Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2012
ReviewSynbiotics and probiotics in the critically ill after the PROPATRIA trial.
Recent clinical trials have furthered our understanding of the role of probiotic and synbiotic therapy across a variety of diverse diseases including antibiotic-associated diarrhea, Clostridium difficile associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. Although each of these conditions has implications for critically ill patients, relatively few studies have specifically studied this vulnerable population. ⋯ Regardless of technical issues with the study, the increased mortality seen with probiotics cannot be ignored. As a result, various regulatory agencies have clarified their stance on the safety of probiotic research and the legacy of PROPATRIA is increasingly stringent regulation of this fledgling niche.
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Curr Opin Clin Nutr Metab Care · Mar 2012
ReviewThe impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients.
Hyperglycemia, hypoglycemia and increased glycemic variability are independently associated with increased risk of mortality in critically ill patients. The purpose of this review is to evaluate the evidence from interventional trials of intensive insulin therapy, as well as observational cohort studies, relating premorbid diabetic status and these three domains of glycemic control to mortality. ⋯ Premorbid diabetic status impacts the relationship of the three domains of glycemic control to risk of mortality in critically ill patients. The data presented in this review are hypothesis generating; future trials of IIT in the critically ill should stratify management and outcomes by premorbid diabetic status.
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To review and discuss the evidence and arguments to combine enteral nutrition and parenteral nutrition in the ICU, in particular with reference to the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. ⋯ The difference between the guidelines from the European Society of Enteral and Parenteral Nutrition in Europe and American Society for Parenteral and Enteral Nutrition/Society of Critical Care Medicine in North America concerning the combination of enteral nutrition and parenteral nutrition during the initial week of ICU stay was reviewed. The EPaNIC study clearly demonstrates that early parenteral nutrition in the ICU is not in the best interests of most patients. Exactly at what time point the combination of enteral nutrition and parenteral nutrition should be considered is still an open question.
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Curr Opin Clin Nutr Metab Care · Mar 2012
ReviewMetabolic conditioning to attenuate the adverse effects of perioperative fasting and improve patient outcomes.
To review recent articles, published between October 2009 and September 2011, that examined the adverse metabolic consequences of perioperative fasting and interventions that may be utilized to minimize these effects. ⋯ Numerous perioperative interventions are available, which if utilized should help attenuate the adverse effects of perioperative fasting and lead to improved patient outcomes.
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To summarize the current knowledge on vitamin D with a special focus on critically ill patients. ⋯ To date, it is not clear whether vitamin D deficiency is a surrogate marker for increased morbidity or whether treatment with sufficiently large doses of vitamin D may improve patient outcome in an intensive care setting.