Jpen Parenter Enter
-
Jpen Parenter Enter · Sep 2015
Review Meta AnalysisModulation of Dietary Lipid Composition During Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis.
Pharmaconutrition including omega-3 and competitive analogs of omega-6 fatty acids has been used to modulate the inflammatory response during acute respiratory distress syndrome (ARDS). The clinical benefit of this approach when assessed in prospective randomized clinical trials has been inconsistent. We tried to assess the reasons for the conflicting results, including the possible influence of the composition of the control solution. ⋯ Use of enteral pharmaconutrition in patients with ARDS was associated with decreased mortality only when the comparator solution contained a greater amount of lipid than is currently recommended. Hence, there is insufficient evidence to support the use of enteral pharmaconutrition in ARDS.
-
Jpen Parenter Enter · Sep 2015
Body Composition Tools for Assessment of Adult Malnutrition at the Bedside: A Tutorial on Research Considerations and Clinical Applications.
Because of the key role played by the body's lean tissue reserves (of which skeletal muscle is a major component) in the response to injury and illness, its maintenance is of central importance to nutrition status. With the recent development of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition diagnostic framework for malnutrition, the loss of muscle mass has been recognized as one of the defining criteria. Objective methods to evaluate muscle loss in individuals with acute and chronic illness are needed. ⋯ In this tutorial, key concepts and statistical methods used in the validation of bedside methods to assess lean tissue compartments are discussed. Body composition assessment methods that are most widely available for practice and research in the clinical setting are presented, and clinical cases are used to illustrate how the clinician might use bioimpedance and/or ultrasound as a tool to assess nutrition status at the bedside. Future research needs regarding malnutrition assessment are identified.
-
Preoperative malnutrition is increasingly prevalent in patients undergoing cardiac surgery. Although prealbumin is a widely used indicator of nutrition status, its use in the preoperative assessment of patients undergoing cardiac surgery is not well defined. The purpose of this study is to determine the impact of preoperative prealbumin levels on outcomes after cardiac surgery. ⋯ Patients undergoing cardiac surgery with preoperative prealbumin levels of ≤ 20 mg/dL have an increased risk for postoperative infections and the need for longer mechanical ventilation. If feasible, nutrition optimization of such patients may be considered prior to cardiac surgery.