails enrished in various nutrients Macronutrients: glutamine, arginine, omega-3 FAs Micronutrients: Vits A, C & E, selenium & zinc Various concentrations (special formula) To optimize immune function & cell recovery
7 Current evidence suggests that IED is beneficial in major elective surgery, trauma, burns, head and neck cancer, & non-septic critically ill patients on mechanical ventilation IED in severe sepsis/ critically ill patients is controversial (McClave SA et al. JPEN 2009;33: ) Mortality rate (Zaloga GP. Crit Care Med, 1998; 26:1143±1146) Canadian Clinical Practice Guidelines Committee recommended that IEDs should not be used in critically ill patients (Heyland DK. J Parenter Enteral Nutr 2003; 27: )
8 Over 30 RCTs of immunonutrition in over 2000 critically ill patients No benefit on outcome No evident to support (Kieft H et al. Intensive Care Med. 2005;31:524 32; Ochoa JB. Crit Care Med 2008;36:347 8) 597 patients, high-protein formula enriched with arginine, glutamine, antioxidants, & omega-3 FAs No change in outcome (Heyland et al. Crit Care Med. 2013; ) Poor methodological quality & small sample size Various nutrient combinations Heterogeneous patient population ( MIXED COCKTAIL approach)
9 Pharmaconutrition In 2008, Jones & Heyland proposed administration of specific nutrients in supranormal amounts has pharmacological effects on the inflammatory response to critical illness & can improve clinical outcomes ACTIVE therapeutic treatment (Jone and N.E. Heyland. Current Opinion in Gastroenterology. 2008;24: ) (Preiser et al. Critical Care. 2015; 19:35)
10 Meguid et al. (Ann Surg 2009) & Dupertuis et al. (Curr Opin Clin Nutr Metab Care 2009) suggested pharmaconutrition with disease-dedicated therapy approach Last decade Increasing evidences of therapeutic effects Impact on clinical outcomes NO Paediatric data (Meguid MM et al. Ann Surg 2009;249:364 5) (Dupertuis YM et al. Curr Opin Clin Nutr Metab Care 2009;12: )
11 Glutamine Non-essential amino acid Fuel for rapidly dividing cells e.g. lymphocytes, enterocytes, & colonocytes Protects structural & functional integrity of intestinal mucosa Augments cellular immune functions Precursor for endogenous synthesis of arginine Most extensively studied
12 Early small studies, benefits: antioxidant defenses, immune function, & N 2 retention Enhance tissue Heat Shock Protein (HSP) expression & reduce cellular apoptosis & cytokine release Improve tissue metabolic function Enhance stress tolerance Infectious complications (RR 0.79, 95% CI , P = 0.005) Mortality, especially with PN (RR 0.75, 95% CI , P = 0.008) Decreased length of hospital stay & ventilator time (Wischmeyer PE. Crit Care Med. 2007;35(suppl 9):S541 4) (Canadian clinical practice guidelines, ESPEN guideline on PN, SCCM & ASPEN 2009)
13 More recent studies, conflicting results In the Scottish Intensive Care Glutamine or Selenium Evaluative Trial No measurable improvement in new infection rates or survival (Andrews PJ et al. BMJ. 2011;342:d1542) Scandinavian glutamine trial Reduction in mortality when received glutamine for more than 3 days 3 meta-analysis: conflicting results (Wernerman J et al. Acta Anaesthesiol Scand. 2011;55:812 8) (Fadda V et al. Clin Nutr. 2013;32:492 3; Bollhalder L et al. Clin Nutr. 2013;32:213 23; Heyland D, et al. N Engl J Med. 2013;368: ) Very different approaches in dosing, timing, & backgrounds Used with caution, & harmful effects yet to be clarified
14 Arginine Metabolized by NO synthase to NO Stimulates release of hormones: GH, prolactin & insulin number & function of T cells Depletion of arginine & T-cell activation & immunocompetence, risk of infection With sepsis NO synthase upregulated, high arginine could be harmful Catabolic state, low serum arginine Dietary intake Uptake in endothelium, liver, and intestine Metabolism
15 Mortality & worsened shock In sepsis (Bertolini G. Intensive Care Med. 2003;29:834 40) Beneficial for elective surgery patients in reducing post-op infection (Drover JW. J Am Coll Surg. 2011;212:385 99)
16 Omega-3 Fatty Acid Fish oil, borate oil Incorporation into inflammatory cell membrane phosopholipids, leukotriene B 4,thromboxane A 2 & prostaglandin E 2 production Mixed report 60% mortality reduction ALI & ARDS (Pontes-Arruda A. J Parenter Enteral Nutr. 2008;32: ) (Zhu D et al. Intensive Care Med. 2014;40: )
17 2013 & 2015 Canadian Clinical Practice guideline ( Insufficient data to recommend use of fish oil alone for critically ill Lack of treatment effect on outcome Too sparse data
18 2008 meta-analysis of 3 studies demonstrated that enteral formula enriched with fish oils, borate oils & antioxidants significantly reduces mortality (RR 0.63, 95% CI 0.48, 0.84, P=0.002) in ARDS (
19 Canadian Clinical Practice guideline ( & 2015: enteral formula with fish oils, borage oils & antioxidants in ALI & ARDS should be considered Overall treatment effect on mortality decreased Lack good control group in several studies ( high fat formula, additional protein Lack of a treatment effect
20 Selenium & Antioxidants Part of a complex endogenous defence system protecting tissues from the damaging effects of oxidative stress Antioxidants, oxygen free radicals, systemic inflammatory response, subsequent cell injury, organ failure, & even higher mortality Selenium either alone or in combination with other trace elements & vits (Zn & vits A, C & E)
21 High-dose selenium (1000mcg/day) supplementation in 249 pts with severe systemic inflammatory response syndrome, sepsis, & septic shock demonstrated a large, but not significant, reduction in mortality [odds ratio (OR) 0.66, 95% CI 0.39, 1.10, P=0.109] Greater treatment effect detected in high normal levels of selenium compared with normal levels (Angstwurm MW et al. Crit Care Med 2007; 35: )
22 Mortality (RR 0.69, 95% CI 0.59, 0.82, P=0.0001), but had no effect on infectious complications or ICU length of stay in critically ill patients (Heyland DK et al. Intensive Care Med 2005; 31: )
23 High normal serum selenium was proposed as a target for result Antioxidant strategies, particularly selenium, should be considered for critically ill patients
24 Challenges Defining individual optimal dose Duration, efficacy, & routes of nutrient supplementation Heterogeneous patient populations
25 Summary Pharmaconutrition is an interesting field in critical area No Paediaric data yet Artificial nutrition/ immunonutrition/pharmaconutrition Glutamine/ arginine/ Omega-3 FAs (fish oil & borate oil)/selenium & antioxidants
26 Arginine: not recommended for sepsis Glutamine: needs further clarification Enteral fish oils, borage oils & antioxidants in ALI & ARDS should be considered High dose selenium could be helpful
27 THANK YOU
Amino acids: the forgotten building blocks? Vanessa Kotze RD(SA) Lecturer: Dpt of Human Nutrition
Amino acids: the forgotten building blocks? Vanessa Kotze RD(SA) Lecturer: Dpt of Human Nutrition Focus of presentation Adult critical illness Each amino acid Protein synthesis properties Evidence Guidelines
More informationNutrition and Sepsis
Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.
More informationTPN and lipid. RCT of 57 patients. TPN with lipid vs TPN without lipid. TPN associated with increased infectious complications
TPN and lipid RCT of 57 patients TPN with lipid vs TPN without lipid TPN associated with increased infectious complications * * * * Battistella FD, et al. J Trauma 1997; 43:52. Data Needed 1. New TPN trials
More informationVeeradej Pisprasert, MD PhD
Immunonutrition: Asian Perspectives Evidence of Immunonutrition in Asia Veeradej Pisprasert, MD PhD Division of Clinical Nutrition Department of Medicine, Khon Kaen University pveera@kku.ac.th Outline
More informationDr Ahmad Shaltut Othman Anaesthesiologist & Intensivist Hosp Sultanah Bahiyah Alor Setar
FEEDING WITH FISH OIL Dr Ahmad Shaltut Othman Anaesthesiologist & Intensivist Hosp Sultanah Bahiyah Alor Setar New horizons in clinical nutrition from Support to Therapy Landmarks in Parenteral Nutrition
More informationENTERAL NUTRITION IN THE CRITICALLY ILL
ENTERAL NUTRITION IN THE CRITICALLY ILL 1 Ebb phase Flow phase acute response (catabolic) adoptive response (anabolic) 2 3 Metabolic Response to Stress (catabolic phase) Glucose and Protein Metabolism
More informationNutrition. ICU Fellowship Training Radboudumc
Nutrition ICU Fellowship Training Radboudumc Critical Care MCQ s Nasogastric (NG) and nasojejunal (NJ) feeding tubes: A. Enteral nutrition is associated with a reduced risk of bacterial and toxin translocation.
More informationWhat other beneficial effects might GLN exert in critical illness??
What other beneficial effects might GLN exert in critical illness?? Prevention of Enhanced Gut Permeability Who believes bacteria translocate from the gut to blood and cause infection? Yes No Bacteria
More informationNutrition and GI. How much?
Nutrition and GI How much? The goal of nutritional supplementation is to meet but not exceed the nutritional requirements of patients with critical illness. Due to the inherent variability between patients
More informationFeeding the septic patient How and when? Masterclass ICU nurses
Feeding the septic patient How and when? Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16 - FiO2 60%)
More informationAshraf El Houfi MD MS (pulmonology) FRCP (UK) EDIC Consultant ICU Dubai Hospital
Ashraf El Houfi MD MS (pulmonology) FRCP (UK) EDIC Consultant ICU Dubai Hospital Protein Lipids Lipids? Lipids Energy source/storage 9 Kcal/g Carb.& Prot. 4 Kcal/g Membrane Function glycero-phospholipids
More informationNutrition Support in Critically Ill Cardiothoracic Patients
Nutrition Support in Critically Ill Cardiothoracic Patients อ.นพ.พรพจน เปรมโยธ น สาชาโภชนาการคล น ก ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล Outline Malnutrition in cardiothoracic patients Nutritional
More information10/3/2012. Pediatric Parenteral Nutrition A Comprehensive Review
Critical Care Nutrition Foundation for Moving Forward Justine Turner MD PhD Department of Pediatric Gastroenterology and Nutrition University of Alberta I have the following financial relationships to
More information11.1 Supplemental Antioxidant Nutrients: Combined Vitamins and Trace Elements April 2013
. Supplemental Antioxidant Nutrients: Combined Vitamins and Trace Elements April 23 23 Recommendation: Based on 7 level and 7 level 2 studies, the use of supplemental combined vitamins and trace elements
More informationTiming of Parenteral Nutrition
Timing of Parenteral Nutrition Arun Bansal; MD, FCCM, MRCPCH Professor Pediatric Critical Care PGIMER, Chandigarh, INDIA drarunbansal@gmail.com Malnutrition in Critically Ill Incidence: from 19 32% Associated
More informationIntensive Care Nutrition. Dr Alan Race BSc(Hons) PhD FRCA
Intensive Care Nutrition Dr Alan Race BSc(Hons) PhD FRCA Objectives 1. What examiners say 2. Definition 3. Assessment 4. Requirements 5. Types of delivery 6. CALORIES Trial 7. Timing 8. Immunomodulation
More informationThe Meat and Potatoes of Critical Care Nutrition ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND
The Meat and Potatoes of Critical Care Nutrition ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND 2013 Canadian Clinical Practice Guidelines www.criticalcarenutrition.com NEJM March 27, 2014 Use
More informationHeather Evans, MD University of Washington Seattle, WA
Heather Evans, MD University of Washington Seattle, WA 1 American College of Surgeons Division of Education Heather L. Evans, MD, MS, FACS Nothing to disclose 2 Determine nutritional goals Determine when
More informationAbout OMICS International
About OMICS International OMICS International through its Open Access Initiative is committed to make genuine and reliable contributions to the scientific community. OMICS International hosts over 700
More informationpatients : review of advances in last five years Dr. Aditya Jindal
Enteral nutrition in medical ICU patients : review of advances in last five years Dr. Aditya Jindal Our food should be our medicine and our medicine should be our food. Hippocrates Introduction ti Nutritional
More informationAcetaminophen recommendations from the Food and Drug Administration Advisory Committee
TABLE OF CONTENTS Acetaminophen: recommendations from the FDA Advisory Committee 1 Recombinant human erythropoiesis-stimulating agents and mortality in cancer patients Hospital-acquired pneumonia: risks
More informationEnteral Nutrition: Whom, Why, When, What and Where to Feed?
Meier RF, Reddy BR, Soeters PB (eds): The Importance of Nutrition as an Integral Part of Disease Management. Nestlé Nutr Inst Workshop Ser, vol 82, pp 53 59, (DOI: 10.1159/000382002) Nestec Ltd., Vevey/S.
More informationNutritional Issues. Perioperative Nutritional Interventions. A challenging case you are likely familiar with
Perioperative Nutritional Interventions Lygia Stewart MD, John Maa MD, and Annette Romani RD UCSF Post-Graduate Course Nutritional Issues Who needs nutritional supplementation? Oral, feeding tube, or TPN?
More informationDescribe mechanisms of how immunonutrition benefits patients in surgery beyond that of treating or preventing malnutrition
Juan B. Ochoa MD, FACS Professor of Surgery and Critical Care University of Pittsburgh Medical and Scientific Director, Nestlé HealthCare Nutrition, NestléHealthScience North America Sponsor Disclosure:
More informationTHE AUTHOR OF THIS WHAT S NEW IN NUTRITION? OBJECTIVES & OUTLINE EVIDENCE-BASED MEDICINE: PARENTERAL NUTRITION (PN)
WHAT S NEW IN NUTRITION? Alisha Mutch, Pharm.D., BCPS THE AUTHOR OF THIS PRESENTATION HAS NOTHING TO DISCLOSE. OBJECTIVES & OUTLINE MALNUTRITION OBJECTIVES Indicate when parenteral nutrition (PN) is warranted
More informationNutrition Support. John Cha Department of Surgery DHMC/UCHSC
Nutrition Support John Cha Department of Surgery DHMC/UCHSC Overview Why? When? How much? What route? Fancy stuff: enhanced nutrition Advantages of Nutrition Decreased catabolism Improved wound healing
More informationMalnutrition: An independent Risk Factor for Postoperative Complications
Malnutrition: An independent Risk Factor for Postoperative Complications Bryan P. Hooks, D.O. University of Pittsburgh-Horizon June 24, 2017 Orthopedic Surgeon-Adult Reconstruction Disclosures: None Objectives:
More informationSurgical Nutrition for the Cardiothoracic Patient. Stephanie Kunioki RD, CNSC, LD Memorial Hermann TMC
Surgical Nutrition for the Cardiothoracic Patient Stephanie Kunioki RD, CNSC, LD Memorial Hermann TMC Financial Disclosures NONE Declared PROPER NUTRITION Surgical Effects on Nutrition Intake & Status
More informationICU NUTRITION UPDATE : ESPEN GUIDELINES Mirey Karavetian Assistant Professor Zayed University
ICU NUTRITION UPDATE : ESPEN GUIDELINES 2018 Mirey Karavetian Assistant Professor Zayed University http://www.espen.org/files/espen- Guidelines/ESPEN_Guideline_on_clinical_nutrition_in_-ICU.pdf Medical
More informationGuidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: ASPEN-SCCM 2017
Number of Patients Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: ASPEN-SCCM 2017 Jorge A. Coss-Bu, MD Associate Professor of Pediatrics
More informationBenchmarking your ICU s feeding performance: How early is early?
Benchmarking your ICU s feeding performance: How early is early? Dr Gordon S. Doig, Associate Professor in Intensive Care, Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney,
More informationOklahoma Dietetic Association. Ainsley Malone, MS, RD, LD, CNSD April, 16, 2008 Permissive Underfeeding: What, Where and Why? Mt.
The What, Why and When of Permissive Ainsley Malone, MS, RD, CNSD Nutrition Support Team Mt. Carmel West Hospital Mt. Carmel West 500 bed academic center Non-physician based NST Dietitian, pharmacist and
More informationArginine as an Example of a Conditionally Essential Nutrient: Sickle Cell Disease & Trauma Claudia R. Morris MD, FAAP
Arginine as an Example of a Conditionally Essential Nutrient: Sickle Cell Disease & Trauma Claudia R. Morris MD, FAAP Examining Special Nutritional Requirements in Disease States, A Workshop April 1, 2018
More informationLipids in TPN: Ready for Prime Time? Dr Jonathan Tan Senior Consultant Anaesthesiology and Intensive Care Tan Tock Seng Hospital, Singapore
Lipids in TPN: Ready for Prime Time? Dr Jonathan Tan Senior Consultant Anaesthesiology and Intensive Care Tan Tock Seng Hospital, Singapore Disclosures Travel and speakers honourarium from Abbott, Baxter,
More informationProviding Optimal Nutritional Support on the ICU common problems and practical solutions. Pete Turner Specialist Nutritional Support Dietitian
Providing Optimal Nutritional Support on the ICU common problems and practical solutions Pete Turner Specialist Nutritional Support Dietitian ICU Nutritional Support ACCEPT study showed improved ICU survival
More informationESPEN Congress Madrid 2018
ESPEN Congress Madrid 2018 New ESPEN Guidelines Nutrition In The ICU P. Singer (IL) ESPEN Guidelines: Nutrition in the ICU Pierre Singer Annika Reintam Blaser Mette M Berger Waleed Alhazzani Philip C Calder
More information4.1 (b) Composition of Enteral Nutrition: Immune Enhancing Diets: Fish oils June 28 th, 2005
4.1 (b) Composition of Enteral Nutrition: Immune Enhancing Diets: s June 28 th, 2005 Recommendation: Based on one level 1 study, the use of an enteral formula with fish oils should be considered in patients
More informationThe effectiveness of trace element supplementation following severe burn injury: A systematic review protocol
The effectiveness of trace element supplementation following severe burn injury: A systematic review protocol Rochelle Kurmis BND APD, CF JBI 1,2 Edoardo Aromataris BSc(Hons), PhD 1 John Greenwood AM,
More informationESPEN Congress Madrid 2018
ESPEN Congress Madrid 2018 Lipid Emulsions In Parenteral Nutrition Lipid Emulsions And Outcome In Critical Care Patients K. Demirag (TR) Lipid emulsions and outcome in critical care patients Dr. Kubilay
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominal pain, enteral therapy in acute pancreatitis and, 812 Abscess(es), pancreatic, nutritional support for, 814 815 Acute Physiology and
More information/03/ $03.00/0 Vol. 27, No. 5 JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
0148-6071/03/2705-0355$03.00/0 Vol. 27, No. 5 JOURNAL OF PARENTERAL AND ENTERAL NUTRITION Printed in U.S.A. Copyright 2003 by the American Society for Parenteral and Enteral Nutrition Special Interest
More informationINTRAVENOUS LIPID EMULSION (ILE) ASSESSING NEW OPTIONS IN PARENTERAL NUTRITION:
INTRAVENOUS LIPID EMULSION (ILE) IN PARENTERAL NUTRITION: ASSESSING NEW OPTIONS Todd Canada, PharmD, BCNSP, BCCCP, FASHP, FTSHP University of Texas MD Anderson Cancer Center Houston, Texas Disclosures
More informationProtein dosing in the ICU: How much, when and why?
Protein dosing in the ICU: How much, when and why? Dr. Gordon S. Doig, Associate Professor in Intensive Care Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, Australia
More informationN U TRITION A N D C R I TICALLY I L L PATIENTS W I TH S E P S I S
N U TRITION A N D M E TABOLISM: C R I TICALLY I L L PATIENTS W I TH S E P S I S A R T H U R R. H. V A N Z A N T E N, M D P H D I N T E R N IST - IN TENSIV IST H O S P I T AL M E D I C A L D I R E C T OR
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acetate, in pediatric surgical patients, 525 526 Acute respiratory distress syndrome (ARDS), immune-modulating nutrition in, 584 585 Aerobic
More informationNutritional intervention in hospitalised paediatric patients. Dr Y.K.Amdekar
Nutritional intervention in hospitalised paediatric patients Dr Y.K.Amdekar Back to basics Suboptimal nutrient intake is always dangerous in health and more so in disease to feed or not to feed is it a
More informationNutrition Management of the Critically Ill Pediatric Patient: Facilitating the Transition to Enteral Nutrition
Nutrition Management of the Critically Ill Pediatric Patient: Facilitating the Transition to Enteral Nutrition Ana Abad-Jorge, EdD, MS, RDN, CNSC Program Director, Bachelor of Professional Studies in Health
More informationESPEN Congress Copenhagen 2016
ESPEN Congress Copenhagen 2016 ESPEN GUIDELINES SURGERY A. Weimann (DE) ESPEN Guideline Clinical Nutrition in Surgery Conflicts of interest Speaker `s honoraria: Baxter Germany Berlin Chemie B. Braun Melsungen
More informationCurrent concepts in Critical Care Nutrition
Current concepts in Critical Care Nutrition Dr.N.Ramakrishnan AB (Int Med), AB (Crit Care), MMM, FACP, FCCP, FCCM Director, Critical Care Services Apollo Hospitals, Chennai Objectives Why? Enteral or Parenteral
More informationBy; Ashraf El Houfi MD MS (pulmonology) MRCP (UK) FRCP (London) EDIC Consultant ICU Dubai Hospital
By; Ashraf El Houfi MD MS (pulmonology) MRCP (UK) FRCP (London) EDIC Consultant ICU Dubai Hospital Introduction The significance of nutrition in hospital setting (especially the ICU) cannot be overstated.
More informationNutritional physiology of the critically ill patient
Section 1 General Concepts Nutritional physiology of the critically ill patient David C. Frankenfield 1 Introduction Nutritional physiology refers to the role of food and nutrition in the function of the
More informationREducing Deaths from OXidative Stress
C a n adian Critic a The REDOXS Study REducing Deaths due to OXidative Stress The REDOXS Study REducing Deaths from OXidative Stress Study Chair Dr. Daren Heyland, MD, FRCPC Project Leaders Rupinder Dhaliwal,
More informationWhen to start SPN in critically ill patients? Refereeravond IC
When to start SPN in critically ill patients? Refereeravond IC Introduction (1) Protein/calorie malnutrition is very frequent in critically ill patients Protein/calorie malnutrition is associated with
More informationNO DISCLOSURES 5/9/2015
Annette Stralovich-Romani, RD, CNSC Adult Critical Care Nutritionist UCSF Medical Center NO DISCLOSURES Incidence & consequences of malnutrition Underfeeding in the ICU Causes/ consequences Nutrition intervention
More information[No conflicts of interest]
[No conflicts of interest] Patients and staff at: Available evidence pre-calories Three meta-analyses: Gramlich L et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes
More informationNutrition care plan for surgical patients. Objectives
Slide 1 Nutrition care plan for surgical patients Surgical Nutrition Training Module Level 1 Philippine Society of General Surgeons Committee on Surgical Training In this session we will discuss the most
More informationProtein in Critically Ill Patients. Ashraf El Houfi. MD MS(pulmonology) MRCP(UK) FRCP(London) EDIC Consultant ICU Dubai Hospital
Protein in Critically Ill Patients Ashraf El Houfi. MD MS(pulmonology) MRCP(UK) FRCP(London) EDIC Consultant ICU Dubai Hospital Proteins Proteins Protein is needed to Build, Maintain, and Repair body tissue
More informationNutritional Management of Emergency Gastrointestinal (GI) Surgeries
Nutritional Management of Emergency Gastrointestinal (GI) Surgeries Alexander, MD, FACS Introduction Emergency gastrointestinal (GI) surgery is different than elective GI surgery in many ways. Emergencies
More informationCan we save lives with more vitamin C?
ANZICS NZ 5/4/2017 Can we save lives with more vitamin C? Anitra Carr, PhD Sir Charles Hercus Health Research Fellow Department of Pathology University of Otago, Christchurch, NZ Human vitamin C requirement
More informationErnährungstherapie des Kritisch Kranken Enteral Parenteral Ganz egal?
Ernährungstherapie des Kritisch Kranken Enteral Parenteral Ganz egal? PD Dr. med. Claudia Heidegger Service des Soins Intensifs Genf/Schweiz Dresden 11. Juni 2016 Nutrition News Nutrition controversy in
More informationNutritional Support of the Injured Patient
Nutritional Support of the Injured Patient A health care practice does not usually attend to severely traumatized, burned, or critically ill patients because they are usually hospitalized for extended
More informationStellenwert der prä- und postoperativen Sicht des Chirurgen
Interdisziplinäre Chirurgie Stellenwert der prä- und postoperativen Ernährung Sicht des Chirurgen Kantonsspital Luzern 24.11.2005 Prof. L. Krähenbühl Chirurgische Klinik Hôpital Cantonal Fribourg Problems
More informationParenterale voeding tijdens kritieke ziekte: bijkomende analyses van de EPaNIC studie
Parenterale voeding tijdens kritieke ziekte: bijkomende analyses van de EPaNIC studie Namens alle auteurs Michaël P. Casaer M.D. Department of Intensive Care Medicine University Hospital Gasthuisberg Catholic
More information9.3 Composition of Parenteral Nutrition: Zinc (either alone or in combination with other antioxidants)
9.3 Composition of Parenteral Nutrition: Zinc (either alone or in combination with other antioxidants) There are no new randomized controlled trials since the 2015 updates and hence there are no changes
More informationSymposium 4. Hot Topics in Parenteral Nutrition. Supported by an unrestricted educational grant from Baxter
Symposium 4 Hot Topics in Parenteral Nutrition Supported by an unrestricted educational grant from Baxter Rationale for using new lipid emulsions a review of evidence from clinical trials Philip Calder
More informationICU Acquired Weakness: Role of Specific Nutrients
ICU Acquired Weakness: Role of Specific Nutrients Dr Jonathan TAN Senior Consultant Dept of Anaesthesiology, Intensive Care & Pain Medicine Tan Tock Seng Hospital, Singapore Purpose? Healthcare professionals?
More informationImproving Outcomes in Surgery, Trauma and Critical Illness: One Bite at a Time
Improving Outcomes in Surgery, Trauma and Critical Illness: One Bite at a Time Juan B. Ochoa, MD, FACS Professor of Surgery and Critical Care University of Pittsburgh- UPMC (on Leave) Medical and Scientific
More informationfocus on protein metabolism
Leipzig DGEM 2010 Glutamine and the gut: focus on protein metabolism P. Déchelotte, Rouen, France Gut : a key organ for glutamine metabolism GLN and a target organ modulated by glutamine Clinical benefits
More informationCritical illness or major surgery usually results in
: Improving Outcomes in Multiple Trauma and Gastrointestinal Cancer Resection Rex O. Brown, PharmD, FCCP, BCNSP ABSTRACT Immune-enhancing diets are nutritionally complete enteral nutrition formulations
More informationOmega-3 fatty acids in clinical nutrition
Omega-3 fatty acids in clinical nutrition Alastair Forbes With thanks to Jon Shaffer, UK and many ESPEN colleagues Omega-3 fatty acids in clinical nutrition Review of lipids in nutrition Why and how lipids
More informationNutritional Demands of Disease and Trauma
al Demands of Disease and Trauma Lecture 89 Medical School al Requirements Based on needs to support optimal physiological function Are changed by disease or injury metabolism is altered to prevent further
More information4.1b(i) Composition of Enteral Nutrition: Fish Oils, Borage Oils and Antioxidants* May 2015
4.1b(i) Composition of Enteral Nutrition: Fish Oils, Borage Oils and Antioxidants* May 2015 2015 Recommendation: Based on 3 level 1 studies and 5 level 2 studies, the use of an enteral formula with fish
More informationFeeding the Critically Ill Obese Patient
Feeding the Critically Ill Obese Patient Carla Vartanian 1 Critically Ill Obese Patients WHO: Obesity is abnormal or excessive fat accumulation that may impair health, or as a BMI 30. The American Medical
More informationESPEN Congress The Hague 2017
ESPEN Congress The Hague 2017 Meeting nutritional needs of acute care patients Feeding acute pancreatitis patients J. Luttikhold (NL) FEEDING ACUTE PANCREATITIS PATIENTS Joanna Luttikhold, MD PhD Registrar
More informationNutrition in critical illness:
Nutrition in critical illness: from theory to daily practice Aim of the presentation Summarize the guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient.
More informationJournal Club: The Use of Fish Oil Lipid Emulsion for Gastrointestinal Surgery Patients
S a m m i M o n t a g F i s h O i l E m u l s i o n J o u r n a l C l u b - P a g e 1 Journal Club: The Use of Fish Oil Lipid Emulsion for Gastrointestinal Surgery Patients Introduction/Background I. Surgical
More informationNutrition care plan. Components and development
Nutrition care plan Components and development Objectives To define the nutrition care plan To present the components of the nutrition care plan To discuss the different approaches in determining the contents
More informationProtein Supplementation in the Pediatric Intensive Care Unit. Jan Hau Lee, MBBS, MRCPCH, MCI Children s Intensive Care Unit 28 th July 2017
Protein Supplementation in the Pediatric Intensive Care Unit Jan Hau Lee, MBBS, MRCPCH, MCI Children s Intensive Care Unit 28 th July 2017 1 Objectives Basis for protein supplementation Challenges in monitoring
More informationAntioxidant Dosing and Micronutrient Management in the Intensive Care Unit
PENSA 2017 November 21, 2017 Antioxidant Dosing and Micronutrient Management in the Intensive Care Unit Lingtak-Neander Chan, PharmD, BCNSP, CNSC, FACN Professor of Pharmacy, Interdisciplinary Faculty
More informationIS THERE A PLACE IN THE ICU FOR PERMISSIVE UNDERFEEDING AND WHERE? ENGELA FRANCIS RD(SA)
IS THERE A PLACE IN THE ICU FOR PERMISSIVE UNDERFEEDING AND WHERE? ENGELA FRANCIS RD(SA) DEFINITION: PERMISSIVE UNDERFEEDING No clear definition in literature Permissive underfeeding definition prior to
More informationIMMUNONUTRITION AND GI SURGERY (UPPER AND LOWER) STUDIES COMPENDIUM
IMMUNONUTRITION AND GI SURGERY (UPPER AND LOWER) Colorectal or gastric cancer Xu 2006 (WJS;30:1284-1289) RCT to determine the effect of preoperative immunonutrition on nutritional status, immunity, and
More informationNutrition in Acute Kidney Injury Enrico Fiaccadori
Nutrition in Acute Kidney Injury Enrico Fiaccadori Nephrology Dept. Parma University Medical School Parma, Italy Diagnosis, epidemiology and prognostic impact of proteinenergy wasting (PEW) in AKI Pathogenetic
More information11.2 Supplemental Antioxidant Nutrients: Parenteral Selenium* January 31 st 2009
11.2 Supplemental Antioxidant Nutrients: Parenteral Selenium* January 31 st 2009 Recommendation: There are insufficient data to make a recommendation regarding IV/PN selenium supplementation, alone or
More informationPancreatitis: Critical care and Nutritional Considerations. Vance L. Smith, MD Montefiore Medical Center Acute Care Surgery
Pancreatitis: Critical care and Nutritional Considerations Vance L. Smith, MD Montefiore Medical Center Acute Care Surgery No disclosures Pathophysiology Mr. H. 42 yo male found to have gallstone pancreatitis
More information8.0 Parenteral Nutrition vs. Standard care January 31 st 2009
8.0 Parenteral Nutrition vs. Standard care January 31 st 2009 Recommendation: Based on 5 level 2 studies, in critically ill patients with an intact gastrointestinal tract, we recommend that parenteral
More informationInt. Med J Vol. 6 No 1 June 2007 Enteral Nutrition In Intensive Care: Tiger Tube For Small Bowel Feeding In Acute Pancreatitis.
Page 1 of 6 Int. Med J Vol. 6 No 1 June 2007 Enteral Nutrition In Intensive Care: Tiger Tube For Small Bowel Feeding In Acute Pancreatitis. Case Report Mohd Basri bin Mat Nor. Department of Anaesthesiology
More informationThe Role of Parenteral Nutrition. in PEDIATRIC INTENSIVE CARE UNIT. Dzulfikar DLH. Pediatric Emergency and Intensive Care Unit
The Role of Parenteral Nutrition in PEDIATRIC INTENSIVE CARE UNIT Dzulfikar DLH Pediatric Emergency and Intensive Care Unit Department of Child Health, Faculty of Medicine Universitas Padjajaran, Hasan
More informationTHE PHYSIOLOGICAL IMPACT OF TRAUMA AND INFECTION = The Metabolic Response to Stress
THE PHYSIOLOGICAL IMPACT OF TRAUMA AND INFECTION = The Metabolic Response to Stress JP Pretorius Head: Department of Critical Care Head: Clinical Unit Surgical/Trauma ICU University of Pretoria & Steve
More informationList of Topics and Modules (2012)
List of Topics and Modules (202) Code Title Credits for Live course Topic 0 Introduction to Clinical Nutrition EDU T0 M 0. Introduction to clinical nutrition support Topic Metabolism of Metabolism of Macronutrients,
More informationL.Mageswary Dietitian Hospital Selayang
L.Mageswary Dietitian Hospital Selayang 14 15 AUG ASMIC 2015 Learning Objectives 1. To understand the importance of nutrition support in ICU 2. To know the right time to feed 3. To understand the indications
More informationFrances Carroll DipION Nutritional Therapy Blues Scheme Coach francescarroll.co.uk
Illness and Injury About Frances Carroll DipION Nutritional Therapy Blues Scheme Coach francescarroll.co.uk Helen Money BSc Human Nutrition PGC Applied Sports Nutrition helenmoneynutrition.com Requirements
More informationJodie R. Orwig, RDN, LDN
Jodie R. Orwig, RDN, LDN In the first 12-24 hours post injury, the #1goal is stabilizing the patient, not nutrition. Goal #2 is surgery, as indicated, to correct the injury Preservation of organ function
More informationESPEN Congress Geneva 2014 LLL LIVE COURSE: ICU NUTRITION AND PROBLEM SOLVING. Substitution, supplementation and pharmaco-nutrition M.
ESPEN Congress Geneva 2014 LLL LIVE COURSE: ICU NUTRITION AND PROBLEM SOLVING Substitution, supplementation and pharmaco-nutrition M. Berger (CH) Nutritional Support in Intensive Care Unit Patients Substitution,
More informationMetabolic response to stress. Pierre Singer, MD Institute for Nutrition Research Critical Care Medicine Rabin Medical Center Tel Aviv University
Metabolic response to stress Pierre Singer, MD Institute for Nutrition Research Critical Care Medicine Rabin Medical Center Tel Aviv University Disclosures Speaker fees from Abbott, GE, Cosmed, B Braun,
More informationESPEN Congress Lisbon 2004
ESPEN Congress Lisbon 2004 Pharmacists Session Specialised formulas for enteral and parenteral nutrition A clinical reality or marketing exercise Bruce McElroy Specialised Formulas for Enteral and Parenteral
More informationFeeding the critically ill child
Feeding the critically ill child Khaw Sia (1913 1984) Lee Jan Hau, MBBS, MRCPCH, MCI Children s Intensive Care Unit September 2018 1 2 3 No disclosures Outline Is there a need to optimize enteral nutrition?
More informationA R T H U R R. H. V A N Z A N T E N, MD PHD I N T E R N I S T - I N T E N S I V I S T H O S P I T A L MEDICAL DIRECTOR G E L D E R S E V A L L E I
FEEDING THE OBESE CRITICALLY ILL PATIENT A R T H U R R. H. V A N Z A N T E N, MD PHD I N T E R N I S T - I N T E N S I V I S T H O S P I T A L MEDICAL DIRECTOR G E L D E R S E V A L L E I HOSPITAL, EDE,
More informationLet the Sun Shine in: Vitamin D and other Supplements in the ICU
Let the Sun Shine in: Vitamin D and other Supplements in the ICU Kimberly Zammit, PharmD, BCPS, BCCCP, FASHP Clinical Pharmacy Coordinator, Critical Care and Cardiology Buffalo General Medical Center Disclosures
More information10.2 Strategies to Optimize Parenteral Nutrition and Minimize Risks: Use of lipids May 2015
10.2 Strategies to Optimize Parenteral Nutrition and Minimize Risks: Use of lipids May 2015 There are no new randomized controlled trials since the 2009 and 2013 updates and hence there are no changes
More information6.5 Enteral Nutrition: Other Formulas: ß Hydroxyl Methyl Butyrate (HMB) May 2015
6.5 Enteral Nutrition: Other Formulas: ß Hydroxyl Methyl Butyrate () May 2015 There were no new randomized controlled trials since the 2013 update and hence there are no changes to the following summary
More information