Feeding the septic patient How and when? Masterclass ICU nurses
|
|
- Roy Montgomery
- 5 years ago
- Views:
Transcription
1 Feeding the septic patient How and when? Masterclass ICU nurses
2 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%) Intensivist / fellow / nurses discuss the following questions at the bedside:
3 Questions What is the caloric need of this patient and does over-/underfeeding really matter? When should we start nutrition and what do we do if enteral nutrition fails? What is the protein need of this patient and how do we effectuate a positive nitrogen balance? Does this patient benefit from specific supplements?
4 Critical illness metabolism Hypermetabolism Increased gluconeogenesis Insulin resistance Endogenous lipolysis Loss of protein reserve
5 What is the respiratory quotient? RQ = VCO 2 VO2 Lipids 0.7 Carbohydrates 1.0 Protein 0.8 Complete nutrition
6 What is his caloric need? Predictive equations: Harris-Benedict, ESPEN (25 kcal/kg/dd), Faisy, Penn State University Indirect calorimetry Measures VO2 and VCO2 EE = (3.941 VO2 (l/min) VCO2 (l/min)) 1440 (kcal/dd) Ventilator-derived VCO2 with RQ of administered nutrition
7 High variability in caloric needs 62 patients with severe sepsis Xinying Wang CW. Ann Nutr Metab 2015;66:
8 What should we use? Because RQ of most feedings = 0.86 EE (kcal/dd) = VCO2 (ml//min) 8.19 Stapel SN. Crit Care 2015;19:370
9 Our patient.. Caloric needs 2630 / 2597 kcal Actual intake 2628 kcal
10 Does over-/underfeeding matter? Early overfeeding and late underfeeding are both associated with increased mortality Wijs PJM. Crit Care 2014;18:701
11 When should we start feeding? Early enteral nutrition < 24 hrs is beneficial Doig GS. Intensive Care Med 2009;35:
12 Underfeeding very frequent Singer P. Intensive Care Med 2015;41:
13 Trophic vs full EN in patients with ALI Multi-centre trial (N=44) Patients with ALI < 48 hrs planned for EN Trophic (10-20 kcal/h for 6D) vs full EN Primary outcome: VFD s through D 28 EDEN trial ARDSNET. JAMA 2012;307:
14 ARDSNET. JAMA 2012;307:
15 Trophic vs full EN N = vs 1300 kcal/d for the first 6 days 30 NS Full NS Trophic VFD s (days) 60 D-Mortality (%) GI complaints (%) Higher glucose levels and higher insulin dose in full feeding group ARDSNET. JAMA 2012;307:
16 Early adequate caloric intake is not necessary Maric PE. Intensive Care Med 2016
17 PEN if enteral nutrition fails? Certainly not early - maybe after 5-7 days
18
19 EPaNIC trial Multicenter RCT comparing early start SPN (D3) versus late start (D8) Adult ICU patients nutritionally at risk (NRS > 2) but not chronically malnourished (BMI 17) 60 P = 0.02 P = P = 0.02 P = ICU stay > 3D New infection MV > 2D Hospital stay > 15D Casaer MP. NEJM 2011
20 CALORIES trial RCT (MC - adults) early EN vs PEN in unplanned admissions (start < 36 hrs) Patients > 18 years expected to require nutritional support for at least 2 days Exclusively for 5 D, until ICU discharge or death Energy target 25 kcal/kg Harvey SE. N Engl J Med 2014;371:
21 Clinical outcome 40 EN PEN P = 0.57 P = 0.40 P = 1.00 P = P < % D mortality 90-D mortality SAE Hypoglycemia Vomiting Harvey SE. N Engl J Med 2014;371:
22 What is the protein need of this patient? Nitrogen balance NB (g/day) = Protein intake (g/day)/ urine urea nitrogen (g/day)/ However - effect of positive nitrogen balance unclear
23 The importance of the skelet muscle mass Low muscle mass Normal muscle mass ,5 Mortality (%) , Male 7,5 Female BMI not an independent predictor for mortality when muscle mass is accounted for Wijs PJM. Crit Care 2014;18:R12
24
25 Our patient.. Protein loss gr Protein intake gr Protein balance gr / day
26 How do we effectuate a positive nitrogen balance? 0 Nitrogen balance Nitrogen balance (g/d) D3 D7 AA 0.8/kg AA 1.2/kg Ferrie S. JPEN 2016
27 Are that any specific supplements that may help? Glutamine Selenium
28 Glutamine sensitive tissues Rapidly replicating cells
29 Glutamine N = 502 SIGNET study New infections Mortality ICU Mortality 6 M % 30 % Glutamine Selenium Both Neither 0 Any glutamine Any selenium For patients treated > 5 days selenium reduced the number of new infections No differences in secondary outcomes Andrews PJD. BMJ 2011;342:d1542
30 Glutamine supplement Glutamine No glutamine Antioxidants No antioxidants 40 P = 0.05 P = ,4 27, ,8 28,8 Secondary outcomes Glutamine No glutamine P-value % 20 % 20 In-hospital mortality 37.2% 31% M mortality 43,7% 37,2% Mortality 28 D 0 Mortality 28 D Urea 13,4% 4% < No interaction between glutamine and antioxidants N = 1218 Heyland D. N Engl J Med 2013
31 ASPEN guidelines 2016 Start EN within hrs as soon as resuscitation is complete and patient is hemodynamically stable Do not use TPN or combination TPN/EN in the acute phase of severe sepsis No evidence for supplementation of zinc, selenium and antioxidants Protein delivery of gr/kg No immune modulating formulas McClave SA. JPEN 2016;40:
32 Our patient.. Early enteral nutrition - no TPN Protein intake 1.3 gr/kg/day Caloric intake 2600 kcal/day No glutamine or selenium supplementation Indirect calorimetry AND nitrogen balance 1 /week
Nutrition. 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 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 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 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 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 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 informationIndirect Calorimetry: Clinical Implications in Critically Ill Patients
Indirect Calorimetry: Clinical Implications in Critically Ill Patients Sharla Tajchman, PharmD, BCPS, BCNSP Critical Care / Nutrition Support Clinical Pharmacy Specialist University of Texas MD Anderson
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 informationKombinierte enterale und parenterale Ernährung für welche PatientInnen?
2014 Kombinierte enterale und parenterale Ernährung für welche PatientInnen? Dr. CP. Heidegger Intensive Care/Geneva claudia-paula.heidegger@hcuge.ch Bern Freitag, 4. April 2014 Nutrition News Worldwide
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 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 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 informationSASPEN: Meet the Expert. Pr. Me'e M Berger Service of Intensive Care & Burns CHUV Lausanne Switzerland
SASPEN: Meet the Expert Pr. Me'e M Berger Service of Intensive Care & Burns CHUV Lausanne Switzerland 40 Ensuring my patients are properly fed. Nutrition therapy must be planned as any other ICU therapy
More informationIndirect calorimetry: Is it necessary for everyone? Or do you prefer to guess?
Indirect calorimetry: Is it necessary for everyone? Or do you prefer to guess? Is indirect calorimetry necessary? Pierre Singer, MD Institute for Nutrition Research Critical Care Department Rabin Medical
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 informationParenteral nutrition and calorie delivery in the ICU: controversy, clarity, or call to action?
EDITORIAL C URRENT OPINION Parenteral nutrition and calorie delivery in the ICU: controversy, clarity, or call to action? Paul Wischmeyer Purpose of review This review will highlight recent data evaluating
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 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 informationDetermining energy requirements in the ICU. GUTTORMSEN, Anne Berit, PICHARD, Claude. Abstract
Article Determining energy requirements in the ICU GUTTORMSEN, Anne Berit, PICHARD, Claude Abstract Nutritionists, intensive care doctors, researchers, and innovators must collaborate to develop an indirect
More informationMetabolic Control in Critical Care: Nutrition Therapy
LOGO Metabolic Control in Critical Care: Nutrition Therapy ผศ.นพ.พรพจน เปรมโยธ น สาขาโภชนาการคล น ก ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล 2016 SCCM/ASPEN Guidelines Nutrition Therapy in the ICU
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 informationNutrition Procedures Nutrition Prescription Protein Target Lower Protein Dose Higher Protein Dose 1.2 g/kg/day Calorie Target
Nutrition Procedures Nutrition Prescription Protein and energy targets will be achieved through any combination of EN, protein supplements, and PN or amino acids. The only difference between the nutrition
More informationNutritional Assessment of the Critically Ill Patient Terry L. Forrette, M.H.S., RRT
Nutritional Assessment of the Critically Ill Patient Sponsored by GE Healthcare Metabolic Rate How Much Fuel Does the Patient Need? Resting Energy Expenditure Basal Energy Expenditure REE or EE BEE Metabolic
More informationESPEN Congress The Hague 2017
ESPEN Congress The Hague 2017 Using the gut in acute care patients Permissive underfeeding in practice J.-C. Preiser (BE) PERMISSIVE UNDERFEEDING IN PRACTICE ESPEN congress Jean-Charles Preiser, M.D.,
More informationAdvanced Enteral Nutrition Program For Dietitians. Week 5 Underfeeding in the ICU: Good or Bad? Presented on December 9, 2015
Advanced Enteral Nutrition Program For Dietitians Week 5 Underfeeding in the ICU: Good or Bad? Presented on December 9, 2015 Sponsor Disclosure: Financial support for this presentation was provided by
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 informationThis article was published on October 22, 2018, at NEJM.org.
1 20 8 b E 8 b E C T aa 4 JG R d This article was published on October 22, 2018, at NEJM.org. 2003 2009 (ESPEN) (ASPEN/SCCM) CCPG 20-25kcal/kg/day 25-30kcal/kg/day EN PN( ) Enteral Nutrition EN 24 ICU
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 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 informationNutritional Assessment of the Critically Ill Patient Terry L. Forrette, M.H.S., RRT
Nutritional Assessment of the Critically Ill Patient Tools to understand metabolic monitoring GE Healthcare - R&S Global Training August 3, 2010 1 Metabolic Rate Fuel Sources Substrate Utilization Metabolic
More informationRecognize the importance of early nutritional support in the ICU Assessment and monitoring of nutritional status Determine how to estimate specific
Recognize the importance of early nutritional support in the ICU Assessment and monitoring of nutritional status Determine how to estimate specific nutritional requirements Enteral vs. Parenteral Specific
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 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 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 informationMetabolic monitoring in the ICU
Metabolic monitoring in the ICU Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hô pital Cochin & Institut Cochin, Paris-F Conflicts of interest - Disclosure GE Healthcare Received
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 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 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 informationWhat s New in Parenteral Nutrition?
1 What s New in Parenteral Nutrition? พ นโทหญ ง ส รกานต เตชะวณ ช MD, MSc, ABPNS ห วหน าหน วยโภชนศาสตร คล น ก กองอาย รกรรม โรงพยาบาลพระมงก ฎเกล า 7 กรกฎาคม พ.ศ. 2559 What s New in Parenteral Nutrition?
More informationESPEN Congress Geneva 2014 NUTRITION AT EXTREMES: THE UNLIKELY BENEFITS OF STARVATION
ESPEN Congress Geneva 2014 NUTRITION AT EXTREMES: THE UNLIKELY BENEFITS OF STARVATION Management of the severely malnourished: the case of anorexia nervosa C. De la Cuerda (ES) Management of the severely
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 informationYear in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen
Year in Review 2013 Intensive Care Training Program Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation Enteral feeding Fluid
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 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 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 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 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 informationICU ENTERAL FEEDING GUIDELINES
DISCLAIMER: These guidelines are intended to serve as a general statement regarding appropriate patient care practices based upon the available medical literature and clinical expertise at the time of
More informationInfluence of Calorie Protein Delivery on Outcomes and Body Composition. Changes in the Intensive Care Unit. Sarah Peterson
Influence of Calorie Protein Delivery on Outcomes and Body Composition Changes in the Intensive Care Unit BY Sarah Peterson B.A., Nutrition and Dietetics, The College of St. Scholastica, Duluth, MN 1999
More informationThe Basics of Nutritional Support Terry L. Forrette, M.H.S., RRT
Presentation Overview The basics of metabolism Methods to measure metabolic rate Using indirect calorimetry Case studies Importance of Nutritional Support Malnutrition occurs in approx.40% of hospitalized
More informationNutritional management of the burns patient in the ICU
Nutritional management of the burns patient in the ICU (20) Pr. Me'e M Berger Service of Intensive Care & Burns CHUV Lausanne Switzerland Mette M Berger Disclosures Grants: Baxter, BBraun, Fresenius Kabi
More informationYear in Review: Critical Care Medicine
Year in Review: Critical Care Medicine No disclosures Eric J. Seeley, M.D. Assistant Professor of Medicine Division of Pulmonary and Critical Care Medicine Why I Selected These Studies High quality studies
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 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 informationSECTION 4: RECRUIT PARTICIPANTS
SECTION 4: RECRUIT PARTICIPANTS Contents Participant Eligibility & Enrollment... 2 Screening... 2 Study ID Numbers... 2 Inclusion Criteria... 2 Exclusion Criteria... 4 Co-Enrollment... 5 Informed Consent
More informationDisclosures. None. Enteral Nutrition and Vasoactive Therapy! But actually.. Stocks Advisory boards Grants Speakers Bureau. Paul Marik, MD,FCCM,FCCP
Enteral Nutrition and Vasoactive Therapy! Paul Marik, MD,FCCM,FCCP Disclosures Stocks Advisory boards Grants Speakers Bureau None But actually.. 1 We suggest a determination of nutrition risk (NUTRIC score)
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 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 informationIndirect Calorimetry and the GE Engstrom Carestation. Jorge E. Rodriguez BSRC, RRT
Jorge E. Rodriguez BSRC, RRT Indirect tcl Calorimetry and the GE To obtain the most accurate metabolic data from Indirect Calorimetry, one must: Evaluate the patient. Obtain consistent, Steady State data.
More informationASPEN/SCCM Critical Care Nutrition Guidelines: What s New and Updated?
ASPEN/SCCM Critical Care Nutrition Guidelines: What s New and Updated? Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University WiSPEN Annual Fall Symposium 2016 September 16, 2016 Objectives
More informationE S T A B L I S H I N G N U T R I T I O N I N Y O U R I C U The Need for a Protocol
E S T A B L I S H I N G N U T R I T I O N I N Y O U R I C U The Need for a Protocol Arthur RH van Zanten, MD PhD Gelderse Vallei Hospital, Ede, The Netherlands Learning objectives Develop an evidence based
More informationAppendix. This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors.
Appendix This appendix was part of the submitted manuscript and has been peer reviewed It is posted as supplied by the authors Protein delivery and clinical outcomes in the critically ill: A systematic
More informationAmanda Hernandez FND Parenteral Nutrition Worksheet October 26, 2011
Amanda Hernandez FND 430-001 Parenteral Nutrition Worksheet October 26, 2011 1. HP needs TPN because he has short bowel syndrome and his GI tract is not functional. His entire jejunum was and proximal
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 informationESPEN Congress Copenhagen 2016
ESPEN Congress Copenhagen 2016 THE DIVERSITY OF OBESITY MALNUTRITION IN THE OBESE R. Barazzoni (IT) Malnutrition in the obese patient Rocco Barazzoni Dept of Medical, Surgical and Health Sciences University
More informationNutrition Supplementation in the ICU
Nutrition Supplementation in the ICU ROSEMARY KOZAR MD PHD SHOCK TRAUMA UNIVERSITY OF MARYLAND Canadian Clinical Practice Guidelines www.criticalcarenutrition.com NEJM March 27, 2014 1 Use of Enteral vs
More informationDivision of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Enteral Nutrition Algorithm Clinical Practice Guideline
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Enteral Nutrition Algorithm Clinical Practice Guideline Original Date: 08/2011 Purpose: To promote the early use of
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 informationProtein: A New Perspective. Speaker: Mara Lee Beebe, MS, RD, LD, CNSC Developed by: Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN
Protein: A New Perspective Speaker: Mara Lee Beebe, MS, RD, LD, CNSC Developed by: Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN Speaker Disclaimer Opinions and positions expressed by the speaker are
More informationProtein: A New Perspective. Protein Essential Facts. Speaker Disclaimer
Speaker Disclaimer Protein: A New Perspective Opinions and positions expressed by the speaker are solely those of the speaker and do not necessarily reflect the views, opinions or positions of Nutricia
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 informationEffects of mechanical ventilation on organ function. Masterclass ICU nurses
Effects of mechanical ventilation on organ function 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
More informationESPEN Congress Prague 2007
ESPEN Congress Prague 2007 Nutrition implication of obesity and Type II Diabetes Nutrition support in obese patient Claude Pichard Nutrition Support in Obese Patients Prague, 2007 C. Pichard, MD, PhD,
More informationEarly enteral nutrition in the major trauma patient requiring intensive care: An overview of the evidence.
Early enteral nutrition in the major trauma patient requiring intensive care: An overview of the evidence. Dr. Gordon S. Doig Associate Professor in Intensive Care Northern Clinical School Intensive Care
More informationNutrition in ECMO. Elize Craucamp RD(SA)
Nutrition in ECMO Elize Craucamp RD(SA) ECMO What now!? KEEP CALM AND FEED THE ECMO PATIENT Despite the fact that little is known about nutritional strategies for adult ECMO patients! Neither overcomplicate
More informationNUTRITION. Dr. Yahya Almarhabi. MD Trauma surgery
NUTRITION Dr. Yahya Almarhabi. MD Trauma surgery Question-1 A patient recovering from sepsis and acute lung injury (admission weight 75 kg) is difficult to wean from the ventilator. Minute ventilation
More informationClinical Guidelines for the Hospitalized Adult Patient with Obesity
Clinical Guidelines for the Hospitalized Adult Patient with Obesity 1 Definition of obesity: Obesity is characterized by an excess storage of adipose tissue that is related to an imbalance between energy
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 informationA.S.P.E.N. Clinical Guidelines: Pediatric Critical Care. Nilesh M. Mehta MD, DCH
1 A.S.P.E.N. Clinical Guidelines: Pediatric Critical Care Nilesh M. Mehta MD, DCH Division of Critical Care Medicine Children s Hospital Boston 300 Longwood Avenue / Bader 634 Boston, Massachusetts 02115
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 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 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 informationA J shaped relationship between caloric intake and survival in critically ill patients
Crosara et al. Ann. Intensive Care () :37 DOI.1186/s13613--79-3 RESEARCH Open Access A J shaped relationship between caloric intake and survival in critically ill patients Isabel Carolina Reis Crosara
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 informationProtein targets in critical illness
Protein targets in critical illness Danielle Bear HEE / NIHR Clinical Doctoral Fellow & Critical Care Dietitian Guy s and St Thomas NHS Foundation Trust, London, UK @danni_dietitian CONFLICTS Conference
More informationCase Discussion. Nutrition in IBD. Rémy Meier MD. Ulcerative colitis. Crohn s disease
26.08.2017 Case Discussion Nutrition in IBD Crohn s disease Ulcerative colitis Rémy Meier MD Case Presentation 30 years old female, with diarrhea for 3 months Shool frequency 3-4 loose stools/day with
More informationRelationship of Delayed Parenteral Nutrition Protocol with the Clinical Outcomes in a Medical Intensive Care Unit
Original Article Clin Nutr Res 2014;3:33-38 pissn 2287-3732 eissn 2287-3740 Relationship of Delayed Parenteral Nutrition Protocol with the Clinical Outcomes in a Medical Intensive Care Unit Hosun Lee 1,
More informationClinical Manifestations. Principles of Nutrition Assessment. Significance of nutritional assessment. Nutrition Deficiency States.
Clinical Manifestations Principles of Nutrition Assessment Audis Bethea, Pharm.D. Assistant Professor Therapeutics I December 5 & 9, 2003 Impaired cellular immunity Impaired wound healing End organ dysfunction
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 information8.0 Parenteral Nutrition vs. Standard care May 2015
8.0 Parenteral Nutrition vs. Standard care May 015 015 Recommendation: Based on 6 level studies, in critically ill patients with an intact gastrointestinal tract, we recommend that parenteral nutrition
More informationPediatric Nutrition Care as a strategy to prevent hospital malnutrition. Div Pediatric Nutrition and Metabolic Diseases Dept of Child Health
Pediatric Nutrition Care as a strategy to prevent hospital malnutrition Div Pediatric Nutrition and Metabolic Diseases Dept of Child Health Child is not a miniature adult Specific for child growth and
More informationHow to meet protein requirements in the ICU? Kate Fetterplace APD Senior Dietitian PhD Candidate
How to meet protein requirements in the ICU? Kate Fetterplace APD Senior Dietitian PhD Candidate Acknowledgments & Conflicts Supervisors and collaborators A/Prof Adam Deane A/Prof Christopher MacIsaac
More information3.2 Nutritional Prescription of Enteral Nutrition: Enhanced Dose of Enteral Nutrition May 2015
. Nutritional Prescription of Enteral Nutrition: Enhanced Dose of Enteral Nutrition May 015 015 Recommendation: Based on 1 level 1 study, level studies and cluster randomized controlled trials, when starting
More informationLuis S. Marsano, MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Louisville and Louisville VAMC 2015
Luis S. Marsano, MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Louisville and Louisville VAMC 2015 Protein-calorie malnutrition (PCM) is extremely common
More informationJournal of Parenteral and Enteral Nutrition
Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/ Optimal Protein and Energy Nutrition Decreases Mortality in Mechanically Ventilated, Critically Ill Patients : A Prospective Observational
More informationA number of observational studies of adult
Carol Rees Parrish, M.S., R.D., Series Editor Full Force Enteral Nutrition: A New Hope, or the Dark Side? A Critical Look at Enhanced Enteral Feeding Protocols Joe Krenitsky Enteral nutrition (EN) is the
More informationSCCM Critical Care Nutrition Guidelines: Would anything t:hange in a 2013 edition?
SCCM Critical Care Nutrition Guidelines: Would anything t:hange in a 2013 edition? Robert G. Martindale MD, PhD Professor of Surgery Chief r Division of General Surgery Oregon Health and Science University
More informationNutritional Assessment of Patients with Respiratory Disease C H A P T E R 1 7
Nutritional Assessment of Patients with Respiratory Disease C H A P T E R 1 7 Nutritional Status Major factor influencing acute and long term outcomes Quantity and quality of food affects the efficiency
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 information