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Singer P, Theilla M. Reply- letter to the editor. Clin Nutr 2023; 42:244. [PMID: 36577624 DOI: 10.1016/j.clnu.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Pierre Singer
- Herzlia Medical Center and General Intensive Care Department Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Israel.
| | - Miriam Theilla
- Tel Aviv-Yaffo Academic College School for Nursing Sciences, Israel
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Theilla M, Singer P, Tadmor B, Bendavid I, Hellerman M, Kagan I. Community optimized management for better eating after hospital sTay among geriatric patients of poor socio-economic status - The COMEAT study. Clin Nutr 2022; 41:1746-1751. [PMID: 35780702 DOI: 10.1016/j.clnu.2022.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In patients suffering from disease-related and socioeconomic malnutrition and being discharged from hospital, continuity of care is challenging. Lack of adequate nutrition may lead to increase in morbidity and mortality. The aim of this study was to overcome the handicap of limited nutrition access in this category of patients and to study its consequences on clinical outcome. METHODS Hospitalized patients screened to be at risk of malnutrition were approached and if diagnosed as suffering from malnutrition and from limited financial resources, they were randomized to receive a delivered daily dinner tray for 6 months and an assistance during the meal by a philanthropic association, or to regular food. At entry to the study, patients were assessed by indirect calorimetry, bioimpedance, Hospital Anxiety and Depression Scale (HADS), Functional independence measure (FIM) and SF 36 quality of life questionnaire. The latest questionnaires were reproduced after 3 and 6 months. Survival was followed at 6 months. The student t-test, the paired t-test, ANOVA were used. 180 days survival curves were expressed using the Kaplan-Meier method. RESULTS 631 patients were screened and 60 patients were randomized. There was no difference between groups. Survival at 6 months was improved significantly in the intervention group (87%) compared to the control group (65%, p<005). HADS did significantly improve at 3 months and other parameters (FIM, SF 36) were not changed significantly. CONCLUSIONS In hospitalized patients at nutritional risk, lunch home delivery, supported by a physical company after hospital discharge was associated with significantly lower mortality rates and improved depression and anxiety scores in elderly patients suffering from socioeconomic related malnutrition.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel; Tel Aviv-Yaffo Academic College School for Nursing Sciences, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel.
| | - Boaz Tadmor
- Administration Office, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Moran Hellerman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
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Theilla M, Tadmor B, Bendavid I, Kagan I, Hellerman M, Singer P. Community optimized management for better eating after hospital stay-com eat. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Singer P, Mesalati-Stahzi R, Bendavid I, Theilla M, Ariel A, Kagan I. Supplemental parenteral nutrition enriched with omega-3 polyunsaturated fatty acids in intensive care patients – a randomized, controlled, double-blind clinical trial. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pironi L, Steiger E, Joly F, Jeppesen PB, Wanten G, Sasdelli AS, Chambrier C, Aimasso U, Mundi MS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Santarpia L, Guglielmi FW, Kozjek NR, Schneider SM, Ellegard L, Thibault R, Matras P, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Udvarhelyi G, Jones L, Won Lee AD, Masconale L, Orlandoni P, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui MEP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Youssef NN, Brillanti G, Nardi E, Lal S. Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey. Clin Nutr ESPEN 2021; 45:433-441. [PMID: 34620351 DOI: 10.1016/j.clnesp.2021.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. METHODS The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. RESULTS In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. CONCLUSIONS SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
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Affiliation(s)
- Loris Pironi
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France.
| | - Ezra Steiger
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Palle B Jeppesen
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anna S Sasdelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | | | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | - Miriam Theilla
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Mireille Serlie
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, Université Côte D'Azur, Nice, France
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Institute of Internal Medicine, University of Tartu, Tartu, Estonia, And Previously at Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Marina Taus
- SOD Dietetica e Nutrizione Clinica, Centro Riferimento Regionale NAD, Ospedali Riuniti di Ancona, Italy
| | - Nuria M Virgili
- Facultatiu Especialista. Servei D'Endocrinologia I Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D Won Lee
- Hospital Das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Nutrizione Clinica-Centro di Riferimento Regionale NAD, IRCCS-INRCA, Ancona, Italy
| | | | - Marta Bueno Díez
- Servei D'Endocrinologia I Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nader N Youssef
- VectivBio AG Basel, Switzerland, Digestive Healthcare Center, NJ, USA
| | - Giorgia Brillanti
- Alma Mater Studiorum, University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Gbareen M, Barnoy S, Theilla M. Subjective and objective nutritional assessment: nurses' role and the effect of cultural differences. BMC Nurs 2021; 20:157. [PMID: 34479561 PMCID: PMC8414867 DOI: 10.1186/s12912-021-00683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though the nutritional assessment of chronically ill patients has a significant effect on outcomes, nurses' time constraints in clinical encounters may make the process impractical. Also, cultural background has an effect on nutritional assessment. Patient nutritional self-assessment can ease some of the nurses' workload. OBJECTIVES To compare tools for subjective and objective nutritional assessment and to examine cultural differences in nutritional assessment between Jews and Arabs living in Israel. METHODS The research design was cross-sectional; data were collected from Jews and Arabs with chronic illnesses living in the community during their visit to a public health clinic. The admitting nurse performed an objective nutritional assessment (Mini Nutritional Assessment (MNA)) after the patients completed the Subjective Nutritional Assessment (SANS). The data were analyzed using descriptive statistics, Pearson's correlation coefficients were calculated to test the relationships between the variables, and independent student t-tests were used to compare the means and differences between groups. The diagnostic accuracy of the MNA and of the SANS was determined using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves. The agreement between the MNA and SANS measurements was estimated by a Bland Altman plot. The level of significance employed throughout the analysis was 0.05. RESULTS The sample was a convenience sample of 228 chronically ill patients, consisting of 121 Arabs and 107 Jews. A significant correlation was found between the subjective and objective nutritional assessments. The Bland-Altman plot demonstrated that the SANS and the MNA have a high level of agreement. Using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves, showed an moderate diagnostic accuracy (73 % sensitivity and 30 % specificity). CONCLUSIONS Since the patient-completed nutritional assessment requires minimal time investment by nurses and we found a significant correlation and evidence for the accuracy and agreement of the objective and subjective assessments, further studies should assess and validate the possibility of replacing the objective nutritional assessment by the subjective assessment. Cultural background has a significant effect on patients' nutritional self-assessment; hence, culture should be considered as part of the nutritional assessment.
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Affiliation(s)
- M Gbareen
- Meuhedet Health Services, Tel Aviv, Israel
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Health Professions building, room 310, Ramat Aviv, 6997801, Tel Aviv, Israel
| | - S Barnoy
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Health Professions building, room 310, Ramat Aviv, 6997801, Tel Aviv, Israel
| | - M Theilla
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Health Professions building, room 310, Ramat Aviv, 6997801, Tel Aviv, Israel.
- Nutrition Nurse, Rabin Medical Center, Beilinson Hospital, Clalit Health Services, Petah Tikva, Israel.
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Singer P, Bendavid I, Mesilati-Stahy R, Green P, Rigler M, Lev S, Schif-Zuck S, Amiram A, Theilla M, Kagan I. Enteral and supplemental parenteral nutrition enriched with omega-3 polyunsaturated fatty acids in intensive care patients - A randomized, controlled, double-blind clinical trial. Clin Nutr 2021; 40:2544-2554. [PMID: 33932802 DOI: 10.1016/j.clnu.2021.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS Enteral nutrition (EN) and parenteral nutrition (PN) enriched with omega-3 polyunsaturated fatty acids (PUFA) have beneficial effects in critical illness. This study aimed to assess the combined effect of EN and supplemental PN enriched with omega-3 PUFA on blood oxygenation in intensive care unit (ICU) patients. METHODS Single-center, prospective, randomized, controlled, double-blind, phase III trial conducted from 10/2013 to 11/2017. A total of 100 ICU patients (18-85 years, APACHE II score > 15) requiring mechanical ventilation were randomly assigned to received combined EN and PN either with omega-3 PUFA (omega-3 group) or without (control group) for up to 28 days. Primary endpoint: 'change of PaO2/FiO2 from day (D) 1 to D4'. Secondary endpoints: lung function parameters, ICU complications, length of hospital stay, days free of ICU care/ventilation/sedation/catecholamine treatment, mortality, erythrocyte fatty acid composition, inflammatory parameters. Safety parameters: standard laboratory assessment, vital signs, physical examination, SOFA score, adverse events. RESULTS Combined EN and PN covered energy requirements to more than 80%. Blood oxygenation (ΔPaO2/FiO2 from D1 to D4: -1.3 ± 83.7, n = 42, and 13.3 ± 86.1, n = 39, in omega-3 and control group, respectively, p = 0.7795) and other lung function parameters did not differ between groups but days free of catecholamine treatment were significantly higher in the omega-3 group (~4 days, p = 0.0481). On D6, significantly more patients in the omega-3 group tolerated EN alone (51.0% vs. 29.8%, p = 0.0342). Eicosapentaenoic acid (EPA) content in erythrocytes was significantly increased in the omega-3 group at last observation compared with the control group (ΔEPA: 0.928 ± 0.808% vs. -0.024 ± 0.190%, p < 0.0001). No further significant group differences were detected. CONCLUSIONS Enteral and supplemental PN both enriched with omega-3 PUFA did not improve lung function but allowed earlier weaning from catecholamine treatment and PN. Supplemental PN succeeded to adequately cover energy requirements in critically ill patients. TRIAL REGISTRATION www.clinicaltrials.gov, registration number: NCT01162928.
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Affiliation(s)
- Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ronit Mesilati-Stahy
- Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Pnina Green
- Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Merav Rigler
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shaul Lev
- Intensive Care Unit, Rabin Medical Center, HaSharon Hospital, Petah Tikva, Israel
| | - Sagie Schif-Zuck
- Department of Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Ariel Amiram
- Department of Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Theilla M, Rattanachaiwong S, Kagan I, Rigler M, Bendavid I, Singer P. Validation of GLIM malnutrition criteria for diagnosis of malnutrition in ICU patients: An observational study. Clin Nutr 2020; 40:3578-3584. [PMID: 33413910 DOI: 10.1016/j.clnu.2020.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Patients in the Intensive Care Unit (ICU) are at high risk of malnutrition. The only validated malnutrition assessment tool is the Subjective Global Assessment (SGA). The Global Leadership Initiative on Malnutrition (GLIM) is a new malnutrition assessment tool. The present study compares the nutrition-related parameters of the following tools: GLIM tool, SGA, Phase Angle (PA), Low Fat-Free Mass Index (FFMI), and Patient- and Nutrition-Derived Outcome Risk Assessment score (PANDORA), in an attempt to validate an objective tool. METHODS Eighty-four ICU patients were included. The tools mentioned above were assessed for their validity in diagnosing malnutrition. All patients were defined as suffering from acute disease and received medical nutrition therapy. To evaluate whether there is a correlation between the GLIM criteria, SGA, PA, and low FFMI, we compared the SGA, PA, and low FFMI to the GLIM criteria using Spearman correlation coefficients and a Chi-square test. Also, a Mann-Whitney U test was used to test the mean differences between the GLIM criteria and the PANDORA. The area under the curve (AUC) of the proposed parameters was evaluated for diagnosis of malnutrition to seek cutoff points that yield good sensitivity and specificity. RESULTS Mean age was 50 ± 20 years, BMI 25.3 ± 5.1 kg/m2, APACHE II 20.5 ± 7.7, PANDORA score 32 ± 8.5. GLIM malnutrition criteria were significantly correlated with the gold standard SGA assessment and with low FFMI, with PA (Phase Angle), and with the PANDORA score. The area under the curve, by using the ROC curve analysis for GLIM criteria stratified by the SGA results, was 0.85 (P < 0.001). Sensitivity was 85%, and specificity 79%. However, when comparing the low FFMI, PA, and PANDORA to the GLIM criteria, the ROC curve analysis results were considered poor rank. CONCLUSIONS The SGA malnutrition assessment highly validated the GLIM criteria framework combined with the two-criteria diagnosis of malnutrition with a high level of precision. The GLIM malnutrition assessment seems to be acceptable in the ICU setting.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Steyer School of Health Professions, Nursing Department, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Merav Rigler
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Pironi L, Steiger E, Joly F, Wanten GJA, Chambrier C, Aimasso U, Sasdelli AS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie MJ, Cooper SC, Poullenot F, Rasmussen HH, Compher CW, Crivelli A, Hughes SJ, Santarpia L, Guglielmi FW, Rotovnik Kozjek N, Ellegard L, Schneider SM, Matras P, Forbes A, Wyer N, Zmarzly A, Taus M, O'Callaghan M, Osland E, Thibault R, Cuerda C, Jones L, Chapman B, Sahin P, Virgili NM, Lee ADW, Orlandoni P, Matysiak K, Di Caro S, Doitchinova-Simeonova M, Masconale L, Spaggiari C, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Petrina Jáuregui E, Zugasti Murillo A, Suárez-Llanos JP, Nardi E, Van Gossum A, Lal S. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure. Gut 2020; 69:1787-1795. [PMID: 31964752 DOI: 10.1136/gutjnl-2018-318172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
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Affiliation(s)
- Loris Pironi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ezra Steiger
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisca Joly
- Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cecile Chambrier
- Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Umberto Aimasso
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | | | - Amelia Jukes
- University Hospital of Wales, Cardiff, Cardiff, UK
| | - Miriam Theilla
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
| | - Marek Kunecki
- Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
| | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mireille J Serlie
- Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Florian Poullenot
- Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene W Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriana Crivelli
- Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | | | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | | | - Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Nicola Wyer
- University Hospital Coventry, Coventry, Coventry, UK
| | | | - Marina Taus
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ronan Thibault
- Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brooke Chapman
- Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | | | - Núria M Virgili
- Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
| | - Andre Dong Won Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Konrad Matysiak
- Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
| | | | | | - Luisa Masconale
- Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
| | - Corrado Spaggiari
- Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
| | - Carmen Garde
- Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | | | - Gabriel Olveira
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | | | | | - José P Suárez-Llanos
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Elena Nardi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - André Van Gossum
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lal
- Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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Kot D, Ławiński M, Słodkowski M, Kagan I, Hellerman M, Theilla M. Effects of Sexual Function, Social Media Use, and Self-Efficacy on Quality of Life Among Home Parenteral Nutrition Patients. JPEN J Parenter Enteral Nutr 2020; 45:991-998. [PMID: 32700380 DOI: 10.1002/jpen.1969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Quality of life (QOL) of home parenteral nutrition (HPN) patients is a critical issue for functioning and survival. This study evaluates the roles of sexual function (SF), self-efficacy (SE), and the use of social media (USM) in the QOL of HPN patients. MATERIALS AND METHODS The study model investigates the independent variables USM and SF and the dependent variable QOL, and SE is a mediator variable between SF and USM. RESULTS We included 203 participants with HPN who completed self-administered, validated questionnaires for QOL, SF, SE, and USM. Statistical analysis included a t-test, Sobel test, bootstrapping method, and Pearson correlations between variances. The mean HPN duration was 10.5 ± 8 years. Results show a significant correlation between QOL scores and SF (P = .001). USM was positively correlated with SE (P = .001). SE as a mediator between USM and SF was supported by significant results in the Sobel test. Patients with a stoma were significantly less sexually active and had lower SE ratings than those without a stoma. CONCLUSION Physical changes that affect SE and boost social relationships by allowing emotional support through social networks are important factors for QOL improvement. These findings may guide health professionals in the management of HPN patients.
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Affiliation(s)
- Dominika Kot
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Ławiński
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Warsaw, Mazowieckie, Poland
| | - Maciej Słodkowski
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hellerman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
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11
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Theilla M. How transplant patients are fed in the intensive care unit: A one-year retrospective study. Asia Pac J Clin Nutr 2020; 29:262-265. [PMID: 32674233 DOI: 10.6133/apjcn.202007_29(2).0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Even though the nutritional status of patients following organ transplant has a significant effect on outcomes, the energy intake of transplant patients hospitalized in the intensive care department is not well reported. The present study aims to examine the medical nutritional therapy of transplant patients in a large transplant center. METHODS AND STUDY DESIGN Data were collected retrospectively. All patients after perioperative transplant surgery or with late complications after organ transplants were included. The study included 78 patients who underwent liver (n=36), kidney (n=21), lung (n=14), pancreas (n=3) or both pancreas and kidney (n=4) transplants in 2017. Energy requirements were predicted using the Faisy-Fagon predictive equations calculated daily for 14 days. Energy intake was assessed, and daily energy balance was calculated. Complications and mortality were noted. RESULTS The mean energy intake was 1150 kcal/day. Most patients were in a negative energy balance (NEB; range -5735 to 3437 kcal/day). A greater NEB was associated with longer length of ventilation (LOV) and length of stay (LOS). The observed mortality rate was 42.3%. The correlation between energy balance (14 days) and LOS was r=-0.549; for LOV, it was r=-0.569. Patients who underwent lung transplant had the highest negative energy balance and the highest mortality (p<0.01). CONCLUSIONS Most of the transplant patients were underfed, and there was a significant correlation between energy balance and mortality (r=-0.324). Optimal energy intake should be assessed prospectively.
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Affiliation(s)
- Miriam Theilla
- General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva. .,Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
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12
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Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clin Nutr 2020; 39:3419-3425. [PMID: 32199698 DOI: 10.1016/j.clnu.2020.02.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE While various nutritional assessment tools have been proposed, consensus is lacking with respect to the most effective tool to identify severe malnutrition in critically ill patients. METHODS We conducted a retrospective study in an adult general intensive care unit (ICU) comparing four nutritional assessment tools: Nutrition Risk Screening (NRS), Nutrition Risk in Critically Ill (NUTRIC), and malnutrition criteria proposed by European Society of Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN). These criteria were tested for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in diagnosis of severe malnutrition, defined as Subjective Global Assessment (SGA) C. RESULTS Hospitalization records for 120 critically ill patients were analyzed. 60 (50%), 17 (14.2%) and 43 (35.8%) patients were classified as SGA A, B, and C, respectively. The sensitivity in diagnosis of severe malnutrition was 79.1%, 58.1%, 65.1%, and 65.1%, and specificity was 94.8%, 74.0%, 94.8%, and 98.7% for NRS, NUTRIC, ESPEN, and ASPEN, respectively. NRS, ESPEN, and ASPEN had higher PPV (89.5%, 87.5%, and 87.5%, respectively) and NPV (89%, 83%, and 83.5%, respectively) than NUTRIC (PPV 55.6% and NPV 76%). NUTRIC showed the highest correlation with mortality, but none of the tools retained their correlation with mortality after adjustment for potential confounding factors. CONCLUSIONS NRS showed the highest sensitivity and high specificity, PPV, and NPV. NUTRIC had least effective overall performance in diagnosis of severe malnutrition in an ICU setting. A larger population may be required to explore the association between mortality and these nutritional assessment tools.
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Affiliation(s)
- Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Benjamin Zribi
- Department of Anesthesia, Rabin Medical Center, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Rigler M, Kagan I, Bendavid I, Theilla M. PT03.05: Validation of GLIM Malnutrition Criteria with SGA and FFMI Measurement in 150 Hospitalized Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Ławiński M, Skroński M, Ukleja A, Andrzejewska M, Nyckowski P, Słodkowski M, Theilla M, Singer P. MON-PO600: Indirect Calorimetry in Oncological Surgery Liver Patients – Comparison of Resting Energy Expenditure with Prediction Equations. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Theilla M, Rattanachaiwong S, Kagan I, Rigler M, Bendavid I, Singer P. GM02: Validation of GLIM Malnutrition Criteria for Diagnosis of Malnutrition in ICU Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32125-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Theilla M, Ławiński M, Kot D, Słodkowski M, Kagan I, Singer P. MON-PO433: Examine the Role of Health Perception, Self-Efficacy and Use of Social Media on QOL of Home Parenteral Nutrition (HPN) Patients in Poland and Israel. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hellerman M, Sabatino A, Theilla M, Kagan I, Fiaccadori E, Singer P. Carbohydrate and Lipid Prescription, Administration, and Oxidation in Critically Ill Patients With Acute Kidney Injury: A Post Hoc Analysis. J Ren Nutr 2019; 29:289-294. [PMID: 30630662 DOI: 10.1053/j.jrn.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/15/2018] [Accepted: 09/16/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In a prospective multicenter study on adult patients with acute kidney injury (AKI) receiving enteral and/or parenteral nutrition, administered carbohydrates and lipids were compared to the prescribed amounts, as well as to substrate utilization data derived from indirect calorimetry measurements. METHODS Resting energy expenditure (REE) was measured by indirect calorimetry. Nitrogen excretion was obtained from the protein catabolic rate calculated from urinary urea nitrogen when available and by urea kinetic-based methods in patients on renal replacement therapy. Fat and carbohydrate oxidations were derived from Frayn formulas. RESULTS Ninety-two REE measurements were available in 35 critically ill patients with AKI (16 on renal replacement therapy). The mean lipid oxidation rate was 101 g/24 h (standard deviation [SD] 73.8), whereas prescribed lipids were 67 g/24 h (SD 32; P < .001). Carbohydrate utilization was derived from the same REE measurements yielding a mean carbohydrate oxidation of 105.8 g/24 h (SD 131.8), thus, much lower than the prescribed carbohydrates (186.7 g/24 h; SD 74.3; P < .001). The amount of fat and carbohydrates administered correlated to the prescribed amount (r = 0.896 and r = 0.829, respectively). Further analysis showed that this nutritional pattern was independent from the presence of sepsis. CONCLUSION Our study suggests that critically ill patients with AKI do not receive an amount of carbohydrate and lipids adequate to support their needs on the basis of measured substrate utilization data. Thus, current nutritional approach in these patients, based on commercial formulas, should be challenged with measured substrate utilization-guided nutritional support.
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Affiliation(s)
- Moran Hellerman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alice Sabatino
- Acute and Chronic Renal Failure Unit, Department of Medicine and Surgery, Renal ICU, Parma University Hospital, Parma, Italy
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrico Fiaccadori
- Acute and Chronic Renal Failure Unit, Department of Medicine and Surgery, Renal ICU, Parma University Hospital, Parma, Italy
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Theilla M, Kagan I, Makalde M, Rattanachaiwong S, Cohen J, Singer P. The place of supplemental parenteral nutrition in critically ill transplanted patients: A one year retrospective study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Kagan I, Zusman O, Bendavid I, Theilla M, Cohen J, Singer P. Validation of carbon dioxide production (VCO 2) as a tool to calculate resting energy expenditure (REE) in mechanically ventilated critically ill patients: a retrospective observational study. Crit Care 2018; 22:186. [PMID: 30075796 PMCID: PMC6091032 DOI: 10.1186/s13054-018-2108-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Indirect calorimetry (IC) measurement is considered the gold standard for the assessment of resting energy expenditure (REE). It is based on the measurement of oxygen and carbon dioxide consumption (VO2 and VCO2, respectively). However, its use is limited by cost and technical issues. It has been proposed that, in critically ill patients, the analysis of VCO2 obtained from the ventilator alone may be used as an accurate method to assess REE in ventilated patients. This retrospective study aimed to assess the accuracy of VCO2 measurement alone in the determination of REE. METHODS This was a retrospective study conducted at the general intensive care unit of a single university-affiliated tertiary medical center. Patients included were invasively ventilated and their REE was measured by using IC. The respiratory quotients (RQs) were set at 0.8, 0.85, and 0.89. Data were collected from computerized patient files. REE obtained from the ventilator by using VCO2 (REE-VCO2) alone was compared with REE obtained from IC (REE-IC). RESULTS Measurements were obtained for 80 patients, and 497 REE-IC measurements were compared with REE-VCO2 obtained at the same time. The mean REE-IC was 2059.5 ± 491.7 kcal/d. The mean REE-RQs corresponding to RQs of 0.80, 0.85, and 0.89 were 1936.8 ± 680.0, 2017.8 ± 708.8, and 2122.1 ± 745.4 kcal/d, respectively. REE-VCO2 derived from an RQ of 0.85 had the lowest mean difference from REE-IC. Whereas accuracy was higher using an RQ of 0.85, agreement (between 85% and 115%) was highest using an RQ of 0.89. CONCLUSIONS The level of agreement of REE obtained from VCO2 readings with REE obtained from IC was generally low. IC continues to be the recommended method for REE assessment.
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Affiliation(s)
- I. Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah-Tikva, Israel
| | - O. Zusman
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah Tikva, Israel
| | - I. Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah-Tikva, Israel
| | - M. Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah-Tikva, Israel
- Stanley Steyer School of Health Professions, Sackler School of Medicine, School of Nursing, Tel Aviv University, Haim Levanon Street 55, Ramat Aviv 6997801 Tel Aviv, Israel
| | - J. Cohen
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah-Tikva, Israel
| | - P. Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital Affiliated to Sackler School of Medicine, Tel Aviv University, Jabotinsky St 39, 49100 Petah-Tikva, Israel
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20
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Wouters Y, Theilla M, Singer P, Tribler S, Jeppesen PB, Pironi L, Vinter‐Jensen L, Rasmussen HH, Rahman F, Wanten GJA. Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition. Aliment Pharmacol Ther 2018; 48:410-422. [PMID: 29978597 PMCID: PMC6099431 DOI: 10.1111/apt.14904] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/27/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The catheter lock solutions 2% taurolidine and 0.9% saline are both used to prevent catheter-related bloodstream infections (CRBSIs) in home parenteral nutrition patients. AIMS To compare the effectiveness and safety of taurolidine and saline. METHODS This multicentre double-blinded trial randomly assigned home parenteral nutrition patients to use either 2% taurolidine or 0.9% saline for 1 year. Patients were stratified in a new catheter group and a pre-existing catheter group. Primary outcome was the rate of CRBSIs/1000 catheter days in the new catheter group and pre-existing catheter group, separately. RESULTS We randomised 105 patients, of which 102 were analysed as modified intention-to-treat population. In the new catheter group, rates of CRBSIs/1000 catheter days were 0.29 and 1.49 in the taurolidine and saline arm respectively (relative risk, 0.20; 95% CI, 0.04-0.71; P = 0.009). In the pre-existing catheter group, rates of CRBSIs/1000 catheter days were 0.39 and 1.32 in the taurolidine and saline arm respectively (relative risk, 0.30; 95% CI, 0.03-1.82; P = 0.25). Excluding one outlier patient in the taurolidine arm, mean costs per patient were $1865 for taurolidine and $4454 for saline (P = 0.03). Drug-related adverse events were rare and generally mild. CONCLUSIONS In the new catheter group, taurolidine showed a clear decrease in CRBSI rate. In the pre-existing catheter group, no superiority of taurolidine could be demonstrated, most likely due to underpowering. Overall, taurolidine reduced the risk for CRBSIs by more than four times. Given its favourable safety and cost profile, taurolidine locking should be considered as an additional strategy to prevent CRBSIs. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT01826526.
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Affiliation(s)
- Y. Wouters
- Intestinal Failure UnitDepartment of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - M. Theilla
- General Intensive Care DepartmentRabin Medical CentreBeilinson Hospital and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - P. Singer
- General Intensive Care DepartmentRabin Medical CentreBeilinson Hospital and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - S. Tribler
- Department of Medical GastroenterologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - P. B. Jeppesen
- Department of Medical GastroenterologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - L. Pironi
- Centre for Chronic Intestinal FailureDepartment of Medical and Surgical ScienceUniversity of BolognaBolognaItaly
| | - L. Vinter‐Jensen
- Department of GastroenterologyCentre for Nutrition and Bowel DiseaseAalborg University HospitalAalborgDenmark
| | - H. H. Rasmussen
- Department of GastroenterologyCentre for Nutrition and Bowel DiseaseAalborg University HospitalAalborgDenmark
| | - F. Rahman
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | - G. J. A. Wanten
- Intestinal Failure UnitDepartment of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
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21
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Zusman O, Kagan I, Bendavid I, Theilla M, Cohen J, Singer P. Predictive equations versus measured energy expenditure by indirect calorimetry: A retrospective validation. Clin Nutr 2018; 38:1206-1210. [PMID: 29776694 DOI: 10.1016/j.clnu.2018.04.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/17/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND & AIMS Measuring resting energy expenditure (REE) via indirect calorimetry (IC) in intensive care unit (ICU) patient is the gold standard recommended by guidelines. However technical difficulties hinder its use and predictive equations are largely used instead. We sought to validate commonly used equations using a large cohort of patients. METHODS Patients hospitalized from 2003 to 2015 in a 16-bed ICU at a university-affiliated, tertiary care hospital who had IC measurement to assess caloric targets were included. Data was drawn from a computerized system and included REE and other variables required by equations. Measurements were restricted to 5 REE per patient to avoid bias. Equation performance was assessed by comparing means, standard deviations, correlation, concordance and agreement, which was defined as a measurement within 85-115% of measured REE. A total of 8 equations were examined. RESULTS A total of 3573 REE measurements in 1440 patients were included. Mean patient age was 58 years and 65% were male. A total of 562 (39%) patients had >2 REE measurements. Standard deviation of REE ranged from 430 to 570 kcal. The Faisy equation had the least mean difference (90 Kcal); Harris-Benedict had the highest correlation (52%) and agreement (50%) and Jolliet the highest concordance (62%). Agreement within 10% of caloric needs was met only in a third of patients. CONCLUSIONS Predictive equations have low performance when compared to REE in ICU patients. We therefore suggest that predictive equations cannot wholly replace indirect calorimetry for the accurate estimation of REE in this population.
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Affiliation(s)
- Oren Zusman
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
| | - Ilya Kagan
- Sackler School of Medicine, Tel Aviv University, Israel; Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Itai Bendavid
- Sackler School of Medicine, Tel Aviv University, Israel; Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Jonathan Cohen
- Sackler School of Medicine, Tel Aviv University, Israel; Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Sackler School of Medicine, Tel Aviv University, Israel; Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Itzhaki M, Bluvstein I, Peles Bortz A, Kostistky H, Bar Noy D, Filshtinsky V, Theilla M. Mental Health Nurse's Exposure to Workplace Violence Leads to Job Stress, Which Leads to Reduced Professional Quality of Life. Front Psychiatry 2018; 9:59. [PMID: 29535652 PMCID: PMC5835109 DOI: 10.3389/fpsyt.2018.00059] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Professional quality of life (ProQOL) reflects how individuals feel about their work as helpers. Psychiatric ward nurses cope with significant psychological and physical challenges, including exposure to verbal and physical violence. This study was based on two aspects of ProQOL, the positive compassion satisfaction, and the negative compassion fatigue, with the aim of investigating the relation of ProQOL to job stress and violence exposure at a large mental health center. Data were collected from 114 mental health nurses (49/63 M/F) who completed a self-administered questionnaire examining violence exposure, ProQOL, and job stress. The results showed that during the last year, almost all nurses (88.6%) experienced verbal violence, and more than half (56.1%) experienced physical violence. Only 2.6% experienced no violence. ProQOL was not associated with violence exposure but was reduced by work stress and by previous exposure to violence; nurses who perceived their work as more stressful had lower satisfaction from their work. In conclusion, although most mental health nurses are exposed to physical and verbal violence, their ProQOL is more related to job stress than to workplace violence (WPV). Hospital managements should conduct work stress reduction intervention programs and promote strategizes to reduce WPV. Further exploration of (a) factors affecting ProQOL and (b) the effect of violence coping workshops on ProQOL is warranted.
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Affiliation(s)
- Michal Itzhaki
- Nursing Department, School of Health Professions, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irit Bluvstein
- Nursing Department, School of Health Professions, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Dor Bar Noy
- Sha'ar Menashe Mental Health Center, Emeq Hefer, Israel
| | | | - Miriam Theilla
- Nursing Department, School of Health Professions, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Zusman O, Kagan I, Theilla M, Bendavid I, Cohen J, Singer P. MON-P013: Early Administration of Protein in Critically Ill Patients Improves Survival: A Large Retrospective Cohort Study. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31070-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wouters Y, Theilla M, Singer P, Tribler S, Jeppesen P, Pironi L, Vinter-Jensen L, Rasmussen H, Rahman F, Wanten G. OR32: Taurolidine Locking Prevents Catheter-Related Bloodstream Infections in Patients on Home Parenteral Nutrition – a Randomized Controlled Trial. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30755-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hellerman M, Sabatino A, Theilla M, Kagan I, Fiaccadori E, Singer P. MON-P008: Substrate Utilization and Administration in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Study. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zusman O, Kagan I, Theilla M, Bendavid I, Cohen J, Singer P. MON-P012: Validation of Predictive Equations to Estimate Resting Energy Expenditure in Critically Ill Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singer P, Cohen Fox L, Aperstein Y, Cohen J, Theilla M, Kagan I. OR60: Gastrointestinal Organ Failure Symptoms Included in Sofa Scores Improve Mortality Prediction in the ICU: A Mathematical Approach. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kagan I, Kremer S, Theilla M, Bendavid I, Singer P, Cohen J. OR63: Effect of Combined Protein Enriched Enteral Feeding and Early Cycle Ergometry in Mechanically Ventilated Critically Ill Patients: A Prospective, Randomized, Comparative, Single-Blind Controlled Study. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sabatino A, Theilla M, Hellerman M, Singer P, Maggiore U, Delsante M, Gandolfini I, Regolisti G, Fiaccadori E. SO041ENERGY AND PROTEIN NEEDS AND NUTRITIONAL ADEQUACY IN CRITICALLY ILL PATIENTS WITH AKI. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Theilla M, Kagan I, Chernov K, Cohen J, Kagan I, Singer P. Self-Evaluation of Quality of Life Among Patients Receiving Home Parenteral Nutrition: A Validation Study. JPEN J Parenter Enteral Nutr 2017; 42:516-521. [DOI: 10.1177/0148607117704812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/23/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of Nursing, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Ilya Kagan
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of Nursing, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Karina Chernov
- Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Cohen
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Pironi L, Konrad D, Brandt C, Joly F, Wanten G, Agostini F, Chambrier C, Aimasso U, Zeraschi S, Kelly D, Szczepanek K, Jukes A, Di Caro S, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Wu J, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Pagano MC, Hughes SJ, Guglielmi FW, Kozjek NR, Schneider SM, Gillanders L, Ellegard L, Thibault R, Matras P, Zmarzly A, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Sahin P, Jones L, Lee ADW, Bertasi V, Orlandoni P, Izbéki F, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui EP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Shaffer J, Lal S. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr 2017; 37:728-738. [PMID: 28483328 DOI: 10.1016/j.clnu.2017.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Denise Konrad
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Federica Agostini
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | | | - Sarah Zeraschi
- Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | | | | | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | | | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jian Wu
- Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Sarah-Jane Hughes
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Lyn Gillanders
- National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anna Zmarzly
- Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospital, Coventry, United Kingdom
| | - Marina Taus
- Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy
| | - Nuria M Virgili
- Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D W Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Marta Bueno Díez
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Carmen Garde
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Theilla M, Cohen J, Kagan I, Attal-Singer J, Lev S, Singer P. Home parenteral nutrition for advanced cancer patients: Contributes to survival? Nutrition 2017; 54:197-200. [PMID: 28571682 DOI: 10.1016/j.nut.2017.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. METHODS All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. RESULTS Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. CONCLUSION These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Cohen
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ilia Kagan
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Joelle Attal-Singer
- Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Institute of Endocrinology, Diabetes Services, Sackler School of Medicine, Tel Aviv University, Israel
| | - Shaul Lev
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel
| | - Pierre Singer
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
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Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care 2016; 20:367. [PMID: 27832823 PMCID: PMC5105237 DOI: 10.1186/s13054-016-1538-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023]
Abstract
Background Intense debate exists regarding the optimal energy and protein intake for intensive care unit (ICU) patients. However, most studies use predictive equations, demonstrated to be inaccurate to target energy intake. We sought to examine the outcome of a large cohort of ICU patients in relation to the percent of administered calories divided by resting energy expenditure (% AdCal/REE) obtained by indirect calorimetry (IC) and to protein intake. Methods Included patients were hospitalized from 2003 to 2015 at a 16-bed ICU at a university affiliated, tertiary care hospital, and had IC measurement to assess caloric targets. Data were drawn from a computerized system and included the % AdCal/REE and protein intake and other variables. A Cox proportional hazards model for 60-day mortality was used, with the % AdCal/REE modeled to accommodate non-linearity. Length of stay (LOS) and length of ventilation (LOV) were also assessed. Results A total of 1171 patients were included. The % AdCal/REE had a significant non-linear (p < 0.01) association with mortality after adjusting for other variables (p < 0.01). Increasing the percentage from zero to 70 % resulted in a hazard ratio (HR) of 0.98 (CI 0.97–0.99) pointing to reduced mortality, while increases above 70 % suggested an increase in mortality with a HR of 1.01 (CI 1.01–1.02). Increasing protein intake was also associated with decreased mortality (HR 0.99, CI 0.98–0.99, p = 0.02). An AdCal/REE >70 % was associated with an increased LOS and LOV. Conclusions The findings of this study suggest that both underfeeding and overfeeding appear to be harmful to critically ill patients, such that achieving an Adcal/REE of 70 % had a survival advantage. A higher caloric intake may also be associated with harm in the form of increased LOS and LOV. The optimal way to define caloric goals therefore requires an exact estimate, which is ideally performed using indirect calorimetry. These findings may provide a basis for future randomized controlled trials comparing specific nutritional regimens based on indirect calorimetry measurements.
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Affiliation(s)
- Oren Zusman
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Cohen
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Theilla M, Kagan I, Chernov K, Cohen J, Singer P. MON-P089: Self-Quality of Life Evaluation in Home Parenteral Nutrition (HPN) Patients: Avalidation Study. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bendavid I, Singer P, Theilla M, Themessl-Huber M, Sulz I, Mouhieddine M, Schuh C, Mora B, Hiesmayr M. NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr 2016; 36:1122-1129. [PMID: 27637833 DOI: 10.1016/j.clnu.2016.07.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/16/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION To determine the nutrition practice in intensive care units and the associated outcome across the world, a yearly 1 day cross sectional audit was performed from 2007 to 2013. The data of this initiative called "nutritionDay ICU" were analyzed. MATERIAL AND METHODS A questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the 1 day prevalence study were included from 2007 to 2013. RESULTS 9777 patients from 46 countries and 880 units were included. Their SAPS 2 was median 38 (IQR 27-51), predicted mortality was 30.7% ± 26.9, and their SOFA score 4.5 ± 3.4 with median 4 (IQR 2-7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI <18.5 or >40 received slightly less calories than all other BMI groups. Two third of the patients were either ventilated or were in the ICU for longer than 24 h at nutritionDay. Routes of feeding used were the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1286 ± 663 kcal/day and using parenteral nutrition 1440 ± 652 kcal/day. 60 days mortality was 26.0%. DISCUSSION This very large collaborative cohort study shows that most of the patients are underfed during according to actual recommendations their ICU stay. Prescribed calories appear to be ordered regardless to the ideal weight of the patient. Nutritional support is slow to start and never reaches the recommended targets. Parenteral nutrition prescription is increasing during the ICU stay but reaching only 20% of the population studied if ICU stay is one week or longer. The nutritional support worldwide does not seem to be guided by weight or disease but more to be standardized and limited to a certain level of calories. These observations are showing the poor observance to guidelines.
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Affiliation(s)
- Itai Bendavid
- Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital and Sackler School of Medicine, Tel Aviv University, 49100, Israel
| | - Pierre Singer
- Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital and Sackler School of Medicine, Tel Aviv University, 49100, Israel.
| | - Miriam Theilla
- Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital and Sackler School of Medicine, Tel Aviv University, 49100, Israel
| | - Michael Themessl-Huber
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, 1090 Vienna, Austria
| | - Isabella Sulz
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, 1090 Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiac Thoracic Vascular Anaesthesia & Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria
| | - Christian Schuh
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, 1090 Vienna, Austria
| | - Bruno Mora
- Division of Cardiac Thoracic Vascular Anaesthesia & Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria
| | - Michael Hiesmayr
- Division of Cardiac Thoracic Vascular Anaesthesia & Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria
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Kagan I, Theilla M, Singer P. Is Total Parenteral Nutrition (TPN) an Evil in Trauma Patients? Curr Trauma Rep 2016. [DOI: 10.1007/s40719-016-0041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
PURPOSE OF REVIEW This article describes recent findings regarding lipid metabolism in critical illness as well as in lipid therapy. RECENT FINDINGS In critical illness, in the presence of a decrease in lipid absorption, adipose tissue lipolysis raises triglyceride levels. High-density lipoprotein and low-density lipoprotein are decreased because of impairment of lecithin-cholesterol acyltransferase, mainly in sepsis. In septic patients, lipid profile may be a predictor of survival. Nonsurvivors have lower levels of high-density lipoprotein and low-density lipoprotein. In metabolomic studies, most of the changes from baseline in septic patients were related to lipid metabolism. Lysophosphatidylcholine was also significantly lower in nonsurviving septic patients. SUMMARY Lipid profile results are too often neglected by the clinician despite increasing knowledge in the modifications related to septic state as well as the importance of these values in the prognosis of the critically ill. Lipid administration (enterally or parenterally) should be guided by better knowledge of the lipid metabolism of the patient.
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Affiliation(s)
- Pnina Green
- aFelsenstein Medical Research Center, Metabolic Laboratory bNursing Department, Steyer School of Health Professions cGeneral intensive Care Department, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
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Theilla M, Ławiński M, Cohen J, Hadar E, Kagan I, Perkewick M, Singer P. Safety of home parenteral nutrition during pregnancy. Clin Nutr 2015; 36:288-292. [PMID: 26708728 DOI: 10.1016/j.clnu.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Few studies have examined the effect of total parenteral nutrition which is lipid-based given throughout pregnancy to patients unable to obtain adequate nutrition by the oral route. In this study we examined the use of lipid-based home parenteral nutrition (HPN) in 7 pregnant women, commenced either before or during pregnancy, and their intra-pregnant course as well as a 2-year follow-up of their offspring is described. METHODS HPN was formulated on an individual basis and protein administered in a dose of 0.8-1.1 g/kg during the three trimesters. Lipid emulsions included long chain triglycerides or olive-oil based formulae and all patients received trace elements. Data were collected during the course of pregnancy and at birth while infants were followed for a period of between 6 months and 2 years using medical records and questionnaires. RESULTS In total, we studied 9 pregnancies (in 7 women). HPN was administered for a median of 9 months (range 3-9 months). The mean energy provided during the 1st, 2nd and 3rd trimester was 9297 ± 2797 kcal/week, 9148 ± 2629 kcal/week and 8564 ± 4059 kcal/week resp. The mean increase in weight during the pregnancy was 9 ± 5 Kg. The only complications noted during the pregnancy consisted of 3 episodes of catheter-related infections which were successfully treated by antibiotics. The infants were born after a mean of 38.00 ± 1.55 weeks of gestation, with a mean first minute Apgar score of 8.7 ± 1.8 which increased to 9.8 ± 0.4 after 10 min. The mean infant birth weight was 2.45 ± 0.37 kg. No complications were noted at birth apart from one infant who suffered from torticollis which resolved spontaneously. During follow up, a decrease in hemoglobin related to low iron levels was noted in 1 infant, 2 infants were noted to be allergic to pollen and one underwent a scrotal hernia reduction. No developmental problems have been observed, neither physiological nor psychomotor, over the 2-year follow-up period. CONCLUSIONS The authors suggest, based on, the current study, that lipid-based HPN for pregnant women is a safe method for meeting the nutritional demands of both mother and fetus, and may be administered throughout the pregnancy.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Michał Ławiński
- Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Poland
| | - Jonathan Cohen
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Eran Hadar
- Department of Maternal Fetal Medicine Unit, Helen Shneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Marek Perkewick
- Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Poland
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
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Theilla M, Kagan I, Lev S, Singer P. SUN-PP171: A Seven-Years Follow-Up of Patients Who Receive Home Parenteral Nutrition - the Survival Rate of Cancer Patients in a Single Center. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kagan I, Cohen J, Ben David I, Theilla M, Silva V, Grinev M, Singer P. SUN-PP053: More is not Always Better. Influence of Caloric and Protein Intake on Morbidity in Multiple Trauma Ventilated Patients: A Secondary Analysis. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Theilla M, Grinev M, Kosak S, Hiesmayr M, Singer P. Fight against malnutrition: The results of a 2006-2012 prospective national and global nutritionDay survey. Clin Nutr ESPEN 2015; 10:e77-e82. [PMID: 28531463 DOI: 10.1016/j.clnesp.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The nutritionDay (nD) initiative has been promoted by the European Society for Clinical Nutrition and Metabolism (ESPEN) to assess and audit the nutritional status of hospitalized patients, as well as to promote awareness. Israel has been participating annually in this project since 2006. OBJECTIVES To evaluate the proportion of malnourished patients in Israel in comparison with the rest of the world. METHODS Data were collected by staff members and the hospitalization outcomes were followed up at day 30. The data were analyzed by the Vienna coordinating center, using "my SQL" (Structured Query Language), an open source relational database management system and analyzed, using SAS (Statistical Analysis System) version 9.2. RESULTS In Israel, 2303 patients (in 114 various medical specialty units) were included in the study during a 7-year survey, while 4316 units recruited 91,351 patients in the world (W), between 2006 and 2012, The median age of patients was 68 years, with 44% of females and BMI of 27 ± 6 (25 in W). Israel had a higher proportion of nutrition care teams per patient (in 88% of the units) than W (71%) (p < 0.05). 43% of the patients had a weight loss within the last 3 months prior to admission (same for W); 36.7% described a decrease in eating more than 50% of their normal food intake (21.3% in W). Food intake at nD showed that 51.4% of the patients ate half to nothing of the served meal (56.2% in W). In Israel, more patients received hospital modified diets (13% vs. 8.2% in W), but less supplements (5.7% vs. 8.3% in W) or enteral/parenteral nutrition (9.0% vs. 13.5% in W, p < 0.05). Length of hospital stay was shorter in Israel (11 days vs. 14 days in W, p < 0.05) and mortality was similar (3.9% vs. 3.8% in W). CONCLUSION Malnutrition of hospitalized patients in Israel was found comparable to the rest of the world. However, in Israel in spite of the higher nutrition staff member/patient ratio there was no increase in the administration of supplements or artificial nutrition to malnourished patients in the surveyed units. Also, the length of hospital stay was shorter and was not associated with an increase in mortality.
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Affiliation(s)
- M Theilla
- Institute for Nutrition Research, Critical Care Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - M Grinev
- Institute for Nutrition Research, Critical Care Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - S Kosak
- nutritionDay, Hoefergasse 13/5, 1090 Vienna, Austria(1)
| | - M Hiesmayr
- nutritionDay, Hoefergasse 13/5, 1090 Vienna, Austria(1)
| | - P Singer
- Institute for Nutrition Research, Critical Care Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
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Theilla M, Grinev M, Kosak S, Hiesmayr M, Singer P. PP190-MON: Nutrition Day in Israel: Accumulated Data from 2006 to 2012. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Theilla M, Kagan I, Lev S, Singer J, Singer P. PP005-MON: Supplemental Enteral EPA and GLA are not Improving Insulin Sensitivity in Severely Trauma Ventilated Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kagan I, Lev S, Grinev M, Theilla M, Cohen J, Stein M, Silva V, Singer P. PP041-SUN: Supplemental Epa and Gla in Multiple Trauma Patients: A Prospective Randomized Blinded Study. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lupinsky L, Singer P, Theilla M, Grinev M, Hirsh R, Lev S, Kagan I, Attal-Singer J. Comparison between two metabolic monitors in the measurement of resting energy expenditure and oxygen consumption in diabetic and non-diabetic ambulatory and hospitalized patients. Nutrition 2014; 31:176-9. [PMID: 25466663 DOI: 10.1016/j.nut.2014.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/11/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess the validity and reliability of the Fitmate metabolic system in measuring the oxygen consumption and resting metabolic rate (RMR) in ambulatory and hospitalized patients. METHODS We conducted a prospective simultaneous clinical comparison. We enrolled 37 patients (19 women and 18 men) for the four groups of the study. Group 1 (n = 12) included patients receiving home parenteral nutrition. Group 2 (n = 5) included diabetic overweight outpatients with body mass index >30 kg/m(2) and hemoglobin A1c > 8 g/dL. Group 3 (n = 10) included hospitalized patients receiving artificial nutrition. Group 4 (n = 10) included patients with congenital heart disease, pulmonary hypertension of any etiology, and other heart disease who have had hemodynamic evaluation during catheterization by the adult congenital team. The patients were tested successively during the same session using the Fitmate metabolic system for 15 min and the Deltatrac II metabolic monitor for 20 min, measuring resting energy expenditure and oxygen consumption. The test was conducted in random order. RESULTS No significant differences were found between Fit Mate and Deltatrac II for oxygen consumption (238 ± 18 and 240 ± 18 mL/min, respectively, P = 0.72, r = 0.86, mean ± SD absolute difference 22.32 ± 16.99 mL/min) or RMR (1659 ± 122.34 and 1625 ± 118.4 kcal/d, P = 0.28, r = 0.87, mean ± SD absolute difference 152.9 ± 111.95 kcal/d). A degree of limit of agreement (403 kcal) was observed using the Bland-Altman test. When compared with Harris-Benedict predictive equations, Fitmate was found to be superior in accuracy. CONCLUSIONS These data indicate that the Fitmate using a mask provided a fair evaluation of REE despite a large limit of agreement. It remains a reliable and valid system for measuring oxygen consumption and RMR in nonventilated patients.
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Affiliation(s)
- Liad Lupinsky
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel.
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Milana Grinev
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Raphael Hirsh
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Shaul Lev
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
| | - Joelle Attal-Singer
- Institute of Endocrinology, Diabetes Services, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Tel-Aviv, Israel
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Theilla M, Chernov K, Cohen R, Kagan I, Frishman S, Liebman C, Singer P. PP151-MON NURSE INVOLVEMENT IN THE NUTRITIONAL SCREENING. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Theilla M, Kagan I, Cohen R, Liebman C, Frishman S, Avraham T, Singer P. PP256-MON JCI ACCREDITATION PROCESS AND ITS IMPACT ON NUTRITION MULTI-PROFESSIONAL CARE IN RABIN MEDICAL CENTER, ISRAEL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Theilla M, Kagan I, Lev S, Cohen J, Anbar R, Singer P. PP070-MON LIVER DYSFUNCTION IN CANCER AND NON CANCER HOME PARENTERAL NUTRITION PATIENTS: A RETROSPECTIVE STUDY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Theilla M, Kagan I, Lev S, Stein M, Anbar R, Grunev M, Singer P. PP029-SUN A DIET ENRICHED IN EPA, GLA AND ANTIOXIDANTS IS SAFE AND DECREASES VAP IN SEVERE MULTIPLE TRAUMA PATIENTS. A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60075-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Anbar R, Theilla M, Kagan I, Lev S, Lupinski L, Grunev M, Singer P. PP020-SUN DAY BY DAY VARIABILITY OF RESTING ENERGY EXPENDITURE (REE) IN MULTIPLE TRAUMA PATIENTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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