Jpen Parenter Enter
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Jpen Parenter Enter · Mar 2008
A comparison between ventilation modes: how does activity level affect energy expenditure estimates?
An appropriate diet is essential to avoid complications of overfeeding or underfeeding in mechanically ventilated intensive care unit (ICU) patients. The paucity of consistent comparative data on energy expenditure for each ventilation mode complicates diet prescription. This study evaluates caloric requirements by comparing estimated and measured energy expenditure values for 2 ventilation modes. ⋯ Results suggest that a 10% activity factor should be adopted only for assisted ventilation because multiplication by an activity factor may lead to overfeeding of patients on controlled ventilation.
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Jpen Parenter Enter · Jan 2008
Effect of calorically dense enteral nutrition formulas on outcome in critically ill trauma and surgical patients.
Surgical and trauma patients are traditionally provided with calorically dense dietary formulas to deliver high amounts of nutrients. The benefits of these formulas remain unproven and may be associated with significant side effects and even increased mortality. We studied outcomes on surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula. ⋯ The data generated suggest that what a patient is fed affects both short- and long-term outcomes. A prospective study should be designed to determine the ideal calories needed in surgical and trauma patients.
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Jpen Parenter Enter · Jan 2008
Comparative StudyA computerized insulin infusion titration protocol improves glucose control with less hypoglycemia compared to a manual titration protocol in a trauma intensive care unit.
Previous studies reflect reduced morbidity and mortality with intensive blood glucose control in critically ill patients. Unfortunately, implementation of such protocols has proved challenging. This study evaluated the degree of glucose control using manual paper-based vs computer-based insulin protocols in a trauma intensive care unit. ⋯ A computerized insulin titration protocol improves glucose control by (1) increasing the percentage of glucose values in range, (2) reducing hyperglycemia, and (3) reducing severe hypoglycemia.
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Jpen Parenter Enter · Jan 2008
Gastric motility function in critically ill patients tolerant vs intolerant to gastric nutrition.
Administration of gastric enteral nutrition (EN) in the intensive care unit (ICU) is commonly impeded by high gastric residual volumes (GRV). This study evaluated gastric emptying in patients with limited GRV (tolerant group) vs volumes > or =150 mL (intolerant group) and whether prokinetic therapy improves gastric motility in intolerant patients. ⋯ ICU patients with elevated GRV during gastric EN have delayed gastric motility. Initiating prokinetic therapy accelerates gastric emptying to resemble that of ICU patients tolerating EN.
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Jpen Parenter Enter · Jan 2008
Brussels 2007 roundtable on metabolism in sepsis and multiple organ failure.
At the 2007 International Symposium on Intensive Care and Emergency Medicine (ISICEM) in Brussels, a roundtable conference on "Metabolic Support in Sepsis and Multiple Organ Failure" was held. The roundtable was endorsed by the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, the European Society for Clinical Nutrition and Metabolism, and the American Society for Parenteral and Enteral Nutrition. Metabolic support in intensive care has become an exciting topic in recent years, with improved understanding of the effects of compromised mitochondrial function, studies demonstrating outcome benefits of tight glucose control, new insights into the mechanisms behind insulin resistance, recognition of glutamine and antioxidants as key nutrients, and emerging knowledge concerning the interactions between metabolism and endocrinology. ⋯ This roundtable's participants each gave a presentation within their specific area of expertise, and each was followed by general discussion. Discussions became heated as new concepts and ideas were debated. New data will be discussed in this summary which reveals metabolic and nutrition interventions that could lead to major improvements in clinically relevant outcomes.