Protein targets in critical illness
|
|
- Evan Neal
- 5 years ago
- Views:
Transcription
1 Protein targets in critical illness Danielle Bear HEE / NIHR Clinical Doctoral Fellow & Critical Care Dietitian Guy s and St Thomas NHS Foundation Trust, London,
2 CONFLICTS Conference fees, advisory board, consulting and honoraria from: Nutricia Nestle Nutrition Baxter Fresenius Kabi Abbott Nutrition
3 OBJECTIVES 1. To understand current literature supporting recommended protein targets in critical illness 2. To discuss the current controversies surrounding recommended protein targets in critical illness 3. To understand factors which may impact protein targets in critical illness 4. To calculate protein targets for various patient groups of critically ill patients
4 CRITICAL CARE NUTRITION GUIDELINES ESPEN GUIDELINES ESPEN Guidelines on Enteral Nutrition: Intensive care $ K.G. Kreymann a,, M.M. Berger b, N.E.P. Deutz c, M. Hiesmayr d, P. Jolliet e, G. Kazandjiev f, G. Nitenberg g, G. van den Berghe h, J. Wernerman i, DGEM: $$ C. Ebner, W. Hartl, C. Heymann, C. Spies Canadian Clinical Practice Guidelines for Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients* Daren K. Heyland, MD, FRCPC, MSc*; Rupinder Dhaliwal, RD*; John W. Drover, MD, FRCSC, FACS ; Leah Gramlich, MD, FRCPC ; Peter Dodek, MD, MHSc ; and the Canadian Critical Care Clinical Practice Guidelines Committee From the *Department of Medicine and the Department of Surgery, Queen s University, Kingston, Ontario; Department of Medicine, Division of
5 PROTEIN TARGETS 1.2g/kg 1.5g/kg 2.0g/kg 2.5g/kg General ICU Trauma Protein losses in exudate (12-30g/L) CRRT Surgical Trauma Burns Obesity
6 SYSTEMATIC REVIEW Clinical trials investigating different protein intakes in critical illness 12 investigating nitrogen balance 3 investigating whole-body protein turnover 1 investigating change in body composition All showed improvements with increased protein intakes Plasma amino acid profile Nitrogen balance Protein turnover Clinical outcomes Hoffer & Bistrian. AJCN 2012; 96:
7 Higher protein is associated with reduced mortality
8
9 PROTEIN TRACERS AND MUSCLE BIOPSY
10 Observational study investigating equivalent of 1g/kg/day parenteral amino acids on 3-hour whole body protein turnover. n=13 studied once & n=7 twice Whole body protein balance increased on both occasions Due to increased protein synthesis Amino acid oxidation not increased
11 MUSCLE ULTRASOUND
12 Higher parenteral amino acid intake (0.9g/kg/day vs 1.1g/kg/day) ü Improved handgrip strength (ICU and hospital discharge) ü Improved Fatigue score ü Reduced muscle wasting Ferrie et al. JPEN 2016;40:
13 Computed Tomography Low Muscle mass associated with Mortality Ventilator-free days and LOS 63-70% of patients have low muscle mass Poulsen CCM 2011, Moisey Crit care 2013, Weijs Crit Care 2014, Braunschweig JPEN 2014
14 PROTEIN INTAKES IN PATIENTS WITH LOW MUSCLE MASS Higher protein intake associated with reduced mortality (28 day, hospital and 6-month) in patients with LOW muscle mass VARS NOMINATION Looijaard et al, 2017, Unpublished
15 Association Between Nutritional Adequacy and SF-36 Scores SF-36 Adjusted Estimate* (95% CI) p-value Physical Functioning Role Physical Physical Component Scale 3-month (n=179) 6-month (n=202) 3-month (n=178) 6-month (n=202) 3-month (n=175) 6-month (n=200) 7.29 (1.43, 13.15) (-1.32, 9.64) (2.65, 13.95) (-2.25, 8.54) (-0.18, 3.81) (-0.65, 3.31) 0.19 *Every 25% increase in nutritional adequacy; adjusted for age, APACHE II score, baseline SOFA, Functional Comorbidity Index, admission category, primary ICU diagnosis, body mass index, and region Wei et al, 2015 CCM.
16
17 Higher protein leads to worse outcome Study Intervention Results EPaNIC Early vs late PN êmuscle quality in early PN group éweakness in early PN group (MRC-sum score) Faster recovery in late PN group MUSCLE-UK Nil - observational é Protein intake with é muscle wasting
18 HOW DOES IT WORK IN PRACTICE?
19 üwho is the patient? üif you should feed (safety and feasibility) üwhen you should feed (timing) ühow you should feed (route) üwhat you should FEED (type and amount) üwhat you are trying to achieve
20 NUTRITIONAL STATUS & ASSESSMENT Weight Height BMI Parameter LIMITATION Calibration of bed scales Fluid shifts Unable to stand Demispan/Ulna length inaccurate As above Weight History Diet History Can ask family (?not as accurate) Medical notes if up to date As above Biochemical parameters Often associated with inflammation
21 NUTRIC VARIABLE RANGE POINTS Score Developed based on acute and chronic factors that affect nutritional status Patients are considered high nutrition risk with a score of 5 Age < <75 75 APACHE II < < SOFA <6 6 - <10 10 Number of co-morbidities Days from hospital to ICU admission 0 - <
22 Ferreira et al. JAMA 2001; 286(14): The APACHE II and SOFA Scores are required for calculation the NUTRIC score
23 NRS 2002 Nutritional Risk Screening (NRS 2002) Table 1: Initial screening Yes No 1 Is BMI <20? 2 Has the patient lost weight within the last 3 months? 3 Has the patient had a reduced dietary intake in the last week? 4 Is the patient severely ill? (e.g. in intensive therapy) Yes: If the answer is 'Yes' to any question, the screening in Table 2 is performed. No: If the answer is 'No' to all questions, the patient is re-screening at weekly intervals. If the patient e.g. is scheduled for a major operation, a preventive nutritional care plan is considered to avoid the associated risk status. NRS is a two-step screening tool. Patients in the ICU automatically progress to step 2. Kondrup et al. Clin Nutr 2003; 22(4):
24 NRS 2002 NRS 2002 may not be specific enough as it classifies all critically ill patients as high risk which may not be the case Absent Score 0 Mild Score 1 Impaired nutritional status Normal nutritional status Wt loss >5% in 3 mths or Food intake below 50-75% of normal requirement in preceding week. Table 2: Final screening Absent Score 0 Mild Score 1 Severity of disease (» increase in requirements) Normal nutritional requirements Hip fracture* Chronic patients, in particular with acute complications: cirrhosis*, COPD*. Chronic hemodialysis, diabetes, oncology. Moderate Score 2 Wt loss >5% in 2 mths or BMI impaired general condition or Food intake 25-50% of normal requirement in preceding week Moderate Score 2 Major abdominal surgery* Stroke* Severe pneumonia, hematologic malignancy. Severe Score 3 Wt loss >5% in 1 mth (>15% in 3 mths) or BMI < impaired general condition or Food intake 0-25% of normal requirement in preceding week in preceding week. Severe Score 3 Head injury* Bone marrow transplantation* Intensive care patients (APACHE>10). Score + Score: = Total score: Age if ³ 70 years: add 1 to total score above = age-adjusted total score: Score ³3: the patient is nutritionally at-risk and a nutritional care plan is initiated Score < 3: weekly rescreening of the patient. If the patient e.g. is scheduled for a major operation, a preventive nutritional care plan is considered to avoid the associated risk status. Kondrup et al. Clin Nutr 2003; 22(4):
25 NOT ALL ICU PATIENTS ARE THE SAME! Age Body Mass Index Muscle mass Severity of illness Admission category Length of stay (LOS) in hospital prior to ICU Predicted ICU LOS Co-morbidities
26 But which weight do I use? Ideal or actual body weight will lead to underfeeding in some patients and overfeeding in others Should be based on Fat Free Mass (FFM), but no reliable bedside tool Might be a place for BIA or CT in the future Protein Target (BMI_20_30 formula) BMI g/kg actual body weight (ABW) BMI < g x height (m2) x 20 BMI > g x height (m2) x 27.5 Weijs et al, Clin Nutr; 2011
27 What do I do in practice? Underweight (BMI <18.5kg/m 2 ) Use actual body weight Normal weight (BMI 19-25kg/m 2 ) Use actual body weight Overweight and obese Use ideal body weight (adjusted to BMI 23 kg/m 2 )
28 HOW DO YOU MEET THE TARGETS IN PRACTICE?
29 HOW DO YOU MONITOR THESE PATIENTS IN PRACTICE?
30 CASE STUDIES What would you consider in your nutrition assessment? Does this patient have any additional considerations which may affect their protein target? Which weight would you use to calculate the protein target? What protein target would you aim for?
31 CASE STUDY 1 71 year old admitted with type 2 respiratory failure due to exacerbation of COPD. PMHx COPD, hypertension Intubated and ventilated, propofol for sedation, but weaning off Anthropometry Weight 73kg; Height 161cm; BMI 28kg/m 2 You review her 72 hours into her ICU admission.
32 CASE STUDY 2 76 year old adm from theatre following bowel resection and washout for four quadrant faecal peritonitis with multiple perforations around anastomosis. Abdomen left open 2/52 ago, had anterior resection for Colon Ca (short ICU stay, but managed on the ward) Intubated and ventilated, propofol for sedation Anthropometry Weight 62kg; Height 178cm; BMI 19.5kg/m 2 4kg weight loss since admission with 5% weight loss in 3 months prior to surgery Referral for PN on day 1 post-op
33 CASE STUDY 3 19 year old adm following high speed road traffic accident Left subdural haemorrhage and diffuse brain swelling Multiple C-Spine fractures Complex bilateral facial and basal skull fractures Large bilateral lung contusions Intubated and ventilated, sedated and paralysed Anthropometry Weight 120kg; Height 178cm; BMI 38kg/m 2 You review within 72 hours of admission to the ICU
34 CONCLUSIONS Higher protein intakes in critical illness may improve outcome Individualised nutrition assessment is required to determine appropriate protein intakes and methods of delivery for each patient Monitoring is essential!
35 REFERENCES Protein Intakes McClave et al. JPEN 2016; 40(2): Singer et al. Clin Nutr 2014; 33; Choban et al. JPEN 2013; 37; Ishibashi et al. Crit Care Med 1998; 26; Diaz et al. J Trauma. 2010;68(6): Cheatham et al. Crit Care Med. 2007;35(1): Hourigan et al. Nutr Clin Pract. 2010;25(5):
Case 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 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 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 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 informationOriginal Article. Zheng Yii Lee 1, Mohd Yusof Barakatun-Nisak 2, Ibrahim Noor Airini 3
Original Article Introduction : The catabolic state during critical illness necessitates critically ill patients to obtain optimal nutritional support 1. Large international studies had shown that providing
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 informationStatistical Analysis Plan: Post-hoc analysis of the CALORIES trial
Statistical Analysis Plan: Post-hoc analysis of the CALORIES trial Author: Version 1.0, Role, Name and Position Signature Date Chief investigator: Prof Kathryn Rowan (Director of Scientific & Strategic
More informationNutrition therapy in the critical care setting: What is best achievable practice? An international multicenter observational study*
Continuing Medical Education Article Nutrition therapy in the critical care setting: What is best achievable practice? An international multicenter observational study* Naomi E. Cahill, RD, MSc; Rupinder
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 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 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 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 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 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 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 informationWhat s New in ICU Nutrition Research? Danielle Bear Principal Critical Care Dietitian St Thomas Hospital, London
What s New in ICU Nutrition Research? Danielle Bear Principal Critical Care Dietitian St Thomas Hospital, London Outline Individualised nutrition support Defining energy targets Feeding route Current research
More informationEtiology based definitions for adult malnutrition: Role of inflammation A systematic approach to nutrition assessment
Etiology based definitions for adult malnutrition: Role of inflammation A systematic approach to nutrition assessment Gordon L Jensen, MD, PhD Penn State University University Park, PA Objectives Review
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 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 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 Protocol for Intensive Care Beatrice CL Lim et al Letter to the Editor
416 Letter to the Editor Implementation of a Proactive Nutrition Protocol Improves Enteral Nutrition in Mechanically Ventilated Patients Admitted to the Neuro-Intensive Care Unit Dear Editor, The enteral
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 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 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 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 informationProteins Amino Acids. K. Georg Kreymann Baxter Healthcare, Deerfield, USA
Proteins Amino Acids K. Georg Kreymann Baxter Healthcare, Deerfield, USA François Magendie (1783-1855) Manfred Köhnlechner (1925-2002) The Manager Diet Main points Arginine supplemented diets should be
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 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 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 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 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 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 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 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 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 informationNutrition in the Elderly 36.3 Nutritional screening and assessment Oral refeeding
Nutrition in the Elderly 36.3 Nutritional screening and assessment Oral refeeding Dr. Jürgen J Bauer Medizinsche Klinik 2 - Klinikum NürnbergN Lehrstuhl für f r Geriatrie Universität t Erlangen-Nürnberg
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 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 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 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 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 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 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 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 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 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 informationRelevance of non-nutritional calories in mechanically ventilated critically ill patients
OPEN European Journal of Clinical Nutrition (2016) 70, 1443 1450 www.nature.com/ejcn ORIGINAL ARTICLE Relevance of non-nutritional calories in mechanically ventilated critically ill patients E Bousie 1,
More informationBRIEF CURRICULUM VITAE
BRIEF CURRICULUM VITAE Daren Keith Heyland MD, FRCPC, MSc. Professor of Medicine, Queen s University Angada 4 Room 5-416, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7 613-549-6666x3339
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 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 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 informationNutrition in Liver Disease An overview of the EASL Clinical Practice Guidelines
Nutrition in Liver Disease An overview of the EASL Clinical Practice Guidelines Marike Bauermeister Registered Dietitian Wits Donald Gordon Medical Centre Malnutrition Malnutrition is a complication in
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 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 information2.0 Early vs. Delayed Nutrient Intake May 2015
2.0 Early vs. Delayed Nutrient Intake May 2015 There were no new randomized controlled trials since the 2013 update and hence there are no changes to the following summary of evidence. 2013 Recommendation:
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 informationInsulin reduces Neuromuscular Complications and Prolonged Mechanical Ventilation in a Medical ICU. Online data supplement
Insulin reduces Neuromuscular Complications and Prolonged Mechanical Ventilation in a Medical ICU Greet Hermans 1, Alexander Wilmer 1, Wouter Meersseman 1, Ilse Milants 2, Pieter J. Wouters 2, Herman Bobbaers
More informationMalnutrition: Where are we headed?
Malnutrition: Where are we headed? Kris M. Mogensen, MS, RD-AP, LDN, CNSC Team Leader Dietitian Brigham and Women s Hospital Instructor Boston University College of Health and Rehabilitation Sciences:
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 informationHealthy Volunteer Ultrasound Test Manual
A Randomized Trial of Supplemental Parenteral Nutrition in Under and Over Weight Critically Ill Patients: The TOP UP Trial Healthy Volunteer Ultrasound Test Manual Intended Audience: Site Investigators
More informationCLINICAL OUTCOMES OF INADEQUATE CALORIE DELIVERY AND PROTEIN DEFICIT IN SURGICAL INTENSIVE CARE PATIENTS. Nutrition in Critical Care
Nutrition in Critical Care CLINICAL OUTCOMES OF INADEQUATE CALORIE DELIVERY AND PROTEIN DEFICIT IN SURGICAL INTENSIVE CARE PATIENTS By D. Dante Yeh, MD, Miroslav P. Peev, MD, Sadeq A. Quraishi, MD, MHA,
More informationPROTEIN ANABOLIC RESISTANCE IN CANCER
PROTEIN ANABOLIC RESISTANCE IN CANCER Dr. Barbara van der Meij CRICOS CODE 00017B CONTENTS Obesity and body composition Metabolic alterations in cancer Protein anabolic resistance Implications for clinical
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 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 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 informationNUTRITION SUPPORT DURING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN CRITICALLY ILL ADULT PATIENTS. Haley Murrell, March 19, 2015
NUTRITION SUPPORT DURING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN CRITICALLY ILL ADULT PATIENTS Haley Murrell, March 19, 2015 Objectives Provide an overview of Extracorporeal Membrane Oxygenation
More informationAvoidable Causes of Delayed Enteral Nutrition in Critically Ill Children
ORIGINAL ARTICLE Pediatrics http://dx.doi.org/10.3346/jkms.2013.28.7.1055 J Korean Med Sci 2013; 28: 1055-1059 Avoidable Causes of Delayed Enteral Nutrition in Critically Ill Children Hosun Lee, 1 Shin
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 informationEnteral Nutrition in the Critically Ill Child: Challenges and Current Guidelines
Enteral Nutrition in the Critically Ill Child: Challenges and Current Guidelines 1 Presented on January 24, 2017 Jorge A. Coss-Bu, MD Associate Professor of Pediatrics Section of Critical Care Baylor College
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 informationESPEN Congress Gothenburg Combined parenteral and enteral nutrition. Crohn s disease. Željko Krznarić
ESPEN Congress Gothenburg 2011 Combined parenteral and enteral nutrition Crohn s disease Željko Krznarić ŽELJKO KRZNARIĆ, FEBGH U N I V E R S I T Y OF Z A G R E B C R O A T I A EDUCATIONAL SESSION COMBINED
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 informationProtein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis
Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis Michael L Davies, Lee-anne S Chapple, Marianne J Chapman, John L Moran and Sandra L Peake Critical illness
More informationAdministration of lipid emulsions to adult intensive care patients: impact on the blood lipid profile
Administration of lipid emulsions to adult intensive care patients: impact on the blood lipid profile, Sophie Schut, Mette M Berger, René Chiolero, André Pannatier Pharmacy and Adult ICU Centre Hospitalier
More informationImproving documentation and coding of malnutrition a five year journey
Improving documentation and coding of malnutrition a five year journey Natalie Simmance, Chief Dietitian Clara Newsome Sally Bell Sonia Grundy St Vincent's Hospital Melbourne Patient Malnutrition common
More informationESPEN Congress The Hague 2017
ESPEN Congress The Hague 2017 Paediatric specificities of nutritional assessment Body composition measurement in children N. Mehta (US) 39 th ESPEN Congress The Hague, Netherlands Body Composition Measurement
More informationMalnutrition in the community everyone's responsibility?
Malnutrition in the community everyone's responsibility? Elizabeth Weekes PhD RD Consultant Dietitian and NIHR Clinical Lecturer Guy s & St Thomas NHS Foundation Trust King s College London Introduction
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 informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.3 Nutritional Support in the Perioperative Period Ken Fearon Learning Objectives Understand the principles behind nutritional care for
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 informationOPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices OPTICS
OPTICS OPTimal nutrition by Informing and Capacitating family members of best nutrition practices Educational Booklet for Families Version April 26 th 2016 Page 1 of 12 This information booklet was originally
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 informationAUTHORS: Luisito O. Llido, MD (1), Mariana S. Sioson, MD (1,2), Jesus Fernando Inciong, MD (1), Grace Manuales, MD (1)
9 Submitted: September 5, 2011 Posted: January 7, 2012 TITLE: Nutrition team supervision on nutrient intake in critical care patients: report of a ten- year experience in the Philippines (years 2000 to
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 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 informationInvestigational Product Procedures Manual
A Randomized Trial of Supplemental Parenteral Nutrition in Under and Over Weight Critically Ill Patients: The TOP UP Trial Investigational Product Procedures Manual Intended Audience: Research Cooridnators/Pharmacists
More informationNUTRITION PLANNING FOR PRE AND POST LIVER TRANSPLANT DAPHNEE.D.K HEAD DEPARTMENT OF DIETETICS APOLLO HOSPITALS (MAIN) CHENNAI
NUTRITION PLANNING FOR PRE AND POST LIVER TRANSPLANT DAPHNEE.D.K HEAD DEPARTMENT OF DIETETICS APOLLO HOSPITALS (MAIN) CHENNAI PRE - OPERATIVE Case Presentation Name: Mr. XXX Age: 51yrs Sex: Male No. of
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 informationDiet what helps? Lindsey Allan Macmillan Oncology Dietitian Royal Surrey County Hospital, Guildford
Diet what helps? Lindsey Allan Macmillan Oncology Dietitian Royal Surrey County Hospital, Guildford Diet and cancer Diet and cancer Nutrition research Lack of funding RCTs Low quality Small sample sizes
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 informationNational Emergency Laparotomy Audit. Help Box Text
National Emergency Laparotomy Audit Help Box Text Version Control Version 1.1 06/12/13 1.2 13/12/13 1.3 20/12/13 1.4 20/01/14 1.5 30/01/14 1.6 13/03/14 1.7 07/04/14 1.8 01/12/14 1.9 05/05/15 1.10 02/07/15
More informationWHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers
WHEN To Initiate Parenteral Nutrition A Frequent Question With New Answers Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN Dubai International Nutrition Conference 2018 Disclosures No commercial relationship
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 informationExtremely well tolerated. Feeding shock
Extremely well tolerated Feeding shock FEEDING DURING CIRCULATORY FAILURE Dr S Omar Chris Hani Baragwanath Hospital Hospital/University of Witwatersrand Introduction Circulatory shock lack of adequate
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 informationNutricia. The importance of protein: an update on the latest evidence
Nutricia The importance of protein: an update on the latest evidence Outline Introduction Review the definition, function and dietary sources of protein Protein Requirements High Protein ONS Evidence Case
More informationVanderbilt University Medical Center Trauma ICU Nutrition Management Guidelines
Vanderbilt University Medical Center Trauma ICU Nutrition Management Guidelines Trauma Critical Care Nutrition Guidelines Clinical judgment may supersede guidelines as patient circumstances warrant ASSESSMENT
More information