GI and Nutrition Archives - PulmCCM
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GI and Nutrition Articles

Oct 142014
 
Total parenteral nutrition vs enteral nutrition: no difference in critically ill? (CALORIES trial)

Feeding patients enterally (nasogastric or nasojejunal tube feedings) has been the standard of care for critically ill patients, based on weak evidence that it reduces infection rates; hence the adage “feed the gut, if you can.” That last caveat is included because so many critically ill patients have gastric motility impairment (with inability to achieve [... read more]

May 162014
 
How to provide nutrition for critically ill patients (Review)

Nutritional Support During Critical Illness This PulmCCM topic review will be periodically updated and expanded as new research is published. Originally published 22 September 2013. Most recent update: 16 May 2013. During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism (synthesis of these same macromolecules). Historically, the [... read more]

Feb 152014
 
Tight glycemic control in critically ill kids: benefits, risks still unclear

Intensive insulin therapy for critically ill adults was rapidly adopted as standard care after 2001 when an apparent benefit was established after cardiac surgery, then medical ICU patients. Eleven years later, after a wave of minor harm signals, the NICE-SUGAR study confirmed for most intensivists that the excess hypoglycemia from intensive glucose control was potentially lethal in adults, and [... read more]

Feb 112014
 
Vitamin D: no relationship to COPD exacerbations

After a stupefying amount of research on vitamin D — with 70 vitamin D studies published in PubMed in January 2014 alone — there is no consistent signal tying vitamin D supplementation to improvement in any health condition. A recent “futility analysis” (a form of meta-analysis) of 40 randomized trials suggests vitamin D does not [... read more]

Jan 052014
 
Acute Liver Failure: Causes & Initial Management (Part 1 of 2)

Acute Liver Failure: Causes and Initial Management See also: Treatment of Acute Liver Failure Acute liver failure, also called fulminant liver failure, has been defined as “a severe liver injury, potentially reversible in nature and with onset of hepatic encephalopathy within 8 weeks of the first symptoms in the absence of pre-existing liver disease.” Acute [... read more]

Jan 052014
 
Acute Liver Failure: Treatment (Part 2 of 2)

Acute Liver Failure: Treatment (Part 2 of 2) See also: Acute Liver Failure: Causes & Initial Management Management of acute liver failure is largely supportive critical care for the multiorgan failure that frequently results. Severe acute liver failure results in rapidly progressive hepatic encephalopathy and lethal cerebral edema; this complication requires special vigilance and expert [... read more]

Dec 012013
 
Do colloids save lives in hypovolemic shock?

So, your patient’s in shock: quick, give some fluids. But colloids or crystalloids? How to choose? They both raise blood pressure, they both improve organ perfusion — but one’s less filling, the other tastes great (what, you haven’t tried them?). It’s no wonder the question makes your head hurt; the evidence base is a jumble. The [... read more]

Jul 112013
 
Early parenteral nutrition does not improve survival

Early Parenteral Nutrition (TPN) Didn’t Save Lives Under the high stress of critical illness, people lose fat and muscle quickly. Obesity appears to be protective during critical illness, possibly because those extra fat reserves come in handy during this period of accelerated catabolism. The strong physiological rationale and the psychological pressure not to appear to be [... read more]

Mar 102013
 
Hope floats: Fecal transplants cure >90% of recurrent C. difficile (RCT)

Fecal Transplants Cure C. difficile Infections, When Drugs Can’t Antibiotics are what cause Clostridium difficile infection to emerge in the first place, so it’s perhaps no surprise that the usual treatment — more antibiotics — often fails. From 15-25% of patients with C. difficile are not permanently cured by their initial treatment with metronidazole, and among those [... read more]

Feb 072013
 
Blood transfusion harmful, even deadly, in some patients with GI bleeds (RCT)

Blood Transfusion: Deadly for GI Bleeds? You read the headline right: in a randomized trial published in the January 3 New England Journal of Medicine, liberal blood transfusions (to a hemoglobin of 9 g/dL) seemed to cause the deaths of people with acute upper gastrointestinal bleeding, as compared to transfusing when hemoglobin fell below 7 [... read more]

Jan 102013
 
Does GERD really cause chronic cough?

Chronic Cough and GERD: A Tangled Connection by Michael Peters, MD Gastroesophageal reflux disease (GERD) is considered to be one of the cardinal causes of chronic cough. A study in Chest challenges that fundamental concept, but comes up short in refuting it. What They Did Samantha Decalmer, Rachel Stovold, Jaclyn A. Smith et al conducted [... read more]

Jan 062013
 
Intensive glucose control probably kills, says NICE-SUGAR post-hoc

Intensive glucose control in critically ill patients — keeping glucose below 120 with a continuous insulin drip — was all the rage for a few years in the early 2000s after it was shown to improve survival in surgery patients, and then seemed to do the same in non-surgical, critically ill MICU patients who were [... read more]

Jan 052013
 
Tranexamic acid saves lives, reduces transfusions. So why does no one use it? (Review)

Tranexamic Acid: Underused for Uncontrolled Bleeding? Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). In the U.S., tranexamic acid is sold as Lysteda (oral) [... read more]

Nov 232012
 
Intensive glucose control in kids: no brain injury vs. standard care 3 yrs later (RCT)

Intensive Glucose Control: Safe for Critically Ill Kids’ Brains? After evangelizing globally for intensive glucose control (~100 mg/dL) to be the standard of care for virtually all critically ill adults for a decade, Greet van den Berghe might be disappointed that mounting evidence shows that a fanatical approach to maintenance of normoglycemia in critical illness [... read more]

Oct 262012
 
Vitamin D is for "doesn't do diddly" for the common cold (RCT)

Extra Vitamin D Doesn’t Prevent Colds in Healthy Adults (JAMA) It looks like you can add Vitamin D to list of supplements (echinacea, vitamin C, etc.) who’ve gone up against the common cold and lost. (Scorekeepers will note that zinc held its own, though, in a Cochrane analysis.) Vitamin D plays an important role in immune responses, [... read more]

Oct 042012
 
Post-pyloric feeding no better than usual NG tube in vented patients (RCT)

Image: EIMJM.com Evidence-based practice guidelines adopted by critical care societies in Canada, Germany, Australia and New Zealand recommend starting enteral nutrition for critical illness shortly after admission to an ICU. In observational studies, critically ill adults get only about 50-70% their caloric goals from enteral feeding; reduced gastric motility is often responsible for the limited [... read more]

Apr 132012
 
Vitamin D supplements don't prevent COPD exacerbations in RCT (Ann Intern Med)

Vitamin D deficiency has been linked to many chronic medical conditions, including asthma and chronic obstructive pulmonary disease (COPD). In some cases, more severe vitamin D deficiency is associated with more severe chronic illness. However, it’s never been shown that vitamin D deficiency supplemenation improves or prevents illness; i.e., that vitamin D deficiency causes or exacerbates [... read more]

Mar 232012
 

An observational trial by Jim Kutsoguiannis, Cathy Alberda, Daren Heyland et al published in the December 2011 Critical Care Medicine showed no difference in 60-day survival among critically ill, mechanically ventilated patients started on parenteral nutrition (TPN) “early” (within 48 hours of ICU admission) or “late” (after 48 hours). Only 258 patients were included in the [... read more]

Nov 262011
 

Many people with chronic respiratory failure literally waste away — as evidenced by the contribution of “B” (for body mass index) in the BODE index’s prediction of survival in severe COPD. Although long-term oxygen therapy improves survival and quality of life, and pulmonary rehabilitation improves exercise capacity and QOL, efforts to halt or reverse the [... read more]

Nov 012011
 

October’s Seminars in Respiratory & Critical Care Medicine brings you 110 pages and 11 articles on organ failure in the intensive care unit, with articles including: Organ failure scoring and predictive models Cardiac alterations due to organ failure The microcirculation as a therapeutic target in shock Immuologic derangements in organ failure Acute lung failure Cardiogenic [... read more]