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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 45th Critical Care Congress on hepatic failure.
The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 45th Critical Care Congress on nutrition.
Margaret Parker, MD, MCCM, speaks with Beth E. Taylor, RD, DCN, about, “Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.),” published in Critical Care Medicine and the Journal of Parenteral and Enteral Nutrition.
Margaret Parker, MD, MCCM, speaks with Ann-Marie Brown, ACNP, PhD, RN, FCCM, Assistant Professor of Nursing at the University of Akron and Advanced Practice Nurse in the Pediatric Intensive Care Unit at Akron Children’s Hospital in Akron, Ohio.
Todd Fraser, MD, speaks with Monty Mythen, MD, about the article, “Trial of the Route of Early Nutritional Support in Critically Ill Adults,” published in The New England Journal of Medicine in 2014.
Michael Weinstein, MD, FACS, speaks with Todd W. Rice, MD, MsC, about the article, “Feeding the Critically Ill Patient,” published in the December 2014 issue of Critical Care Medicine.
Jeffrey Guy, MD, MSc, MMHC, speaks with Nilesh Mehta, MD, about his article published in the July 2012 Critical Care Medicine, “Nutritional Practices and Their Relationship to Clinical Outcomes in Critically Ill Children: An International Multicenter Cohort Study.”
Ainsley Malone, RD, MS, LD, GNSD, discusses goal-directed nutrition with iCritical Care Podcast editor Jeffrey Guy, MD, MSc, MMHC.
Todd W. Rice, MD, MSc, is the lead author of an article published in the May 2011 Critical Care Medicine titled, “Randomized Trial of Initial Trophic Versus Full-Energy Enteral Nutrition in Mechanically Ventilated Patients with Acute Respiratory Failure.”
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?"
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."
Michael Cheatham, MD, FCCM, director of the surgical intensive care units at Orlando Regional Trauma Center in Florida, discusses his latest paper titled, “Is the Evolving Management of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome Improving Survival,” published in the February 2010 issue of Critical Care Medicine.
Phillip S. Barie, MD, MBA, FCCM, discusses decontamination of the digestive tract and oropharynx in an attempt to prevent ventilator-associated pneumonia. He discusses a recent article published in The New England Journal of Medicine, “Decontamination of the Digestive Tract and Oropharynx in ICU Patients.”
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.
This is a presentation from the 2016 Multiprofessional Critical Care Review Course: Pediatric (MCCRC) on Gastrointestinal Abnormalities
uidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance. The PubMed/Medline search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery is an area of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutritionduring critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.
The parenteral multivitamin preparations that are commercially available in the United States (U.S.) meet the requirements for most patients who receive parenteral nutrition (PN). However, a separate parenteral vitamin D preparation (cholecalciferol or ergocalciferol) should be made available for treatment of patients with vitamin D deficiency unresponsive to oral vitamin D supplementation.
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient, from A.S.P.E.N. and the Society of Critical Care Medicine, are based on general conclusions of health professionals who, in developing such guidelines, have balanced potential benefits to be derived from a particular mode of medical therapy against certain risks inherent with such therapy.
Presented at the 48th Critical Care Congress, this session is sponsored by Abbott Nutrition
This is a presentation from the 2017 Multiprofessional Critical Care Review Course: Adult (MCCRC) on the big bad abdomen case review.