Jpen Parenter Enter
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Jpen Parenter Enter · Jan 2013
Practice GuidelineA.S.P.E.N. clinical guidelines: nutrition support of adult patients with hyperglycemia.
Hyperglycemia is a frequent occurrence in adult hospitalized patients who receive nutrition support. Both hyperglycemia and hypoglycemia (resulting from attempts to correct hyperglycemia) are associated with adverse outcomes in diabetic as well as nondiabetic patients. This American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guideline summarizes the most current evidence and provides guidelines for the desired blood glucose goal range in hospitalized patients receiving nutrition support, the definition of hypoglycemia, and the rationale for use of diabetes-specific enteral formulas in hospitalized patients. ⋯ 1. What is the desired blood glucose goal range in adult hospitalized patients receiving nutrition support? We recommend a target blood glucose goal range of 140-180 mg/dL (7.8-10 mmol/L). (Strong) 2. How is hypoglycemia defined in adult hospitalized patients receiving nutrition support? We recommend that hypoglycemia be defined as a blood glucose concentration of <70 mg/dL (<3.9 mmol/L). (Strong) 3. Should diabetes-specific enteral formulas be used for adult hospitalized patients with hyperglycemia? We cannot make a recommendation at this time.
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Jpen Parenter Enter · Jan 2013
Obesity is not associated with increased mortality and morbidity in critically ill children.
To evaluate the effect of obesity on mortality, length of mechanical ventilation, and length of stay (LOS) in critically ill children. ⋯ Critically ill overweight, obese, and severely obese children who require invasive mechanical ventilation have similar mortality, length of stay in the PICU, and ventilator days as compared with normal-weight children.
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Jpen Parenter Enter · Nov 2012
Case ReportsEstablishing early enteral nutrition with the use of self-advancing postpyloric feeding tube in critically ill children.
Early nutrition support is an integral part of the care of critically ill children. Early enteral nutrition (EN) improves nitrogen balance and prevents bacterial translocation and gut mucosal atrophy. Adequate EN is often not achieved as gastric feeds are not tolerated and placing postpyloric feeding tubes can be difficult. Spontaneous transpyloric passage of standard feeding tubes without endoscopic intervention or use of anesthesia can range from 30%-80%. The authors report on their experience with a 14Fr polyurethane self-advancing jejunal feeding tube in a pediatric population. These tubes have been used in the adult population with success, but to the authors' knowledge, there have been no reports of its use in the pediatric age group. ⋯ The self-advancing jejunal feeding tube can be used effectively to establish early EN in critically ill children.
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Jpen Parenter Enter · Nov 2012
Randomized Controlled Trial Comparative StudyMarkers of inflammation and coagulation may be modulated by enteral feeding strategy.
Although enteral nutrition (EN) is provided to most mechanically ventilated patients, the effect of specific feeding strategies on circulating markers of coagulation and inflammation is unknown. ⋯ EN strategy in critically ill patients with acute respiratory failure does not significantly modify inflammation and coagulation by day 6, but trophic feeds may have some modest effects in attenuating inflammation and coagulation.
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Jpen Parenter Enter · Nov 2012
Randomized Controlled TrialHuman leukocyte death after a preoperative infusion of medium/long-chain triglyceride and fish oil parenteral emulsions: a randomized study in gastrointestinal cancer patients.
Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. ⋯ In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis.