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Nutrition

 CME/CE ACTIVITY- Initiating Safe Practices: Enteral and Parenteral Nutrition
Activity funded by an educational grant from Baxter

  • Standardized TPN in the ICU: Safe or Sorry-Jane M. Gervasio, PharmD
  • Calorie Deficit and Outcome in the ICU: Can We Narrow the Gap?-Paul Wischmeyer, MD
  • 2008 Nutrition Survey Results: Are We Still Failing to Deliver What Our Patients Need?-Daren K. Heyland, MD

Watch Video Presentation

WEBCAST-Stress Ulcer Prophylaxis: To Protect Or Not Protect

During this session, the need and effectiveness of prophylaxis in the ICU is debated, along with the associated complications.

  • Robert MacLaren, PharmD, BSC, FCCM, proposes why very ICU patient needs prophylaxis
  • Deborah J. Cook, MD, illustrates why some ICU patients don't needs prophylaxis
  • Jill A. Rebuck, BCPS, FCCM, PharmD, discusses the long term complications

Watch Video Presentation

WEBCAST-Pharmaco-Nutrition

  • Daren K. Heyland, MD, describes the scientific evidence surrounding the use of selenium in sepsis
  • Jan Wernerman, MD, PhD, examines the potential benefits of designer parenteral lipids in the septic patient
  • Paul Wischmeyer, MD, describes the benefits of glutamine supplementation in the ICU

Watch Video Presentation

6th Summer Conference in Intensive Care Medicine:
Nutrition as a Therapeutic Agent to Improve Critical Care Outcomes

Recent hospital nutrition surveys suggest that upward of 40% to 50% of patients, particularly those in the intensive care unit (ICU), have a moderate to severe degree of malnutrition, which can have a significant negative impact on clinical outcomes.  To explore this and other issues related to nutrition in the ICU, the Society of Critical Care Medicine, in collaboration with the European Society of Intensive Care Medicine, held their 6th Summer Conference in Intensive Care Medicine: Nutrition as a Therapeutic Agent to Improve Critical Care Outcomes.  Additional contributors to the development of the conference were the American Society of Parenteral and Enteral Nutrition, the Canadian Critical Care Society, and the Canadian Society for Clinical Nutrition.

The Summer Conference brought together international faculty to discuss controversial topics derived from their research and daily practice in critical care nutrition.  Three distinct areas were addressed:  current knowledge, strategies to maximize therapy benefit, and use of emerging knowledge to improve practice.  

Click here to view the 6th Summer Nutrition Conference presentations.

Publications

Nutritional Support in the Intensive Care Unit. Adult Multiprofessional Critical Care Review. 2005.

Evidence exist that malnutrition impairs immune function, interferes with wound healing, prolongs hospitalization, and increases the risk of infection and death.  Thus, critically ill patients who cannot take in sufficient nutrients orally to meet their caloric and nitrogen requirements are candidate for nutritional support.  Total parenteral nutrition (TPN) entails added risks compared to the enteral route, so TPN is reserved for patients in whom enteral alimentation is contraindicated.  In addition to the risks of central venous cannulation and catheter – related bloodstream infection, TPN is associated with gastrointestinal muscosal atrophy and denudation.  This disruption of normal gut-barrier function may allow entry of bacteria-derived toxins into the bloodstream, stimulating a systemic inflammatory response that might lead to, perpetuate, or worsen organ system dysfunction.  The results of multiple clinical trials involving acutely ill patients and encompassing several disease states demonstrate that nutritional support by the enteral route has important advantages over parenteral route including a lower incidence of septic complications. Therefore, barring any contraindications, enteral nutritional support is the first line option for critically ill patients who cannot meet their nutritional requirements by way of an oral diet. 

Click here to view the entire chapter of Nutritional Support in the Intensive Care Unit. 


For more information on caring for the critically ill and injured patients, the publication Adult Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.



Nutrition in the Pediatric Intensive Care Unit. Pediatric Multiprofessional Critical Care Review. 2006.

Chronic malnutrition is common among newly admitted pediatric intensive care unit (PICU) patients.  The frequency varies depending on the patient population and, in the United States, is significantly related to pre-existing comorbidities.  Acute malnutrition is a frequent development among intensive care patients as well.  Increased catabolism associated with many conditions requiring intensive care plays an important role, along with ongoing losses and nutrient intolerance, but adequate or inappropriate nutrient delivery is also significant.

An accurate history provides important clues that predict existence of malnutrition and help identify deficiencies.  History should include inquires about food aversion, unusual diet practices, recent weight change, nausea, vomiting, diarrhea, abdominal discomfort, fever, and history of infections,   Use of previous tube feedings and parenteral nutrition are increasingly frequent, including as outpatients, and the amount and nature of these formulations should be well-documented.  Use and abuse of vitamins and dietary supplements should also be noted.

  
Click here to view the entire chapter; Nutrition in the Pediatric Intensive Care Unit. 

For more information on caring for critically ill or injured patients, the publication Pediatric Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.



 

Critical Connections Articles

Managing the Stress Response with Nutritional Support

Critical Connections, 2007 April, Volume 6, Number 2

Gastric Versus Intestinal Feedings:  Does it Make a Difference?
Critical Connections, 2007, February, Volume 6, Number 1

Pharmaconutrition: A New Emerging Paradigm
Critical Connections, 2006 December, Volume 5, Number 6



SCCM POD SCCM Pod-101 Nutrition in the ICU
Paul E. Wischmeyer, MD, discusses nutrition in the intensive care unit, specifically addressing what role total parenteral nutrition might have for the critically ill or injured patient. Dr. Wischmeyer is a professor of anesthesiology at the University of Colorado Health Sciences Center in Denver, Colorado. Released: 2/18/09

SCCM POD  SCCM Pod-63 Gastric Versus Intestinal Feedings
John Mazuski, MD, FCCM, and Beth Taylor, MS, RD, CNSD, FCCM, discuss their article published in the February 2007 issue of Critical Connections, titled "Gastric vs. Intestinal Feeding: Does it Make a Difference?" Dr. Mazuski is a professor of surgery at Washington University in St. Louis, Missouri, and Ms. Taylor is a nutrition support dietitian at Barnes Jewish Hospital in St. Louis. Crit Conn. 2007; 6(1): 10

SCCM POD  SCCM Pod-55 Enteral Therapy to Treat Respiratory Distress Syndrome
Eric Pacht, MD, discuss an editorial published in the September issue of Critical Care Medicine, "Enteral therapy to decrease morbidity and improve survival in acute respiratory distress syndrome: Its time has come." Dr. Pacht is a pulmonary and critical care specialist and the director of the intensive care unit at Licking Memorial Hospital in Ohio. (Crit Care Med; 2006 34(9):2292-2493)

SCCM POD  SCCM Pod-46 2007 Congress Keynotes Up Close: Daren Heyland
Daren Heyland, MD, MSc, is of the prominent keynote speakers set to present during the 36th Critical Care Congress, to be held February 17 to 21, 2007. He discusses his presentation, "Pharmaco-Nutrition: A New Emerging Paradigm," and offers insight into his background and accomplishments in critical care. Dr. Heyland is professor of medicine at Queens University in Kingston, Ontario, Canada.

Webcasts

WEBCAST: Glycemic Control

The Glycemic Control in the Critically Ill and Injured Patient: Progress and Problems. 1.5 CE/CME credits are offered to dietitians, pharmacists, physicians and nurses until November 2007.
Click here to begin.

WEBCAST: Nutritional Therapy

RESEARCH FINDINGS: Evaluating the Efficacy of a Novel Nutritional Therapy for Improved Outcomes in Critically Ill Patients. 1.5 CE/CME credits are offered to pharmacists, physicians and nurses until April 2007. Click here to begin

ORGANIZATION INFORMATION

American Society for Enteral and Parenteral Nutrition (A.S.P.E.N.)  

Click here to view the American Society for Enteral and Parenteral Nutrition (A.S.P.E.N.) Nutrition Support Guidelines and Standards.  Access is free, but you will need to create an account.
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