Antioxidant Dosing and Micronutrient Management in the Intensive Care Unit
|
|
- Ophelia Kelly Bailey
- 6 years ago
- Views:
Transcription
1 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 in Nutritional Sciences University of Washington, Seattle, USA
2 OBJECTIVE To identify the issues and challenges of micronutrient management in the critically ill patient. > Antioxidants supplementation > Other Micronutrients
3 Physiological Functions of Micronutrients > Antioxidants > Cell division and proliferation > Neurological development and functions > Catalytic functions > Structural functions > Cell signaling pathways > Immune functions > Metabolic and endocrine regulations > Pigment formation
4 What is the merit of Antioxidant Therapy in ICU Patients > 213 adult ICU patients admitted to 6 hospitals in Spain > Primary diagnosis = Severe Sepsis (ISDC criteria) > Blood samples collected within 2 hours of diagnosis Variable Hazard Ratio on 30-day Survival Serum Lactic acid 1.08 [95% Confidence interval; ] APACHE II Score 1.04 [95% Confidence interval; ] Total Antioxidant Capacity (TAC) 1.50 [95% Confidence interval; ] Lorente L. et al. J Crit Care 2015;30: 217.e7 217.e12
5 Kaplan-Meier Survival Prediction at 30 days Based on Serum Total Antioxidant Capacity (TAC) Cutoff = 2.80 mmol/l Lorente L. et al. J Crit Care 2015;30: 217.e7 217.e12
6 Alonso de Vega JM et al. Crit Care Med 2000;28:
7 Other Evidence Suggesting a Deficiency of Antioxidants in Critically Ill Patients > Serum selenium, zinc, ascorbic acid are lower in ICU patients, compared with healthy control > RBC selenium concentration predicts ICU and hospital mortality in patients with septic shock > Odd ratios (OR) on mortality with normal RBC selenium concentration : ICU mortality 0.95 [95% CI ] Hospital mortality 0.96 [95% CI ] (Costa NA, et al, Critical Care 2014, 18:R92) > Argument against : Acute phase reaction, redistribution
8 Acute illness and hypozincemia Besecker BY, et al. Am J Clin Nutr 2011; 93:
9 Linear Regression Analysis Between Plasma Concentrations of Zinc and C-Reactive Protein in Hypozincemic Patients 70 R 2 = 0.18; p < Plasma Zinc Concentration (mcg/dl) Chan L-N et al, JPEN 2008;32(3): Plasma C-Reactive Protein Concentration (mg/l)
10
11 Odds Ratio for All Cause Mortality at 28 Days in ICU Patients received Antioxidants Heyland D, et al, N Engl J Med 2013;368: Antioxidant Regimen: IV selenium 500 μg ; plus the following PO/EN vitamins and minerals Selenium 300 μg Zinc 20 mg beta carotene10 mg Vitamin E 500 mg Vitamin C1500 mg
12 SELENIUM Supplementation in the ICU compared Outcomes Relative Effect Mortality Overall RR = 0.82 [95% CI = 0.72 to 0.93] 28-day Mortality = 0.84 [95% CI = 0.69 to 1.02] ICU Length-of-stay Days on ventilator Hospital Length-of-stay Mean difference = day [95% CI to 3.34] Mean difference = day [95%CI to 2.67] Mean difference = days [95% CI to -1.44] Allingstrup M et al, Cochrane Database Syst Rev Jul 27;(7):CD Manzanares et al. Critical Care (2016) 20:356
13 High-Dose Vitamin C + Thiamin for Sepsis? Retrospective before-after clinical study 47 patients in both groups Micronutrient regimen: Thiamin 200 mg IV q12h x4 d, (50 ml NS/D5 over 30 min) Vitamin C 1.5 g Q6h, x4 d, (100 ml NS/D5 over min) Plus hydrocortisone 50 mg IV q6hr Odd Ratio of mortality in the patients treated with the vitamin C protocol was 0.13 [95% CI , p=0.02] Marik PE, et al. Chest 2017; 151(6):
14 Clinical Outcomes Between Antioxidanttreated Patients vs No Antioxidant Parameters Treatment group Control group Age 58.3 ± 14.1 yr 62.2 ± 14.3 yr APACHE II Score 22.1 ± ± 5.7 Hospital mortality 8.5 % 40.4 % Median ICU LOS 4 (3-5) days 4 (4-10) days Duration of vasopressors 18.3 ± 9.8 hrs 54.9 ± 28.4 hrs Need for CRRT 10 % 33 % SOFA score, 72 h 4.8 ± ± 2.7 Marik PE, et al. Chest 2017; 151(6):
15 Summary- Antioxidant Therapy in ICU Patients Current Dilemma 1. Antioxidant concentrations appear to be decreased in ICU patients 2. Replacing the deficiencies does not appear to improve clinical outcomes in most trials 3. It is unclear what treatment goals or antioxidant targets to aim for
16 Factors Contributing to the Dilemmas 1. The blood test- Is it prognostic? 2. Selection of regimen- which one to use? The dose The salt and dosage form The duration of therapy The route of administration 3. Patient types 4. What is the goal?
17 Clinical Outcomes According to Plasma Vit. C Clinical Outcomes Normal >0.46 mg/dl (n=37) Severely Low mg/dl (n=8) Plasma Vitamin C (mg/dl) 1.17 ± ± 0.04 ICU Length of Stay (days) 13.6 ± ± 5 Hospital Length of Stay (days) 23.3 ± ± 21.2 Respiratory Failure 91% 100% Renal Failure 39% 0 Liver Failure 11% 12.5% Mortality 21% 37% Hoge E, et al. J Parentr Ent Nutr (JPEN) 2009
18 Comparison of Regimens Among the Three Selenium Trials Clinical Trial Treatment Control SIC Liverpool French 1000 µg loading; µg/hr x 14 days 474 µg x 3 days; 316 µg x 3 days; 158 µg x 3 days; 31.6 µg/day 167 µg/hr x 24hr; µg/hr x 9 days Saline 31.6 µg/day Saline Angstwurm MWA et al. Crit Care Med 2007;35: Mishra V et al. Clin Nutr 2007;26: Forceville X et al. Crit Care 2007;11:R73
19 Selenium Supplementation: Kinetic Consideration Selenium has a complex kinetic profile in the body Distribute to different compartments with highly variable rates and elimination half-lives Peak time in plasma: PO: hrs IV: 1-2 hrs Mean residence times (staying in the body): Plasma: ~ 2 d Liver/Pancreas: ~20 d Tissues: > 200 d Urine excretion within hours Sustained, provision of selenium is needed to fully treat clinical deficiency and restore tissue deficits
20 Comparison of plasma concentration profile of a single 3-gram dose of vitamin C IV bolus 3 grams, single dose PO Padayatty SJ et al. Ann Intern Med 2004;140:533-7.
21 Nathens AB et al. Ann Surg 2002;236(6):
22 Implication A dose response relationship was mostly absent in these interventional trials Where did the vitamins go??? Possible scenarios: Antioxidant vitamins were not absorbed enterally (at high doses) saturation of absorption Antioxidants were used up in the GI tract, by the liver, or wasted through enterohepatic re-circulation Antioxidants were absorbed but sent to depots (e.g., other organs); thus the plasma concentrations did not increase proportionately.
23 Cooperative Actions LOOH Tocopheroxyl radical Ascorbate GSSG NADPH + tocopherol Dehydroascorbate GSH NADP LOO
24 Key Takeaways. > Critical illness is associated with reduced antioxidant concentrations in the plasma > For most antioxidants, it remains unclear whether this is a true deficiency or an acute phase response > Replacing the observed deficiencies has NOT been associated with improved clinical outcomes > More research should be dedicated to understand the kinetics of these micronutrients > Provide detailed doses, delivery technique, infusion time because the kinetics matter > Allow the results to be replicated
25 How Inflammatory Responses Affect the Clinical Assessment of Micronutrients Micronutrient Sample Changes with acute phase reaction (e.g., CRP) Chromium Plasma Copper Serum Ceruloplasmin Serum Selenium Plasma Zinc Serum/plasma 25(OH) vitamin D Plasma Retinol Serum Folate Serum Iron (total) Serum Ferritin Serum Vitamin C (total) Serum/Leukocyte Thurnham DI, McCabe GP. Geneva, Switzerland: World Health Organization; Tomkins A. J Nutr 2003:133: 1649S 1655S.
26 The IRONMAN Trial Eligibility criteria: Hemoglobin < 10 g/dl Exclusion: Ferritin > 1,200 ng/ml TSAT > 50% Intervention: Ferric carboxymaltose 0.5 g/100 ml of NaCl 0.9% May repeat in 4 days based on lab results The IRONMAN Investigators. Intensive Care Med (2016) 42:
27 The IRONMAN Trial Primary outcome- Total RBC Unit transfused per patient Total number of pts received transfusion Not different between 2 groups Other outcomes No difference in mortality, LOS No difference in incidence of nosocomial infections and bacteremia No difference in thromboembolic events More patients with Hgb > 10 g/dl at discharge with IV iron The IRONMAN Investigators. Intensive Care Med (2016) 42:
28 Impact of Iron Supplementation by Any Route on Mortality and Infection Risk in ICU Adult Patients with Anemia Mortality risk In-hospital infections risk Shah et al. Critical Care (2016) 20:306
29 Key Takeaways. > Critical illness is associated with reduced antioxidant concentrations in the plasma > For most antioxidants, it remains unclear whether this is a true deficiency or an acute phase response > Replacing the observed deficiencies has NOT been associated with improved clinical outcomes > Empirical IV iron supplementation does not appear to alter clinical outcomes, nor does it lead to harms > Additional research is needed to determine when iron therapy is warranted in ICU patients
11.1 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 informationUpdates in Critical Care Sepsis, Fluids, Epi and Long-Term Outcomes
Updates in Critical Care Sepsis, Fluids, Epi and Long-Term Outcomes Matt Anderson, MD USD SSOM, Clinical Assistant Professor Regional Health, Critical Care Medicine mjanderson972@gmail.com Disclosure(s)
More informationThe Use of Metabolic Resuscitation in Sepsis
The Use of Metabolic Resuscitation in Sepsis Jennifer M. Roth, PharmD, BCPS, BCCCP Critical Care Clinical Specialist - Surgical Trauma ICU Baylor University Medical Center Disclosures No conflicts of interest
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
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 informationUpdate in Hospital Medicine
Update in Hospital Medicine 2017-2018 Brad Sharpe, MD SFHM UCSF Division of Hospital Medicine 2017-2018 Updated literature March 2017 March 2018 Process: CME collaborative review of journals Including
More informationOHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
More informationIntravenous Vitamin C. Severe Sepsis Acute Lung Injury
Intravenous Vitamin C Severe Sepsis Acute Lung Injury Alpha A. (Berry) Fowler, III, MD Professor of Medicine VCU Pulmonary Disease and Critical Care Medicine I Have No Disclosures Bacterial Sepsis Approximately
More informationTransfusion & Mortality. Philippe Van der Linden MD, PhD
Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:
More informationCORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE
CORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE 1 ABBREVIATIONS ACCP = American College of Chest Physicians ARF =
More informationAdvancements in Sepsis
Objectives Advancements in Sepsis Brian Gilbert, PharmD PGY-1 Pharmacy Resident Jackson Memorial Hospital 3/13/2016 www.fshp.org Pharmacist objectives Review recent updates in resuscitation strategies
More informationPharmaconutrition in PICU. Gan Chin Seng Paediatric Intensivist UMMC
Pharmaconutrition in PICU Gan Chin Seng Paediatric Intensivist UMMC Pharmaconutrition in Critical Care Unit Gan Chin Seng Paediatric Intensivist UMMC Definition New concept Treatment with specific nutrients
More informationSteroid in Paediatric Sepsis. Dr Pon Kah Min Hospital Pulau Pinang
Steroid in Paediatric Sepsis Dr Pon Kah Min Hospital Pulau Pinang Contents Importance of steroid in sepsis Literature Review for adult studies Literature Review for paediatric studies Conclusions. Rationale
More informationTop Sepsis Studies
A75M233/A75M529 Monday 08:00-09:15 Wednesday 14:45-16:00 Maureen A Seckel APRN, ACNS-BC, CCRN, CCNS, FCCM Critical Care CNS and Sepsis Leader Christiana Care Health Services, Newark, DE Top Sepsis Studies
More informationSepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
More informationMorris A. Blajchman, MD, FRCP(C) Emeritus Professor, McMaster University Hamilton, Ontario, CANADA
Morris A. Blajchman, MD, FRCP(C) Emeritus Professor, McMaster University Hamilton, Ontario, CANADA RBC TRANSFUSIONS: GENERAL PRINCIPLES RBCs are usually dispensed on a first-in, first-out basis. Storage
More information4/5/2018. Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY. I have no financial disclosures
Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY I have no financial disclosures 1 Objectives Why do we care about sepsis Understanding the core measures by Centers for Medicare
More informationJohn Park, MD Assistant Professor of Medicine
John Park, MD Assistant Professor of Medicine Faculty photo will be placed here park.john@mayo.edu 2015 MFMER 3543652-1 Sepsis Out with the Old, In with the New Mayo School of Continuous Professional Development
More informationAcute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
More informationEndocrine and Metabolic Complications in the ICU
Endocrine and Metabolic Complications in the ICU Linda Liu, M.D. Associate Professor UCSF Department of Anesthesia UC SF 1 New Progress Discovery of complex neuro-endocrine adaptation to critical illness
More informationFLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures
More informationA Randomized Trial of Glutamine and Antioxidants in Critically Ill Patients
original article A Randomized Trial of Glutamine and Antioxidants in Critically Ill Patients Daren Heyland, M.D., John Muscedere, M.D., Paul E. Wischmeyer, M.D., Deborah Cook, M.D., Gwynne Jones, M.D.,
More informationControversies in Hospital Medicine: Critical Care. Vasopressors, Steroids, and Insulin Therapy
Controversies in Hospital Medicine: Critical Care Vasopressors, Steroids, and Insulin Therapy Douglas Fish, Pharm.D. Professor of Pharmacy, University of Colorado Denver Clinical Specialist in Critical
More informationAugmented Renal Clearance: Let s Get the Discussion Flowing
Augmented Renal Clearance: Let s Get the Discussion Flowing Terry Makhoul, PharmD PGY-2 Emergency Medicine Pharmacy Resident University of Rochester Medical Center Strong Memorial Hospital Disclosures
More informationIVC History, Cancer Research
Riordan Clinic IVC Academy 5 IVC History, Cancer Research O (slides 1 40) Riordan Clinic 2018 High Dose Vitamin C Adjunctive Care for Cancer Patients IVC and Cancer Research Overview History & Research
More informationAnaemia in the ICU: Is there an alternative to using blood transfusion?
Anaemia in the ICU: Is there an alternative to using blood transfusion? Tim Walsh Professor of Critical Care, Edinburgh University World Health Organisation grading of the severity of anaemia Grade of
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 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 informationVOLUME-BASED VS. RATE-BASED FEEDING
VOLUME-BASED VS. RATE-BASED FEEDING Amanda Holyk Critical Care Pharmacist Mount Nittany Medical Center Society of Critical Care Medicine Annual Symposium November 10, 2017 0 Disclosure I have no actual
More informationESPEN Congress Madrid 2018
ESPEN Congress Madrid 2018 Dysglycaemia In Acute Patients With Nutritional Therapy Mechanisms And Consequences Of Dysglycaemia In Patients Receiving Nutritional Therapy M. León- Sanz (ES) Mechanisms and
More informationPatient Blood Management: Enough is Enough
Patient Blood Management: Enough is Enough Richard Benjamin, MBChB, PhD, FRCPath Professor of Pathology Georgetown University Medical Center Washington, D.C. Chief Medical Officer Cerus Corporation Concord,
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 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 informationPolmoniti: Steroidi sì, no, quando. Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma
Polmoniti: Steroidi sì, no, quando Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma Number of patients Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive
More informationThe Role of Selenium in Sepsis
The Open Inflammation Journal, 2011, 4, (Suppl 1-M13) 115-119 115 The Role of Selenium in Sepsis Open Access Jennifer McArthur* and Michael W. Quasney Division of Pediatric Critical Care, Department of
More informationStressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds November 8, 2016 2016 MFMER slide-1 Objectives Identify the significance
More informationFITEYE Tablets (Multivitamin + Minerals)
Published on: 10 Jul 2014 FITEYE Tablets (Multivitamin + Minerals) Each Tablet Contains Vitamin C Vitamin E Vitamin A (as beta carotene) Vitamin B2 Lutein Zeaxanthin Zinc Copper Selenium L-Glutathione
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 informationSepsis 3 & Early Identification. Disclosures. Objectives 9/19/2016. David Carlbom, MD Medical Director, HMC Sepsis Program
Sepsis 3 & Early Identification David Carlbom, MD Medical Director, HMC Sepsis Program Disclosures I have no relevant financial relationships with a commercial interest and will not discuss off-label use
More informationDELIRIUM IN ICU: Prevention and Management. Milind Baldi
DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction
More informationVasopressors in Septic Shock. Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada
Vasopressors in Septic Shock Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada Echocardiogram: EF=25% 57 y.o. female, pneumonia, shock Echocardiogram: EF=25% 57 y.o.
More informationThis document is to help guide the use of the provided GRH IV Iron Sucrose package. The documents included in the IV Iron Sucrose Package are:
This document is to help guide the use of the provided GRH IV Iron Sucrose package. The documents included in the IV Iron Sucrose Package are: 1. Adult Outpatient Iron Sucrose Order set (page 2 and 3)
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 informationLong term monitoring. Dr Alison Culkin Research Dietitian St Mark s Hospital
Long term monitoring Dr Alison Culkin Research Dietitian St Mark s Hospital Patient 23 year old lady 1/4/14 Colectomy for UC 3-7/4/14 Ischaemic bowel 4 laparotomies Jejunostomy at 35 cm 23/5/14 Weight
More informationNo conflicts of interest to disclose
No conflicts of interest to disclose Introduction Epidemiology Surviving sepsis guidelines 2012 Updates Resuscitation protocols Map Goals Transfusion Sepsis-3 Bundle Management Questions Sepsis is a systemic,
More informationEVIDENCE BASED RED CELL TRANSFUSION. Rana Samuel, MD DIRECTOR, PATHOLOGY AND LABORATORY MEDICINE VA WNY Health Care System
EVIDENCE BASED RED CELL TRANSFUSION Rana Samuel, MD DIRECTOR, PATHOLOGY AND LABORATORY MEDICINE VA WNY Health Care System HISTORY Blood transfusion works (ie: red cell transfusion saves lives). based on
More informationRecovery trajectories following critical illness: Can we really modify them? Tim Walsh Professor of Critical Care, Edinburgh University
Recovery trajectories following critical illness: Can we really modify them? Tim Walsh Professor of Critical Care, Edinburgh University Considerations What is the problem? What is the current evidence
More informationEnsuring Safe Management of Parenteral Nutrition During Drug Shortages: Strategies and Protocols for Enabling Clinician Success
Ensuring Safe Management of Parenteral Nutrition During Drug Shortages: Strategies and Protocols for Enabling Clinician Success Mandy Corrigan, MPH, RD, CNSC Nutrition Support Clinician mandycorrigan1@gmail.com
More informationMUCH ADO ABOUT NUTRITION PREVENTION AND MANAGEMENT OF THE NUTRITIONAL CONSEQUENCES IN BARIATRIC SURGERY. Sue Cummings, MS, RD
MUCH ADO ABOUT NUTRITION PREVENTION AND MANAGEMENT OF THE NUTRITIONAL CONSEQUENCES IN BARIATRIC SURGERY Sue Cummings, MS, RD suescummings1@gmail.com Improving Surgical Outcomes Nutritional Complications
More informationBlood transfusions in ICU: double-edged sword. Paul Hébert, MD MHSc(Epid) Physician-in-Chief, CHUM Professor, University of Montreal
Blood transfusions in ICU: double-edged sword Paul Hébert, MD MHSc(Epid) Physician-in-Chief, CHUM Professor, University of Montreal Canadian Critical Care Trials Group Collaborating for Impact Leading
More informationBasics in clinical nutrition: Trace elements and vitamins in parenteral and enteral nutrition
e-spen, the European e-journal of Clinical Nutrition and Metabolism (2008) 3, e293ee297 e-spen, the European e-journal of Clinical Nutrition and Metabolism http://intl.elsevierhealth.com/journals/espen
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 informationDrug Shortages with Parenteral Nutrition
Drug Shortages with Parenteral Nutrition Carol J Rollins, MS, RD, PharmD, BCNSP Coordinator, Nutrition Support Team The University of Arizona Medical Center www.nutritioncare.org Conflict of Interest None
More informationSepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
More informationWhy stable isotopes? The role of stable isotope-based studies in evaluating mineral metabolism. What are the micronutrients?
Mineral stable isotope studies in small children Steven Abrams, MD Professor USDA/ARS Children s Nutrition Research Center and Section of Neonatology Department of Pediatrics Baylor College of Medicine
More informationD.K.M COLLEGE FOR WOMEN (AUTONOMOUS) VELLORE-1 DEPARTMENT OF FOODS AND NUTRITION ESSENTIAL OF MICRO NUTRIENTS
D.K.M COLLEGE FOR WOMEN (AUTONOMOUS) VELLORE-1 DEPARTMENT OF FOODS AND NUTRITION ESSENTIAL OF MICRO NUTRIENTS Class: II M.Sc Subject Code: 15CPFN3A Unit - I (6 Marks Questions) 1. Write a note on performed
More informationObjectives. Pathophysiology of Steroids. Question 1. Pathophysiology 3/1/2010. Steroids in Septic Shock: An Update
Objectives : An Update Michael W. Perry PharmD, BCPS PGY2 Critical Care Resident Palmetto Health Richland Hospital Review the history of steroids in sepsis Summarize the current guidelines for steroids
More informationWhat is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017
Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it
More informationTHE BEST I HAVE READ THIS YEAR (IN PULMONARY AND CRITICAL CARE)
23 March 2018 Boca Raton, Florida THE BEST I HAVE READ THIS YEAR (IN PULMONARY AND Johnson.margaret2@mayo.edu No disclosures or off label uses CRITICAL CARE) Margaret M. Johnson, MD Chair, Division of
More informationTransfusion triggers in acute coronary syndromes: The MINT trial
Transfusion triggers in acute coronary syndromes: The MINT trial Paul Hébert, MD MHSc(Epid) Physician-in-Chief, CHUM Professor, University of Montreal Objectives Review evidence on transfusion triggers
More informationMANAGEMENT AND PREVENTION OF REFEEDING SYNDROME IN INPATIENTS: A PRACTICAL APPROACH
MANAGEMENT AND PREVENTION OF REFEEDING SYNDROME IN INPATIENTS: A PRACTICAL APPROACH Prof. Zeno Stanga, MD Nutritional Medicine Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism
More informationPresented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
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 informationPROJECT WOMEN S ANAEMIA. by My HealthWorks. Associate Member. 125A, 2nd Floor, Shahpur Jat, New Delhi ,
PROJECT WOMEN S ANAEMIA by My HealthWorks Associate Member 125A, 2nd Floor, Shahpur Jat, New Delhi-110049, Whatsapp: 8076964582, Phone No: 011-26496673-(74) info@myhealthworks.in INTRODUCTION Anaemia is
More informationEvidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
More informationTransfusion for the sickest ICU patients: Are there unanswered questions?
Transfusion for the sickest ICU patients: Are there unanswered questions? Tim Walsh Professor of Critical Care Edinburgh University None Conflict of Interest Guidelines on the management of anaemia and
More informationCURRENT GUIDELINES FOR SEPSIS MANAGEMENT
HELLENIC SEPSIS STUDY GROUP www.sepsis.gr CURRENT GUIDELINES FOR SEPSIS MANAGEMENT Evangelos J. Giamarellos-Bourboulis, MD, PhD Associate Professor of Medicine 4 th Department of Internal Medicine, National
More informationRethinking Arterial Catheters in the ICU. Allan Garland, MD, MA Professor of Medicine & Community Health Sciences University of Manitoba
Rethinking Arterial Catheters in the ICU Allan Garland, MD, MA Professor of Medicine & Community Health Sciences University of Manitoba No Conflicts of Interest Introduction The only appropriate rationale
More informationNew Strategies in the Management of Patients with Severe Sepsis
New Strategies in the Management of Patients with Severe Sepsis Michael Zgoda, MD, MBA President, Medical Staff Medical Director, ICU CMC-University, Charlotte, NC Factors of increases in the dx. of severe
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 informationICU Volume 11 - Issue 3 - Autumn Series
ICU Volume 11 - Issue 3 - Autumn 2011 - Series Impact of Pharmacokinetics of Antibiotics in ICU Clinical Practice Introduction The efficacy of a drug is mainly dependent on its ability to achieve an effective
More informationBODY CHEMISTRY TEST. Jannet s Report
BODY CHEMISTRY TEST * Jannet s Report Ver. 1.0, Date created: Nov 15, 01 Disclaimer: VitaminLab is for informational purposes only. lease discuss your results or concerns with your health care professional
More informationManaging Patients with Sepsis
Managing Patients with Sepsis Diagnosis; Initial Resuscitation; ARRT Initiation Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
More informationVariability of the Nutrient Composition of Multivitamin Supplements
3th National Nutrient Databank Conference Variability of the Nutrient Composition of Multivitamin Supplements Song-Yi Park, PhD Suzanne P. Murphy, PhD, RD Donna Au, MPH, RD Laurence N. Kolonel, MD, PhD
More informationMaternal Dietary Intake and Nutritional Status in the Philippines: The 8 th National Nutrition Survey Results
ILSI SEA Region Seminar on Maternal, Infant and Young Child Nutrition, July 24, 217, Bangkok, Thailand Maternal Dietary Intake and Nutritional Status in the Philippines: The 8 th National Nutrition Survey
More informationStaging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationUpdate in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
More informationIron depletion in frequently donating whole blood donors. B. Mayer, H. Radtke
Iron depletion in frequently donating whole blood donors B. Mayer, H. Radtke Iron: relevance oxygen-transporting and storage proteins hemoglobin and myoglobin iron-containing centers in many enzymes mitochondrial
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 informationWhat is the Role of Albumin in Sepsis? An Evidenced Based Affair. Justin Belsky MD PGY3 2/6/14
What is the Role of Albumin in Sepsis? An Evidenced Based Affair Justin Belsky MD PGY3 2/6/14 Microcirculation https://www.youtube.com/watch?v=xao1gsyur7q Capillary Leak in Sepsis Asking the RIGHT Question
More informationPractical recommendations for the post-bariatric surgery medical management
Practical recommendations for the post-bariatric surgery medical management Dr L. Favre CHUV Sce Endocrinologie, diabétologie et métabolisme 26.04.2018 Bariatric surgery in Switzerland Multidisciplinary
More informationDisclosures. Objectives. Procalcitonin: Pearls and Pitfalls in Daily Practice
Procalcitonin: Pearls and Pitfalls in Daily Practice Sarah K Harrison, PharmD, BCCCP Clinical Pearl Disclosures The author of this presentation has no disclosures concerning possible financial or personal
More informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationBIOPHARMACEUTICS and CLINICAL PHARMACY
11 years papers covered BIOPHARMACEUTICS and CLINICAL PHARMACY IV B.Pharm II Semester, Andhra University Topics: Absorption Distribution Protein binding Metabolism Excretion Bioavailability Drug Interactions
More informationSupplementary Online Content
Supplementary Online Content Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney
More informationFood Nutrient Workshop. Medical Education Director
Food Nutrient Workshop By: Heather Schofield, B.Sc., DHMHS Medical Education Director Vitamin and Mineral Absorption Segmental absorptive functions of the GI tract: Mouth Esophagus Stomach - glucose -
More informationFluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
More informationHAP/VAP care bundle interventions - a UK approach. Dr R G Masterton NHS Ayrshire & Arran
HAP/VAP care bundle interventions - a UK approach Dr R G Masterton NHS Ayrshire & Arran How Hazardous Is Health Care? (Leape and Amalberti) Total lives lost per year 100,000 10,000 1,000 100 10 1 HAZARDOUS
More informationPAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre
PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis
More informationINTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
More informationThe FIND-CKD Study Background Study design (Results)
The FIND-CKD Study Background Study design (Results) The FIND-CKD Study An open-label, multicentre, randomized, 3 arm study comparing the 12-month efficacy and safety of Ferric carboxymaltose (FCM, Ferinject
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationChallenges in setting Dietary Reference Values. Where to go from here? Inge Tetens & Susan Fairweather-Tait
Challenges in setting Dietary Reference Values. Where to go from here? Inge Tetens & Susan Fairweather-Tait EFSA symposium on DRVs at FENS Berlin, 22 October 2015 Conflict of interest regarding this presentation:
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 informationWhat the ED clinician needs to know about SEPSIS - 3. Anna Morgan Consultant EM Barts Health
What the ED clinician needs to know about SEPSIS - 3 Anna Morgan Consultant EM Barts Health Aims: (1) To review the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) (2)
More informationTechnical Overview of Micronutrient Testing
Technical Overview of Micronutrient Testing J.F. Crawford, Ph. D. SpectraCell Laboratories, Inc. Houston, TX Recent Publications Antioxidant supplementation increases morbidity and mortality. JAMA, 2007
More informationVANDERBILT UNIVERSITY MEDICAL CENTER MULTIDISCIPLINARY SURGICAL CRITICAL CARE TRAUMA INTENSIVE CARE UNIT GLYCEMIC CONTROL PROTOCOL
VANDERBILT UNIVERSITY MEDICAL CENTER MULTIDISCIPLINARY SURGICAL CRITICAL CARE TRAUMA INTENSIVE CARE UNIT GLYCEMIC CONTROL PROTOCOL Background: For some time, the presence of diabetes and hyperglycemia
More information