The Optimal Lipid Formulation in Enteral Feeding in Critical Illness: Clinical Update and Review of the Literature

Munroe, Craig A.; Frantz, David J.; Martindale, Robert G.; McClave, Stephen A.

doi:10.1007/s11894-011-0203-y

Cited by 10 publications

(3 citation statements)

References 42 publications

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“…Witnessing nutrition in patient care in the mentor's practice allows real‐time application of the concepts learned. By the end of the course, the learners are critically evaluating the current literature and making contributions with their own summative papers and original studies 11 – 16 …”

Section: Lessons Learnedmentioning

confidence: 99%

Physician Nutrition Education

et al. 2014

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Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification.

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Section: Lessons Learnedmentioning

confidence: 99%

Physician Nutrition Education

et al. 2014

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“…Consumption of Supportan in the intensive care setting accounted for 37.9% of total consumption by all wards, which may reflect the beneficial effects of omega-3 fatty acids in critically ill patients, ie, a reduced incidence of complications and shorter hospitalization times 10. However, more research is needed before definitive recommendations can be made concerning the routine use of omega-3 fatty acids in critically ill patients 11.…”

Section: Discussionmentioning

confidence: 99%

Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital

Xiao¹,

Zhu²,

Zhou³

2013

TCRM

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BackgroundA retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teaching hospital.MethodsEnteral nutrition was divided into three types according to the nitrogen source, ie, total protein type [Nutrison Fibre®, Fresubin Energy Fibre®, Fresubin®, Supportan® (a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids), Fresubin Diabetes® (a diabetes-specific formula), Ensure®]; short peptide type (Peptison®); and amino acid type (Vivonex®). A pharmacoeconomic analysis was done based on defined daily dose methodology.ResultsAmong hospitalized patients taking enteral nutrition, 34.8% received enteral nutrition alone, 30% concomitantly received parenteral nutrition, and 35.2% received enteral nutrition after parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving enteral nutrition. In total, 61.5% of patients received triple therapy with Nutrison Fibre, Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs) of formulas in descending order were as follows: Nutrison Fibre, Fresubin Energy Fibre, Fresubin Diabetes > Supportan > Peptison, Ensure > Vivonex, Fresubin. The ratio of the cumulative DDDs for the three types of enteral nutrition was 35:2.8:1 (total protein type to short peptide type to amino acid type). Off-label use of Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress hyperglycemia. Only 2.1% of cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike enteral nutrition formulas, and one adverse drug reaction in an elderly malnourished patient who did not receive vitamin K1-enriched enteral nutrition during treatment with cefoperazone. After 4 months of the trial intervention, off-label use of Fresubin Diabetes was no longer endorsed by the Drug and Therapeutics Committee for nondiabetic patients, and the proportion of this formula prescribed for patients with stress hyperglycemia decreased by 20%, with a 10-fold increase in the amount of Supportan prescribed for cancer patients. Near misses in dispensing look-alike or sound-alike enteral nutrition were successfully abolished, and no severe coagulation disorders occurred after prophylactic administration of vitamin K1-enriched enteral nutrition in elderly malnourished patients receiving cefoperazone.ConclusionThis utilization study indicates that continuous quality improvement is necessary and that a Drug and Therapeutics Committee can play an important role in promoting rational and safe use of enteral nutrition. Appropriateness of this therapy still needs to be improved, especially in addressing the issues of non-evidence-based combined use of multiple enteral nutrition formulas, the relatively high rate of concomitant use of enteral and parenteral nutrition, off-label use of diabetes-specific Fresubin Diabetes, in...

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“…Although this has not been shown definitively in hernia surgery, it has been well shown for major visceral surgical procedures. 26 In patients undergoing emergent or urgent AWR secondary to obstruction or infection who are preoperatively malnourished, these benefits of attention to nutrition are even greater. 27 Whether a benefit from nutrition therapy is realized depends on factors such as route and timing of delivery, content of nutrient substrate, and efforts to promote patient mobility.…”

Section: Nutrition and Metabolic Controlmentioning

confidence: 99%