Scholars@Duke
Paul Edmund Wischmeyer

Paul Edmund Wischmeyer

Professor of Anesthesiology
Anesthesiology, Critical Care Medicine

Selected Publications

Relation of Malnutrition on Septic Older Adults in Emergency Gastrointestinal Surgery: A Modified Global Leadership Initiative on Malnutrition Analysis.

Journal Article J Surg Res · July 2025 INTRODUCTION: Malnutrition in older adults has significant ramifications for surgical outcomes. The incidence of malnutrition is up to 30% in emergent gastrointestinal surgery (EGS). This study aims to investigate malnutrition's correlation on outcomes of ... Full text Link to item Cite

Skeletal Muscle: A Critical Organ for Survival and Recovery in Critical Illness.

Journal Article Crit Care Clin · April 2025 The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. Atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of disease and is exacerbated by aging. T ... Full text Link to item Cite

Novel Strategies to Promote Intensive Care Unit Recovery via Personalized Exercise, Nutrition, and Anabolic Interventions.

Journal Article Crit Care Clin · April 2025 Survivors of critical illness experience significant morbidity, reduced physiologic reserve, and long-term complications that negatively impact quality of life. Although rehabilitative treatments are beneficial during early recovery, there is limited evide ... Full text Link to item Cite

Nutrition in Critical Care-Where Are We Now?

Journal Article Crit Care Clin · April 2025 Full text Link to item Cite

Recent Insights into the Evolving Role of the Gut Microbiome in Critical Care.

Journal Article Crit Care Clin · April 2025 This review explores the evolving understanding of gut microbiota's role in critical illness, focusing on how acute illness and exposures in intensive care unit (ICU) environment negatively impact the gut microbiota and the implications of these changes on ... Full text Link to item Cite

Measured resting energy expenditure in cardiothoracic surgery patients and changes throughout hospitalization: A descriptive cohort study.

Journal Article Clin Nutr ESPEN · April 2025 BACKGROUND & AIMS: There is a general paucity of data on energy needs during critical illness and the subsequent hospital course, particularly in cardiothoracic surgical patients. We measured resting energy expenditure (mREE) via indirect calorimetry on pa ... Full text Link to item Cite

Lipids in parenteral nutrition – expert consensus statements: Translating guidelines into clinical practice

Journal Article Clinical Nutrition Open Science · April 1, 2025 Lipids are integral to parenteral nutrition (PN) in all settings where PN is required, serving as a source of energy and essential fatty acids. In addition, lipids modulate a variety of biological functions, including inflammatory and immune responses. Mor ... Full text Cite

Does enteral nutrition protect against stress ulceration in the critically ill?

Journal Article Curr Opin Clin Nutr Metab Care · March 1, 2025 PURPOSE OF REVIEW: Critically ill patients are at risk of gastrointestinal bleeding (GIB) due to stress ulceration. Strategies to reduce the risk include administration of prophylactic ulcer healing medications. Enteral nutrition (EN) may be favourably ass ... Full text Link to item Cite

Age-Related Vulnerability to Malnutrition-Related Mortality: Younger Patients are at Risk.

Journal Article J Surg Res · February 2025 INTRODUCTION: Malnutrition among older adults continues to be a prevalent health concern. While literature has highlighted an increased risk of malnutrition mortality for adults older than 65 y, the age threshold at which malnutrition effects survival and ... Full text Link to item Cite

Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective.

Journal Article Adv Nutr · January 2025 Malnutrition is a well-studied and significant prognostic risk factor for morbidity and mortality in critically ill perioperative patients. Common nutrition myths in the critically ill may prevent early, consistent, and adequate delivery of enteral nutriti ... Full text Link to item Cite

Nutritional Optimization of the Surgical Patient: A Narrative Review.

Journal Article Adv Nutr · January 2025 An increasing body of literature supports the clinical benefit of nutritional assessment and optimization in surgical patients; however, this data has yet to be consolidated in a practical fashion for use by surgeons. In this narrative review, we concisely ... Full text Link to item Cite

Parenteral nutritional support in surgical patients: expert consensus statements regarding intravenous lipid emulsions containing omega-3 fatty acids.

Journal Article Front Nutr · 2025 OBJECTIVES: The International Lipids in Parenteral Nutrition (PN) Summit was convened to offer practical guidance and expert consensus opinion regarding the use of intravenous lipid emulsions (ILEs) in various clinical settings. Herein, we briefly review a ... Full text Link to item Cite

Enteral and Parenteral Nutrition Timing in eICU Collaborative Research Database by Race: A Retrospective Observational Study.

Journal Article J Surg Res · December 2024 INTRODUCTION: Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing ... Full text Link to item Cite

Addressing the Urgent Need for Clinical Nutrition Education in PostGraduate Medical Training: New Programs and Credentialing.

Journal Article Adv Nutr · November 2024 The importance of nutrition in the development of disease, and in the recovery from illness, is among the most fundamental tenets in human biology and optimal health. Nutrition was fundamental in many traditional forms of medicine until its role in medical ... Full text Link to item Cite

Association between protein intake and functional capacity in critically ill patients: A retrospective cohort study.

Journal Article JPEN J Parenter Enteral Nutr · October 2024 BACKGROUND: Intensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured ... Full text Link to item Cite

How to interpret and apply the results of indirect calorimetry studies: A case-based tutorial.

Journal Article Clin Nutr ESPEN · October 2024 Evidence is growing that the individual adjustment of energy targets guided by indirect calorimetry (IC) can improve outcome. With the development of a new generation of devices that are easier to use and rapid, it appears important to share knowledge and ... Full text Link to item Cite

Predictive Energy Equations Inaccurately Estimate Metabolic Demands of Older Adult Trauma Patients.

Journal Article J Surg Res · October 2024 INTRODUCTION: Suboptimal nutrition promotes unfavorable outcomes in trauma patients, particularly among those aged 60 and over. While many institutions employ predictive energy equations to determine patients' energy requirements, mounting evidence shows t ... Full text Link to item Cite

Ketamine analgo-sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine.

Journal Article Acta Anaesthesiol Scand · October 2024 BACKGROUND: This Rapid Practice Guideline (RPG) aimed to provide evidence-based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mecha ... Full text Link to item Cite

Disparities and Differential Allocation of Nutritional Therapies

Journal Article Current Surgery Reports · September 1, 2024 Purpose of Review: Disparities in malnutrition often exist prior to hospitalization or illness. These disparities may compound unjust negative health outcomes. This review discusses disparities seen in those diagnosed with malnutrition as well as describes ... Full text Cite

Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults: A Rapid Practice Guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine.

Journal Article Anesth Analg · August 29, 2024 BACKGROUND: This Rapid Practice Guideline (RPG) aimed to provide evidence‑based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mecha ... Full text Link to item Cite

Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)-A Pilot Study.

Journal Article Nutrients · August 20, 2024 Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment ... Full text Link to item Cite

The role of lipid emulsions containing omega-3 fatty acids for medical and surgical critical care patients.

Journal Article Crit Care · August 12, 2024 In critical illness the regulation of inflammation and oxidative stress can improve patient outcomes, and thus omega-3 polyunsaturated fatty acids (PUFAs) have been used as part of parenteral nutrition (PN) owing to their potential anti-inflammatory effect ... Full text Link to item Cite

Feasibility of a Novel Augmented 6-Minute Incremental Step Test: A Simplified Cardiorespiratory Fitness Assessment Tool.

Journal Article JACC Adv · August 2024 BACKGROUND: The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing cardiorespiratory fitness (CRF) but has limited accessibility due to competency requirements and cost. Incorporating portable sensor devices into a simple bedsi ... Full text Link to item Cite

Society of Critical Care Medicine and American Society of Health-System Pharmacists Guideline for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults.

Journal Article Crit Care Med · August 1, 2024 RATIONALE: Critically ill adults can develop stress-related mucosal damage from gastrointestinal hypoperfusion and reperfusion injury, predisposing them to clinically important stress-related upper gastrointestinal bleeding (UGIB). OBJECTIVES: The objectiv ... Full text Link to item Cite

Safety and quality of parenteral nutrition: Areas for improvement and future perspectives.

Journal Article Am J Health Syst Pharm · June 13, 2024 PURPOSE: This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit (held November 8-10, 2021, at Charleston, SC, and Bad Homburg, Germany) and aims to raise awareness concerning ... Full text Link to item Cite

Parenteral nutrition in clinical practice: International challenges and strategies.

Journal Article Am J Health Syst Pharm · June 13, 2024 PURPOSE: Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over ... Full text Link to item Cite

Expert consensus statements and summary of proceedings from the International Safety and Quality of Parenteral Nutrition Summit.

Journal Article Am J Health Syst Pharm · June 13, 2024 PURPOSE: The International Safety and Quality of Parenteral Nutrition (PN) Summit consisted of presentations, discussions, and formulation of consensus statements. The purpose here is to briefly summarize the summit and to present the consensus statements. ... Full text Link to item Cite

Parenteral nutrition in the hospital setting/short-term parenteral nutrition.

Journal Article Am J Health Syst Pharm · June 13, 2024 PURPOSE: This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit concerning the acute care setting. Some European practices presented in this article do not conform with USP ge ... Full text Link to item Cite

Racial and ethnic demographics in malnutrition related deaths.

Journal Article Clin Nutr ESPEN · April 2024 BACKGROUND AND AIMS: Currently, 40 million Americans are food insecure. They are forced to skip meals and buy non-nutritious food, leading to health disparities for those of low socioeconomic status. This study aims to investigate relationships between mal ... Full text Link to item Cite

The Use of Parenteral Nutrition and Disparities in Its Allocation Following Traumatic Injury.

Journal Article J Surg Res · January 2024 INTRODUCTION: Severe traumatic injury requires rapid and extensive deployment of resources to save the lives of the critically injured. The sequelae of traumatic injuries frequently require extensive intervention obligating patients to a complicated recove ... Full text Link to item Cite

Efficacy of probiotic treatment as post-exposure prophylaxis for COVID-19: A double-blind, Placebo-Controlled Randomized trial.

Journal Article Clin Nutr · January 2024 BACKGROUND & AIMS: The COVID-19 pandemic continues to pose unprecedented challenges to worldwide health. While vaccines are effective, additional strategies to mitigate the spread/severity of COVID-19 continue to be needed. Emerging evidence suggests susce ... Full text Link to item Cite

Prognostic significance of muscle fasciculations in critically Ill COVID-19 patients under mechanical ventilation

Journal Article Frontiers in Anesthesiology · January 1, 2024 Introduction: The COVID-19 pandemic brought unprecedented challenges to healthcare systems worldwide, particularly the often challenging physical recovery from critical illness. Among the myriad complications faced by these patients, ICU-acquired weakness ... Full text Cite

A novel ultrasound approach in assessing IMAT in critically ill patients

Journal Article Frontiers in Anesthesiology · January 1, 2024 Background: Muscle wasting is a common finding in critically ill patients associated with increased days of mechanical ventilation in the ICU. Muscle wasting and associated morphological changes are hallmarks of ICU-acquired weakness. Muscle wasting can be ... Full text Cite

A systematic review and meta-analysis of the clinimetric properties of the core outcome measurement instruments for clinical effectiveness trials of nutritional and metabolic interventions in critical illness (CONCISE).

Journal Article Crit Care · November 20, 2023 BACKGROUND: CONCISE is an internationally agreed minimum set of outcomes for use in nutritional and metabolic clinical research in critically ill adults. Clinicians and researchers need to be aware of the clinimetric properties of these instruments and und ... Full text Link to item Cite

Incidence and risk factors for postoperative gastrointestinal dysfunction occurrence after gastrointestinal procedures in US patients.

Journal Article Am J Surg · November 2023 BACKGROUND: Incidence of, and potential risk factors for, postoperative gastrointestinal dysfunction (POGD) after gastrointestinal procedures performed in US hospitals were examined. METHODS: This retrospective study used hospital discharge data of inpatie ... Full text Link to item Cite

Preprocedural fasting policies for patients receiving tube feeding: A national survey.

Journal Article JPEN J Parenter Enteral Nutr · November 2023 BACKGROUND: Patients who are critically ill frequently accrue substantial nutrition deficits due to multiple episodes of prolonged fasting prior to procedures. Existing literature suggests that, for most patients receiving tube feeding, the aspiration risk ... Full text Link to item Cite

Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients.

Journal Article Clin Nutr ESPEN · October 2023 BACKGROUND AND AIMS: Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and ... Full text Link to item Cite

Change to Mixed-Lipid Emulsion From Soybean Oil-Based Lipid Emulsion in Pediatric Patients.

Journal Article JAMA Netw Open · September 5, 2023 IMPORTANCE: Critically ill pediatric patients often require parenteral nutrition (PN) in the intensive care unit (ICU). Literature suggests mixed lipid emulsions (LE) with soybean oil reduction strategies may improve outcomes. OBJECTIVE: To examine the ass ... Full text Open Access Link to item Cite

Controlled enteral nutrition in critical care patients - A randomized clinical trial of a novel management system.

Journal Article Clin Nutr · September 2023 PURPOSE: Nutritional therapy is essential to ICU care. Successful early enteral feeding is hindered by lack of protocols, gastrointestinal intolerance and feeding interruptions, leading to impaired nutritional intake. smART+ was developed as a nutrition ma ... Full text Link to item Cite

Lipid emulsions in parenteral nutrition: does it matter?

Journal Article Curr Opin Crit Care · August 1, 2023 PURPOSE OF REVIEW: Recently, clinicians have shown interest in switching patients to nonsoybean-based intravenous lipid emulsion (ILE) formulas for parental nutrition (PN) due to adverse outcomes related to high Omega-6 content in soybean oil (SO) ILE's. T ... Full text Open Access Link to item Cite

Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia-A Randomized Controlled Trial.

Journal Article J Clin Med · July 28, 2023 BACKGROUND: Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare ... Full text Link to item Cite

Personalized nutrition therapy in critical care: 10 expert recommendations.

Journal Article Crit Care · July 4, 2023 Personalization of ICU nutrition is essential to future of critical care. Recommendations from American/European guidelines and practice suggestions incorporating recent literature are presented. Low-dose enteral nutrition (EN) or parenteral nutrition (PN) ... Full text Open Access Link to item Cite

Effects of glutamine and n-3 polyunsaturated fatty acid mixed lipid emulsion supplementation of parenteral nutrition on sepsis score and bacterial clearance in early experimental sepsis.

Journal Article Clin Nutr ESPEN · April 2023 INTRODUCTION: Glutamine (GLN) and n-3 polyunsaturated fatty acids (n-3PUFAs) have been shown to potentially possess immune-modulating and disease-modifying properties in experimental and clinical critical illness when given with parenteral nutrition (PN). ... Full text Link to item Cite

Nutrition for the high-risk surgical patient, when they need it most: Question and answer session.

Journal Article JPEN J Parenter Enteral Nutr · February 2023 Patients requiring complex or extensive surgery are often at high risk for perioperative and postoperative nutrition risk. Despite published guidelines, providing adequate nutrition to these patients continues to remain a clinical challenge. Using the case ... Full text Link to item Cite

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient.

Journal Article JPEN J Parenter Enteral Nutr · February 2023 Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedure ... Full text Link to item Cite

A pilot study to assess the feasibility of a remotely monitored high-intensity interval training program prior to allogeneic hematopoietic stem cell transplantation.

Journal Article PLoS One · 2023 INTRODUCTION: Although allogeneic hematopoietic stem cell transplantation (HCT) can be a curative therapy for hematologic disorders, it is associated with treatment-related complications and losses in cardiorespiratory fitness and physical function. High-i ... Full text Link to item Cite

Hospital change to mixed lipid emulsion from soybean oil-based lipid emulsion for parenteral nutrition in hospitalized and critically ill adults improves outcomes: a pre-post-comparative study.

Journal Article Crit Care · October 18, 2022 INTRODUCTION: Early data suggest use of a mixed lipid emulsion (LE) with a soybean oil reduction strategy in parenteral nutrition (PN) may improve clinical outcomes. Duke University Hospital made a full switch to a Soybean oil/MCT/Olive/Fish Oil lipid (4-O ... Full text Open Access Link to item Cite

Automated versus manual analysis of body composition measures on computed tomography in patients with bladder cancer.

Journal Article Eur J Radiol · September 2022 PURPOSE: Manual measurement of body composition on computed tomography (CT) is time-consuming, limiting its clinical use. We validate a software program, Automatic Body composition Analyzer using Computed tomography image Segmentation (ABACS), for the auto ... Full text Link to item Cite

Core outcome measures for clinical effectiveness trials of nutritional and metabolic interventions in critical illness: an international modified Delphi consensus study evaluation (CONCISE).

Journal Article Crit Care · August 6, 2022 BACKGROUND: Clinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worse ... Full text Link to item Cite

Validation of the perioperative nutrition screen for prediction of postoperative outcomes.

Journal Article JPEN J Parenter Enteral Nutr · August 2022 BACKGROUND: Preoperative nutrition risk is often underrecognized and undertreated. The perioperative nutrition screen (PONS) was recently introduced as an efficient tool to rapidly screen for preoperative nutrition risk. The relationship between identifica ... Full text Link to item Cite

Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years.

Journal Article Transplant Cell Ther · August 2022 Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who b ... Full text Link to item Cite

Micronutrient deficiencies in critically ill patients receiving continuous renal replacement therapy.

Journal Article Clin Nutr ESPEN · August 2022 BACKGROUND & AIMS: Continuous renal replacement therapy (CRRT) is essential to the management of acute kidney injury (AKI) in critical illness. Unfortunately, large quantities of micronutrients are shown to be lost in CRRT effluent. Current literature desc ... Full text Link to item Cite

Role of Early Enteral Nutrition in Mechanically Ventilated COVID-19 Patients.

Journal Article Crit Care Explor · April 2022 UNLABELLED: Current guidance recommends initiation of early enteral nutrition (early EN) within 24-36 hours of ICU admission in critically ill COVID-19 patients. Despite this recommendation, there is quite limited evidence describing the effect of early EN ... Full text Link to item Cite

The Critical Role of Nutrition and Exercise: Optimization in the Patient With Cancer.

Journal Article J Adv Pract Oncol · April 2022 Undergoing surgery is one of the greatest physical and emotional challenges a patient can face, and doing so without preparation can lead to increased complications and mortality. At JADPRO Live Virtual 2021, Paul Wischmeyer, MD, EDIC, FCCM, FASPEN, emphas ... Full text Link to item Cite

Nutrition Status Optimization for Improved Perioperative Outcomes

Journal Article Current Anesthesiology Reports · March 1, 2022 Purpose of Review: Preoperative malnutrition is common in surgical patients and occurs in up to two-in-three major gastrointestinal and cancer surgery patients. Perioperative malnutrition is well-known to be associated with adverse clinical outcomes follow ... Full text Cite

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice.

Journal Article Crit Care · December 14, 2021 The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose ... Full text Link to item Cite

How Differences in the Disease Process of the COVID-19 Pandemic Pose Challenges to the Delivery of Critical Care Nutrition.

Journal Article Curr Nutr Rep · December 2021 PURPOSE OF REVIEW: The COVID-19 pandemic is a unique disease process that has caused unprecedented challenges for intensive care specialists. The hyperinflammatory hypermetabolic nature of the disease and the complexity of its management create barriers to ... Full text Link to item Cite

Prolonged progressive hypermetabolism during COVID-19 hospitalization undetected by common predictive energy equations.

Journal Article Clin Nutr ESPEN · October 2021 BACKGROUND & AIMS: Indirect calorimetry (IC) is the gold-standard for determining measured resting energy expenditure (mREE) in critical illness. When IC is not available, predicted resting energy expenditure (pREE) equations are commonly utilized, which o ... Full text Link to item Cite

Preoperative carbohydrate loading in surgical patients with type 2 diabetes: Are concerns supported by data?

Journal Article Clin Nutr ESPEN · October 2021 Currently, there is a lack of consensus on the provision of preoperative carbohydrate loading in patients with type 2 diabetes mellitus (T2DM) due to theoretical concerns including the possibility of delayed gastric emptying, perioperative hyperglycemia, a ... Full text Link to item Cite

Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19.

Journal Article Nutrients · September 21, 2021 Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The lite ... Full text Link to item Cite

Indirect calorimetry in critical illness: a new standard of care?

Journal Article Curr Opin Crit Care · August 1, 2021 PURPOSE OF REVIEW: Review recent literature on the role of indirect calorimetry in critical care nutrition management. RECENT FINDINGS: Critical illness demands objective, targeted nutritional therapy to prevent adverse effects of underfeeding/over feeding ... Full text Link to item Cite

Nutrients and micronutrients at risk during renal replacement therapy: a scoping review.

Journal Article Curr Opin Crit Care · August 1, 2021 PURPOSE OF REVIEW: Malnutrition is frequent in patients with acute kidney injury. Nutrient clearance during renal replacement therapy (RRT) potentially contributes to this complication. Although losses of amino acid, trace elements and vitamins have been d ... Full text Link to item Cite

Randomised, double-blind, placebo-controlled trial of Probiotics To Eliminate COVID-19 Transmission in Exposed Household Contacts (PROTECT-EHC): a clinical trial protocol.

Journal Article BMJ Open · May 5, 2021 INTRODUCTION: The COVID-19 pandemic has proven to be an unprecedented challenge to worldwide health, and strategies to mitigate the spread and severity of COVID-19 infection are urgently needed. Emerging evidence suggests that the composition of the gut mi ... Full text Open Access Link to item Cite

Review of evolution and current status of protein requirements and provision in acute illness and critical care.

Journal Article Clin Nutr · May 2021 Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in incr ... Full text Link to item Cite

Diet and Exercise Are not Associated with Skeletal Muscle Mass and Sarcopenia in Patients with Bladder Cancer.

Journal Article Eur Urol Oncol · April 2021 BACKGROUND: There is limited understanding about why sarcopenia is happening in bladder cancer, and which modifiable and nonmodifiable patient-level factors affect its occurrence. OBJECTIVE: The objective is to determine the extent to which nonmodifiable r ... Full text Open Access Link to item Cite

Overcoming challenges to enteral nutrition delivery in critical care.

Journal Article Curr Opin Crit Care · April 1, 2021 PURPOSE OF REVIEW: Existing data and all ICU nutrition guidelines emphasize enteral nutrition (EN) represents a primary therapy leading to both nutritional and non-nutritional benefits. Unfortunately, iatrogenic malnutrition and underfeeding is virtually u ... Full text Link to item Cite

Point-Counterpoint: Indirect Calorimetry Is Essential for Optimal Nutrition Therapy in the Intensive Care Unit.

Journal Article Nutr Clin Pract · April 2021 Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide n ... Full text Link to item Cite

Early oral protein-containing diets following elective lower gastrointestinal tract surgery in adults: a meta-analysis of randomized clinical trials.

Journal Article Perioper Med (Lond) · March 23, 2021 BACKGROUND: Although current guidelines make consensus recommendations for the early resumption of oral intake after surgery, a recent comprehensive meta-analysis failed to identify any patient-centered benefits. We hypothesized this finding was attributab ... Full text Link to item Cite

Postoperative Utilization of Oral Nutrition Supplements in Surgical Patients in US Hospitals.

Journal Article JPEN J Parenter Enteral Nutr · March 2021 BACKGROUND: Postoperative nutrition delivery is essential to surgical recovery; unfortunately, postoperative dietary intake is often poor. Recent surgical guidelines recommend use of oral nutritional supplements (ONS) to improve nutrition delivery. Our aim ... Full text Link to item Cite

Evaluation of malnutrition via modified GLIM criteria for in patients undergoing emergent gastrointestinal surgery.

Journal Article Clin Nutr · March 2021 BACKGROUND: Malnutrition remains a critical public health issue in the US, particularly in surgery where perioperative malnutrition is commonly underdiagnosed and undertreated. In 2016, the Global Leadership Initiative on Malnutrition (GLIM) proposed a set ... Full text Link to item Cite

Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients.

Journal Article Br J Anaesth · March 2021 BACKGROUND: Malnutrition in older hip fracture patients is associated with increased complication rates and mortality. As postoperative nutrition delivery is essential to surgical recovery, postoperative nutritional supplements including oral nutritional s ... Full text Link to item Cite

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review.

Journal Article Front Nutr · 2021 Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge a ... Full text Open Access Link to item Cite

Implications for Neuromodulation Therapy to Control Inflammation and Related Organ Dysfunction in COVID-19.

Journal Article J Cardiovasc Transl Res · December 2020 COVID-19 is a syndrome that includes more than just isolated respiratory disease, as severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) also interacts with the cardiovascular, nervous, renal, and immune system at multiple levels, increasing morbid ... Full text Open Access Link to item Cite

The clinical evaluation of the new indirect calorimeter developed by the ICALIC project.

Journal Article Clin Nutr · October 2020 BACKGROUND & AIMS: The ICALIC project was initiated for developing an accurate, reliable and user friendly indirect calorimeter (IC) and aimed at evaluating its ease of use and the feasibility of the EE measurements in intensive care unit (ICU). METHODS: T ... Full text Link to item Cite

Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors.

Journal Article Curr Opin Crit Care · October 2020 PURPOSE OF REVIEW: ICU survivors frequently suffer significant, prolonged physical disability. 'ICU Survivorship', or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address ... Full text Link to item Cite

Tutorial: Development and Implementation of a Multidisciplinary Preoperative Nutrition Optimization Clinic.

Journal Article JPEN J Parenter Enteral Nutr · September 2020 Although much is known about surgical risk, little evidence exists regarding how best to proactively address preoperative risk factors to improve surgical outcomes. Preoperative malnutrition is a widely prevalent and modifiable risk factor in patients unde ... Full text Link to item Cite

Assessments of frailty in bladder cancer.

Journal Article Urol Oncol · September 2020 BACKGROUND AND AIMS: The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and ... Full text Open Access Link to item Cite

Novel approaches to metabolic assessment and structured exercise to promote recovery in ICU survivors.

Journal Article Curr Opin Crit Care · August 2020 PURPOSE OF REVIEW: Survivorship or addressing impaired quality of life (QoL) in ICU survivors has been named 'the defining challenge of critical care' for this century to address this challenge; in addition to optimal nutrition, we must learn to employ tar ... Full text Open Access Link to item Cite

Perioperative Nutrition Care of Orthopedic Surgery Patient.

Journal Article Tech Orthop · March 2020 Despite evidence that malnutrition is associated with significant complications in orthopedic surgery1, unrecognized malnutrition continues to be a "silent epidemic", effecting up to 50% of hospitalized patients. Specifically, pre-surgical malnutrition is ... Full text Link to item Cite

Role of heat shock protein and cytokine expression as markers of clinical outcomes with glutamine-supplemented parenteral nutrition in surgical ICU patients.

Journal Article Clin Nutr · February 2020 BACKGROUND: Nutrients, such as glutamine (GLN), have been shown to effect levels of a family of protective proteins termed heat shock proteins (HSPs) in experimental and clinical critical illness. HSPs are believed to serve as extracellular inflammatory me ... Full text Link to item Cite

Immediate Post-operative Enterocyte Injury, as Determined by Increased Circulating Intestinal Fatty Acid Binding Protein, Is Associated With Subsequent Development of Necrotizing Enterocolitis After Infant Cardiothoracic Surgery.

Journal Article Front Pediatr · 2020 Objectives: 1 Measure serial serum intestinal fatty acid binding protein levels in infants undergoing cardiac surgery with cardiopulmonary bypass to evaluate for evidence of early post-operative enterocyte injury. 2 Determine the association between immedi ... Full text Open Access Link to item Cite

Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery.

Journal Article Perioper Med (Lond) · 2020 BACKGROUND: Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lac ... Full text Open Access Link to item Cite

Percutaneous tracheostomy for long-term ventilated COVID-19-patients: rationale and first clinical-safe for all-experience.

Journal Article Anaesthesiol Intensive Ther · 2020 INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from ... Full text Link to item Cite

Mitochondrial Dysfunction in Critical Illness: Implications for Nutritional Therapy.

Journal Article Curr Nutr Rep · December 2019 PURPOSE OF THE REVIEW: This paper will review the evidence for mitochondrial dysfunction in critical illness, describe the mechanisms which lead to multiple organ failure, and detail the implications of this pathophysiologic process on nutritional therapy. ... Full text Link to item Cite

Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases.

Journal Article Crit Care · November 21, 2019 BACKGROUND: Although mortality due to critical illness has fallen over decades, the number of patients with long-term functional disabilities has increased, leading to impaired quality of life and significant healthcare costs. As an essential part of the m ... Full text Open Access Link to item Cite

Geriatric Assessment Identifies Impairments in Younger Candidates for Allogeneic Hematopoietic Stem Cell Transplantation

Conference Blood · November 13, 2019 Introduction: Geriatric assessment (GA) is a multidimensional evaluation of patient health and function that may detect impairments not identified as part of routine care, predict treatment-related morbidity and mortality, and inform treatment plan ... Full text Cite

Glutamine in Burn Injury.

Journal Article Nutr Clin Pract · October 2019 Burn injury is the most devastating of survivable injuries and is a worldwide public health crisis. Burn injury is among the most severe metabolic stresses a patient can sustain. A major burn leads to an inflammatory response and catabolism that, when comp ... Full text Link to item Cite

Metabolic support in the critically ill: a consensus of 19.

Journal Article Crit Care · September 18, 2019 Metabolic alterations in the critically ill have been studied for more than a century, but the heterogeneity of the critically ill patient population, the varying duration and severity of the acute phase of illness, and the many confounding factors have hi ... Full text Link to item Cite

The glutamine debate in surgery and critical care.

Journal Article Curr Opin Crit Care · August 2019 PURPOSE OF REVIEW: Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. H ... Full text Link to item Cite

The malnourished surgery patient: a silent epidemic in perioperative outcomes?

Journal Article Curr Opin Anaesthesiol · June 2019 PURPOSE OF REVIEW: As many as two of every three major surgery patients are malnourished preoperatively - a diagnosis rarely made and treated even less frequently. Unfortunately, perioperative malnutrition is perhaps the least often identified surgical ris ... Full text Link to item Cite

Frailty in the End-Stage Lung Disease or Heart Failure Patient: Implications for the Perioperative Transplant Clinician.

Journal Article J Cardiothorac Vasc Anesth · May 2019 The syndrome of frailty for patients undergoing heart or lung transplantation has been a recent focus for perioperative clinicians because of its association with postoperative complications and poor outcomes. Patients with end-stage cardiac or pulmonary f ... Full text Open Access Link to item Cite

Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery.

Journal Article Shock · March 2019 OBJECTIVE: Infant cardiopulmonary bypass (CPB) increases intestinal permeability leading to endotoxemia. Alkaline phosphatase (AP) reduces endotoxin toxicity in vitro but its effects on endotoxemia in human disease are poorly understood. We assessed the as ... Full text Link to item Cite

Probiotic and synbiotic therapy in the critically ill: State of the art.

Journal Article Nutrition · March 2019 Recent medical history has largely viewed our bacterial symbionts as pathogens to be eradicated rather than as essential partners in optimal health. However, one of the most exciting scientific advances in recent years has been the realization that commens ... Full text Link to item Cite

Sarcopenia in bladder cancer patients is an unmodifiable outcomes predictor.

Conference Journal of Clinical Oncology · March 1, 2019 480 Background: Sarcopenia, a severe loss of skeletal muscle mass, predicts poor outcomes in bladder cancer (BC). But, why sarcopenia occurs in BC is unknown. Our objective was to assess if diet and physical activity were the pri ... Full text Cite

Renal Angina Is a Sensitive, but Nonspecific Identifier of Postcardiac Surgery Acute Kidney Injury.

Journal Article J Cardiothorac Vasc Anesth · February 2019 OBJECTIVES: Acute kidney injury (AKI) is a common complication of cardiac surgery, and early detection is difficult. This study was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and statistical p ... Full text Link to item Cite

Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance.

Journal Article JPEN J Parenter Enteral Nutr · January 2019 BACKGROUND: Enteral feeding via feeding tube (FT) provides essential nutrition support to critically ill patients or those who cannot intake adequate nutrition via the oral route. Unfortunately, 1%-2% of FTs placed blindly at bedside enter the airway undet ... Full text Link to item Cite

Pre-operative nutrition and the elective surgical patient: why, how and what?

Journal Article Anaesthesia · January 2019 Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden Circle approach to explain 'why' avoiding pre-operative malnutrition and supporting prot ... Full text Open Access Link to item Cite

Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay.

Journal Article J Am Heart Assoc · December 18, 2018 Background Mortality for infants undergoing complex cardiac surgery is >10% with a 30% to 40% risk of complications. Early identification and treatment of high-risk infants remains challenging. Metabolites are small molecules that determine the minute-to-m ... Full text Link to item Cite

Surgical Prehabilitation: Nutrition and Exercise.

Journal Article Anesthesiol Clin · December 2018 Complications after major surgery account for a disproportionate amount of in-hospital morbidity and mortality. Recent efforts have focused on preoperative optimization in an attempt to modify the risk associated with major surgery. Underaddressed, but imp ... Full text Link to item Cite

Dietary patterns and health-related quality of life in bladder cancer survivors.

Journal Article Urol Oncol · October 2018 PURPOSE: A nutritious diet has been associated with better health-related quality of life (HRQOL) in a variety of cancer survivors. However, little is known about dietary habits and its association with HRQOL in bladder cancer survivors. The objective of t ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery.

Journal Article Anesth Analg · June 2018 The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but t ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

Journal Article Anesth Analg · June 2018 Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.

Journal Article Anesth Analg · June 2018 Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative c ... Full text Open Access Link to item Cite

Supplemental Parenteral Nutrition: Review of the Literature and Current Nutrition Guidelines.

Journal Article Nutr Clin Pract · June 2018 Parenteral nutrition has significantly and positively affected the clinical care of patients for >50 years. The 2016 Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition guidelines for the provision of nutrition support t ... Full text Link to item Cite

Infant cardiopulmonary bypass: CD73 kinetics, association with clinical outcomes, and influence on serum adenosine production capacity.

Journal Article Pediatr Res · April 2018 BackgroundExtracellular adenine nucleotides contribute to ischemia-reperfusion injury following infant cardiopulmonary bypass (CPB), whereas conversion to adenosine may be protective. Alkaline phosphatase (AP), a key enzyme responsible for this conversion, ... Full text Link to item Cite

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.

Journal Article Anesth Analg · February 2018 Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinar ... Full text Link to item Cite

Nutrition Therapy in Sepsis.

Journal Article Crit Care Clin · January 2018 Sepsis is characterized by early massive catabolism, lean body mass (LBM) loss, and escalating hypermetabolism persisting for months to years. Early enteral nutrition should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein an ... Full text Link to item Cite

American Gut: an Open Platform for Citizen Science Microbiome Research.

Journal Article mSystems · 2018 Although much work has linked the human microbiome to specific phenotypes and lifestyle variables, data from different projects have been challenging to integrate and the extent of microbial and molecular diversity in human stool remains unknown. Using sta ... Full text Link to item Cite

Tailoring nutrition therapy to illness and recovery.

Journal Article Crit Care · December 28, 2017 Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of ... Full text Open Access Link to item Cite

Seven unconfirmed ideas to improve future ICU practice.

Journal Article Crit Care · December 28, 2017 With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are ... Full text Open Access Link to item Cite

Lactobacillus rhamnosus GG treatment improves intestinal permeability and modulates inflammatory response and homeostasis of spleen and colon in experimental model of Pseudomonas aeruginosa pneumonia.

Journal Article Clin Nutr · December 2017 BACKGROUND & AIMS: Recent clinical trials and in vivo models demonstrate probiotic administration can reduce occurrence and improve outcome of pneumonia and sepsis, both major clinical challenges worldwide. Potential probiotic benefits include maintenance ... Full text Link to item Cite

Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and Relationship to Organ Injury and Major Cardiovascular Events.

Journal Article J Pediatr · November 2017 OBJECTIVES: To determine the kinetics of alkaline phosphatase (AP) activity and concentration after infant cardiopulmonary bypass, including isoform-specific changes, and to measure the association between postoperative AP activity and major postoperative ... Full text Link to item Cite

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise.

Journal Article Curr Opin Crit Care · August 2017 PURPOSE OF REVIEW: We have significantly improved hospital mortality from sepsis and critical illness in last 10 years; however, over this same period we have tripled the number of 'ICU survivors' going to rehabilitation. Furthermore, as up to half the dea ... Full text Link to item Cite

A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial.

Journal Article Crit Care · June 9, 2017 BACKGROUND: Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit ... Full text Open Access Link to item Cite

Assessment of perioperative nutrition practices and attitudes-A national survey of colorectal and GI surgical oncology programs.

Journal Article Am J Surg · June 2017 BACKGROUND: Implementation of evidence-based peri-operative nutrition in the U.S. is poorly described and hypothesized to be suboptimal. This study broadly describes practices and attitudes regarding nutrition screening/intervention in U.S. gastrointestina ... Full text Link to item Cite

Blurred Lines: Dysbiosis and Probiotics in the ICU.

Journal Article Chest · February 2017 Clinicians have traditionally dichotomized bacteria as friendly commensals or harmful pathogens. However, the line separating the two has become blurred with the recognition that the intestinal microbiome is a complex entity in which species can shift side ... Full text Link to item Cite

Prehabilitation and Nutritional Support to Improve Perioperative Outcomes.

Journal Article Curr Anesthesiol Rep · 2017 PURPOSE OF REVIEW: The purpose of this study is to evaluate the role of physical exercise and nutrition interventions in adult patients before elective major surgery. RECENT FINDINGS: Exercise training before elective adult major surgery is feasible, safe, ... Full text Link to item Cite

A RandomizEd trial of ENtERal Glutamine to minimIZE thermal injury (The RE-ENERGIZE Trial): a clinical trial protocol.

Journal Article Scars Burn Heal · 2017 BACKGROUND: Burn injury represents a significant public health problem worldwide. More than in any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies resulting in impaired immune function and inc ... Full text Link to item Cite

Therapeutic role of glutamine in inflammatory bowel disease

Chapter · January 1, 2017 The concept that dietary elements may serve as modulators of intestinal physiology and the gut’s response to stress or injury has been hypothesized for many years. The gut is an attractive target for dietary modulation, owing to its direct exposure to nutr ... Full text Cite

Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis.

Journal Article Crit Care · August 19, 2016 BACKGROUND: Critical illness is characterized by a loss of commensal flora and an overgrowth of potentially pathogenic bacteria, leading to a high susceptibility to nosocomial infections. Probiotics are living non-pathogenic microorganisms, which may prote ... Full text Open Access Link to item Cite

Role of the microbiome, probiotics, and 'dysbiosis therapy' in critical illness.

Journal Article Curr Opin Crit Care · August 2016 PURPOSE OF REVIEW: Loss of 'health-promoting' microbes and overgrowth of pathogenic bacteria (dysbiosis) in ICU is believed to contribute to nosocomial infections, sepsis, and organ failure (multiple organ dysfunction syndrome). This review discusses new u ... Full text Open Access Link to item Cite

Protein-energy nutrition in the ICU is the power couple: A hypothesis forming analysis.

Journal Article Clin Nutr · August 2016 BACKGROUND & AIMS: We hypothesize that an optimal and simultaneous provision of energy and protein is favorable to clinical outcome of the critically ill patients. METHODS: We conducted a review of the literature, obtained via electronic databases and focu ... Full text Link to item Cite

Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial.

Journal Article Ann Surg · April 2016 OBJECTIVE: To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical intensive care unit (SICU) patients. SUMMARY BACKGROUND DATA: GLN requirements may increase with critical illness. GLN-supplemente ... Full text Link to item Cite

Extreme Dysbiosis of the Microbiome in Critical Illness.

Journal Article mSphere · 2016 Critical illness is hypothesized to associate with loss of "health-promoting" commensal microbes and overgrowth of pathogenic bacteria (dysbiosis). This dysbiosis is believed to increase susceptibility to nosocomial infections, sepsis, and organ failure. A ... Full text Link to item Cite

Alkaline Phosphatase, Soluble Extracellular Adenine Nucleotides, and Adenosine Production after Infant Cardiopulmonary Bypass.

Journal Article PLoS One · 2016 RATIONALE: Decreased alkaline phosphatase activity after infant cardiac surgery is associated with increased post-operative cardiovascular support requirements. In adults undergoing coronary artery bypass grafting, alkaline phosphatase infusion may reduce ... Full text Link to item Cite

Nutrition Modulation of Cardiotoxicity and Anticancer Efficacy Related to Doxorubicin Chemotherapy by Glutamine and ω-3 Polyunsaturated Fatty Acids.

Journal Article JPEN J Parenter Enteral Nutr · January 2016 BACKGROUND: Doxorubicin (DOX) has been one of the most effective antitumor agents against a broad spectrum of malignancies. However, DOX-induced cardiotoxicity forms the major cumulative dose-limiting factor. Glutamine and ω-3 polyunsaturated fatty acids ( ... Full text Link to item Cite

Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD.

Conference Chest · June 2015 BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. ... Full text Link to item Cite

Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial.

Journal Article JPEN J Parenter Enteral Nutr · May 2015 BACKGROUND: The recent large randomized controlled trial of glutamine and antioxidant supplementation suggested that high-dose glutamine is associated with increased mortality in critically ill patients with multiorgan failure. The objectives of the presen ... Full text Link to item Cite

Metabolic and nutritional support of critically ill patients: consensus and controversies.

Journal Article Crit Care · January 29, 2015 The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, ide ... Full text Open Access Link to item Cite

A few of our favorite unconfirmed ideas.

Journal Article Crit Care · 2015 Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially s ... Full text Open Access Link to item Cite

Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology.

Journal Article Crit Care · 2015 Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given t ... Full text Link to item Cite

Brief Glutamine Pretreatment Increases Alveolar Macrophage CD163/Heme Oxygenase-1/p38-MAPK Dephosphorylation Pathway and Decreases Capillary Damage but Not Neutrophil Recruitment in IL-1/LPS-Insufflated Rats.

Journal Article PLoS One · 2015 BACKGROUND: Glutamine (GLN) attenuates acute lung injury (ALI) but its effect on alveolar macrophages is unknown. We hypothesized that GLN pretreatment would induce the anti-inflammatory CD163/heme oxygenase (HO)-1/p38-MAPK dephosphorylation pathway in alv ... Full text Open Access Link to item Cite

Bedside ultrasound measurement of skeletal muscle.

Journal Article Curr Opin Clin Nutr Metab Care · September 2014 PURPOSE OF REVIEW: Skeletal muscle and lean body mass may be vital to prognosis and functional recovery in chronic and acute illness, particularly in conditions in which muscle atrophy is prevalent. Ultrasound provides a precise and expedient method to mea ... Full text Link to item Cite

Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?

Journal Article Forum Health Econ Policy · September 1, 2014 We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congesti ... Full text Link to item Cite

Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness.

Journal Article JPEN J Parenter Enteral Nutr · September 2014 BACKGROUND: Critically ill patients commonly experience skeletal muscle wasting that may predict clinical outcome. Ultrasound is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) and subsequently lean body mass (LBM) at ... Full text Link to item Cite

Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?

Journal Article Forum for Health Economics & Policy · September 2014 We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congesti ... Cite

Parenteral glutamine supplementation in critical illness: a systematic review.

Journal Article Crit Care · April 18, 2014 INTRODUCTION: The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of tradit ... Full text Link to item Cite

Enteral fish oil in critical illness: perspectives and systematic review.

Journal Article Curr Opin Clin Nutr Metab Care · March 2014 PURPOSE OF REVIEW: To summarize recent research addressing the role of enteral fish oil supplementation in critical illness. RECENT FINDINGS: A number of new multicenter trials examining both the use of fish oil given as a supplement to enteral nutrition s ... Full text Link to item Cite

Lactobacillus rhamnosus GG and Bifidobacterium longum attenuate lung injury and inflammatory response in experimental sepsis.

Journal Article PLoS One · 2014 INTRODUCTION: Probiotic use to prevent nosocomial gastrointestinal and potentially respiratory tract infections in critical care has shown great promise in recent clinical trials of adult and pediatric patients. Despite well-documented benefits of probioti ... Full text Link to item Cite

Lactobacillus rhamnosus GG improves outcome in experimental pseudomonas aeruginosa pneumonia: potential role of regulatory T cells.

Journal Article Shock · December 2013 INTRODUCTION: Recent clinical trials show Lactobacillus rhamnosus GG (LGG) administration in critical illness has the potential to reduce nosocomial infections and improve clinical outcome. However, the mechanism(s) of LGG-mediated benefit following illnes ... Full text Link to item Cite

Early propranolol treatment induces lung heme-oxygenase-1, attenuates metabolic dysfunction, and improves survival following experimental sepsis.

Journal Article Crit Care · September 10, 2013 INTRODUCTION: Pharmacological agents that block beta-adrenergic receptors have been associated with improved outcome in burn injury. It has been hypothesized that injuries leading to a hypermetabolic state, such as septic shock, may also benefit from beta- ... Full text Open Access Link to item Cite

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

Journal Article JPEN J Parenter Enteral Nutr · September 2013 In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing eviden ... Full text Link to item Cite

Pharmaconutrition review: physiological mechanisms.

Journal Article JPEN J Parenter Enteral Nutr · September 2013 The search to improve outcomes in critically ill patients through nutrition support has steadily progressed over the past 4 decades. One current approach to this problem is the addition of specific nutrients as primary therapy to improve host defenses and ... Full text Link to item Cite

Clinical evidence for pharmaconutrition in major elective surgery.

Journal Article JPEN J Parenter Enteral Nutr · September 2013 In recent years, standard nutrition preparations have been modified by adding specific nutrients, such as arginine, ω-3 fatty acids, glutamine, and others, which have been shown to upregulate host immune response, modulate inflammatory response, and improv ... Full text Link to item Cite

Does artificial nutrition improve outcome of critical illness? An alternative viewpoint!

Journal Article Crit Care · August 27, 2013 Recent studies challenge the beneficial role of artificial nutrition provided to critically ill patients and point out the limitations of existing studies in this area. We take a differing view of the existing data and refute many of the arguments put forw ... Full text Link to item Cite

Probiotic administration reduces mortality and improves intestinal epithelial homeostasis in experimental sepsis.

Journal Article Anesthesiology · July 2013 BACKGROUND: Recent clinical trials indicate that probiotic administration in critical illness has potential to reduce nosocomial infections and improve clinical outcome. However, the mechanism(s) of probiotic-mediated protection against infection and sepsi ... Full text Link to item Cite

P38MAP kinase, but not phosphoinositol-3 kinase, signal downstream of glutamine-mediated fibronectin-integrin signaling after intestinal injury.

Journal Article Nutr J · June 21, 2013 BACKGROUND: Glutamine appears to mediate protection against gut injury via multiple pathways. These include fibronectin-integrin, PI3-K/MAPK pathways, and activation of heat shock protein (HSP) response. We hypothesize there may be a relationship between t ... Full text Link to item Cite

A randomized trial of glutamine and antioxidants in critically ill patients.

Journal Article N Engl J Med · April 18, 2013 BACKGROUND: Critically ill patients have considerable oxidative stress. Glutamine and antioxidant supplementation may offer therapeutic benefit, although current data are conflicting. METHODS: In this blinded 2-by-2 factorial trial, we randomly assigned 12 ... Full text Link to item Cite

Epidermal growth factor receptor expression and signaling are essential in glutamine's cytoprotective mechanism in heat-stressed intestinal epithelial-6 cells.

Journal Article Am J Physiol Gastrointest Liver Physiol · March 1, 2013 Epidermal growth factor receptor (EGFR) expression and signaling can induce cellular protection after intestinal inflammation. L-Glutamine (GLN) is known to prevent apoptosis after intestinal injury by activating MAPK and phosphatidylinositol 3-kinase (PI3 ... Full text Link to item Cite

Optimizing energy and protein balance in the ICU.

Journal Article Curr Opin Clin Nutr Metab Care · March 2013 PURPOSE OF REVIEW: Perhaps now more than ever, appropriate nutrition delivery in the ICU is a highly debated issue. Nutrition guidelines for ICU patients by European Society for Clinical Nutrition and Metabolism in Europe, The Canadian Nutrition Guidelines ... Full text Link to item Cite

Glutamine.

Chapter · 2013 Glutamine (GLN) has been shown to be a key pharmaconutrient in the body's response to stress and injury. It exerts its protective effects via multiple mechanisms, including direct protection of cells and tissue from injury, attenuation inflammation, and pr ... Full text Link to item Cite

L-Threonine induces heat shock protein expression and decreases apoptosis in heat-stressed intestinal epithelial cells.

Journal Article Nutrition · 2013 OBJECTIVES: Osmotically acting amino acids can be cytoprotective following injury. As threonine (THR) induces osmotic cell swelling, our aim was to investigate the potential for THR to induce cellular protection in intestinal epithelial cells and evaluate ... Full text Link to item Cite

Left ventricular assist device effects on metabolic substrates in the failing heart.

Journal Article PLoS One · 2013 BACKGROUND: Heart failure patients have inadequate nutritional intake and alterations in metabolism contributing to an overall energy depleted state. Left ventricular assist device (LVAD) support is a common and successful intervention in patients with end ... Full text Link to item Cite

The evolution of nutrition in critical care: how much, how soon?

Journal Article Crit Care · 2013 Critical care is a very recent advance in the history of human evolution. Prior to the existence of ICU care, when the saber-tooth tiger attacked you had but a few critical hours to recover or you died. Mother Nature, and her survival of the fittest mental ... Full text Link to item Cite

Characteristics and current practice of parenteral nutrition in hospitalized patients.

Journal Article JPEN J Parenter Enteral Nutr · January 2013 BACKGROUND: For 40 years, parenteral nutrition (PN) has provided therapeutic benefits to patients unable to receive oral/enteral nutrition. Very limited published evidence exists to describe modern PN practices or characteristics of patients receiving PN. ... Full text Link to item Cite

Our favorite unproven ideas for future critical care.

Journal Article Crit Care · 2013 The future of critical care medicine will be shaped not only by the evidence-validated foundations of science, but also by innovations based on unproven and, in many cases, untested concepts and thoughtful visions of scientists and clinicians familiar with ... Full text Link to item Cite

Glutamine-mediated dual regulation of heat shock transcription factor-1 activation and expression.

Conference J Biol Chem · November 23, 2012 BACKGROUND: Regulation of transcriptional activity of heat shock factor-1 (HSF1) is widely thought to be the main point of control for heat shock protein (Hsp) expression. RESULTS: Glutamine increases Hsf1 gene transcription in a C/EBPβ-dependent manner an ... Full text Link to item Cite

Relationship of vitamin D deficiency to clinical outcomes in critically ill patients.

Journal Article JPEN J Parenter Enteral Nutr · November 2012 BACKGROUND: Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the b ... Full text Link to item Cite

Is there a difference in bloodstream infections in critically ill patients associated with ready-to-use versus compounded parenteral nutrition?

Journal Article Clin Nutr · October 2012 BACKGROUND & AIMS: Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodst ... Full text Link to item Cite

Pharmacologically dosed oral glutamine reduces myocardial injury in patients undergoing cardiac surgery: a randomized pilot feasibility trial.

Journal Article JPEN J Parenter Enteral Nutr · September 2012 BACKGROUND AND OBJECTIVE: Glutamine (GLN) has been shown to protect against in vitro and in vivo myocardial injury. In humans, perioperative ischemia/reperfusion (I/R) injury during cardiac surgery is associated with higher morbidity and mortality. The obj ... Full text Link to item Cite

Glutamine prevents apoptosis in intestinal epithelial cells and induces differential protective pathways in heat and oxidant injury models.

Journal Article JPEN J Parenter Enteral Nutr · September 2012 BACKGROUND: Glutamine (GLN) can decrease mortality and length of hospital stay in the critically ill. GLN protects via enhancing protective heat shock proteins (HSPs) in heat stress (HS). GLN's effect on HSPs in oxidant injury and apoptosis remains to be e ... Full text Link to item Cite

Parenteral nutrition and calorie delivery in the ICU: controversy, clarity, or call to action?

Journal Article Curr Opin Crit Care · April 2012 PURPOSE OF REVIEW: This review will highlight recent data evaluating the role of parenteral nutrition and calorie delivery in the intensive care setting. Specific focus will be placed on recent trials of early and/or supplemental parenteral nutrition (SPN) ... Full text Link to item Cite

Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition.

Journal Article Intensive Care Med · April 2012 PURPOSE: To assess coagulation status and factor Xa inhibition in surgical intensive care unit (ICU) patients administered prophylactic unfractionated heparin for venous thromboembolism (VTE) prophylaxis. METHODS: We conducted a randomized, single-blind st ... Full text Link to item Cite

Fibronectin-integrin signaling is required for L-glutamine's protection against gut injury.

Journal Article PLoS One · 2012 BACKGROUND: Extracellular matrix (ECM) stabilization and fibronectin (FN)-Integrin signaling can mediate cellular protection. L-glutamine (GLN) is known to prevent apoptosis after injury. However, it is currently unknown if ECM stabilization and FN-Integri ... Full text Link to item Cite

Nutrition therapy cost analysis in the US: pre-mixed multi-chamber bag vs compounded parenteral nutrition.

Journal Article Appl Health Econ Health Policy · September 1, 2011 BACKGROUND: Bloodstream infections (BSI) occur in up to 350 000 inpatient admissions each year in the US, with BSI rates among patients receiving parenteral nutrition (PN) varying from 1.3% to 39%. BSI-attributable costs were estimated to approximate $US12 ... Full text Link to item Cite

Nutritional pharmacology in surgery and critical care: 'you must unlearn what you have learned'.

Journal Article Curr Opin Anaesthesiol · August 2011 PURPOSE OF REVIEW: This review highlights the rapidly evolving field of 'pharmaconutrition' by discussing the mechanistic and clinical data for calorie delivery and nutrients shown to improve outcome in surgical and ICU care. RECENT FINDINGS: International ... Full text Link to item Cite

What's new in Shock, July 2011?

Journal Article Shock · July 2011 Full text Link to item Cite

Glutamine therapy improves outcome of in vitro and in vivo experimental colitis models.

Journal Article JPEN J Parenter Enteral Nutr · March 2011 BACKGROUND: Pharmacologic doses of glutamine (GLN) can improve clinical outcome following acute illness and injury. Recent studies indicate enhanced heat shock protein (HSP) expression is a key mechanism underlying GLN's protection. However, such a link ha ... Full text Link to item Cite

IMPACT OF VITAMIN D DEFICIENCY ON OUTCOME IN CRITICALLY ILL PATIENTS

Journal Article JOURNAL OF INVESTIGATIVE MEDICINE · January 1, 2011 Link to item Cite

Clinical review: Optimizing enteral nutrition for critically ill patients--a simple data-driven formula.

Journal Article Crit Care · 2011 In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain spec ... Full text Open Access Link to item Cite

Nutrition modulation of gastrointestinal toxicity related to cancer chemotherapy: from preclinical findings to clinical strategy.

Journal Article JPEN J Parenter Enteral Nutr · January 2011 Chemotherapy-induced gut toxicity is a major dose-limiting toxicity for many anticancer drugs. Gastrointestinal (GI) complications compromise the efficacy of chemotherapy, promote overall malnutrition, aggravate cancer cachexia, and may contribute to worse ... Full text Link to item Cite

Malnutrition in the acutely ill patient: Is it more than just protein and energy?

Journal Article South African Journal of Clinical Nutrition · January 1, 2011 Malnutrition has traditionally been thought to involve deficiencies in protein and energy (macronutrients); however, we know that specific key nutrients, when deficient. can also lead to significant morbidity and mortality. Large studies performed with rep ... Full text Cite

IMPACT OF VITAMIN D DEFICIENCY ON OUTCOME IN CRITICALLY ILL PATIENTS

Conference CRITICAL CARE MEDICINE · December 1, 2010 Link to item Cite

Discovery and verification of protein differences between Er positive/Her2/neu negative breast tumor tissue and matched adjacent normal breast tissue.

Journal Article Breast Cancer Res Treat · November 2010 This study was designed to quantify and identify differences in protein levels between tumor and adjacent normal breast tissue from the same breast in 18 women with stage I/II ER positive/Her2/neu negative invasive breast cancer. Eighteen separate differen ... Full text Link to item Cite

Preface

Chapter · July 1, 2010 Full text Cite

Glutamine in critical illness: the time has come, the time is now.

Journal Article Crit Care Clin · July 2010 Glutamine (GLN) has been shown to be a key pharmaconutrient in the body's response to stress and injury. It exerts its protective effects via multiple mechanisms, including direct protection of cells and tissue from injury, attenuation inflammation, and pr ... Full text Link to item Cite

The future of critical care nutrition therapy.

Journal Article Crit Care Clin · July 2010 At present, we are in a "revival" period in clinical nutrition in critical care, especially in the area of "pharmaconutrition." Adequate nutrition may hinge not only on how many calories are provided but also on the ability to provide key pharmacologically ... Full text Link to item Cite

Glutamine as indispensable nutrient in oncology: experimental and clinical evidence.

Journal Article Eur J Nutr · June 2010 BACKGROUND: In hypermetabolic situations, glutamine is intensively used by rapidly dividing cells such as enterocytes, lymphocytes, and fibroblasts as nitrogen source and/or alternative energy fuel. It is hypothesized that in cancer patients the increased ... Full text Link to item Cite

Nutrition therapy for the critically ill surgical patient: we need to do better!

Journal Article JPEN J Parenter Enteral Nutr · 2010 BACKGROUND: To identify opportunities for quality improvement, the nutrition adequacy of critically ill surgical patients, in contrast to medical patients, is described. METHODS: International, prospective, and observational studies conducted in 2007 and 2 ... Full text Link to item Cite

HYPEROXIA TOLERANT RATS OVEREXPRESS LUNG HEME-OXYGENASE-1

Conference CRITICAL CARE MEDICINE · December 1, 2009 Link to item Cite

Glutamine enhances heat shock protein 70 expression via increased hexosamine biosynthetic pathway activity.

Journal Article Am J Physiol Cell Physiol · December 2009 Glutamine (GLN) plays a key role in cellular protection following injury via enhancement of heat shock protein 70 (HSP70). The pathway by which GLN enhances HSP70 is unknown. GLN is a key substrate for the hexosamine biosynthetic pathway (HBP), which has b ... Full text Link to item Cite

Performance-enhancing sports supplements: role in critical care.

Journal Article Crit Care Med · October 2009 Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefi ... Full text Link to item Cite

Effects of pharmaconutrients on cellular dysfunction and the microcirculation in critical illness.

Journal Article Curr Opin Anaesthesiol · April 2009 PURPOSE OF REVIEW: A growing body of data has revealed that specific nutrient deficiencies contribute to microvascular and cellular dysfunction following critical illness. Further, targeted administration of these 'pharmaconutrients' may reverse or improve ... Full text Link to item Cite

Glutamine in acute lung injury: the experimental model matters.

Journal Article Am J Physiol Lung Cell Mol Physiol · March 2009 Full text Link to item Cite

Extracellular superoxide dismutase haplotypes are associated with acute lung injury and mortality.

Journal Article Am J Respir Crit Care Med · January 15, 2009 RATIONALE: Extracellular superoxide dismutase (EC-SOD) is a potent antioxidant that plays an important role in controlling oxidant-mediated stress and inflammation. High levels of EC-SOD are found in the lung. Acute lung injury (ALI) frequently occurs in p ... Full text Link to item Cite

Comment on: probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial.

Journal Article JPEN J Parenter Enteral Nutr · 2009 BACKGROUND: Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of pr ... Full text Link to item Cite

Monitoring recombinant factor VIIa treatment: efficacy depends on high levels of fibrinogen in a model of severe dilutional coagulopathy.

Journal Article J Cardiothorac Vasc Anesth · October 2008 OBJECTIVES: Recombinant activated factor VII (rFVIIa) is increasingly being given to treat massive bleeding. However, there is no clear guidance on which patients are suitable for treatment and how the effects of treatment should be monitored. The aim of t ... Full text Link to item Cite

Glutamine attenuates inflammation and NF-kappaB activation via Cullin-1 deneddylation.

Journal Article Biochem Biophys Res Commun · August 29, 2008 Glutamine (GLN) can inhibit NF-kBeta activation and cytokine expression following sepsis. NF-kappaB activation and inflammatory cytokine expression, depend on neddylation of Cullin-1 (Cul-1) to proceed. Our aim was to evaluate whether GLN inhibits Cul-1 ne ... Full text Link to item Cite

A survey of inhalational anaesthetic abuse in anaesthesia training programmes.

Conference Anaesthesia · June 2008 This study aims to assess the prevalence and outcomes of inhalational anaesthetic abuse among anaesthesia training programmes. Online surveys were completed by chairpersons of academic anaesthesia training programmes in the United States. The response rate ... Full text Link to item Cite

Glutamine: role in critical illness and ongoing clinical trials.

Journal Article Curr Opin Gastroenterol · March 2008 PURPOSE OF REVIEW: This review will assess recent clinical and mechanistic data examining glutamine's ability to reduce morbidity and mortality in critical illness. RECENT FINDINGS: Updated metaanalysis data reveal a significant benefit of glutamine supple ... Full text Link to item Cite

Nutrition therapy in critically ill infants and children.

Journal Article JPEN J Parenter Enteral Nutr · 2008 Infants and children are susceptible to the profound metabolic effects of critical illness. In addition, preexisting malnutrition and obesity have adverse consequences during the intensive care unit stay. Early enteral and parenteral feeding can improve nu ... Full text Link to item Cite

Glutamine induces heat shock protein expression via O-glycosylation and phosphorylation of HSF-1 and Sp1.

Journal Article JPEN J Parenter Enteral Nutr · 2008 BACKGROUND: Glutamine (GLN) improves outcome in experimental and clinical states of illness and injury. The authors hypothesized GLN-mediated enhancement of O-glycosylation and subsequent phosphorylation of key transcription factors in the HSP70 pathway wo ... Full text Link to item Cite

Erythromycin vs metoclopramide for facilitating gastric emptying and tolerance to intragastric nutrition in critically ill patients.

Journal Article JPEN J Parenter Enteral Nutr · 2008 BACKGROUND: The purpose of this study is to evaluate erythromycin vs metoclopramide for facilitating gastric emptying and tolerance to intragastric enteral nutrition (EN). METHODS: Twenty critically ill patients with a gastric residual >150 mL while receiv ... Full text Link to item Cite

Gastric motility function in critically ill patients tolerant vs intolerant to gastric nutrition.

Journal Article JPEN J Parenter Enteral Nutr · 2008 BACKGROUND: Administration of gastric enteral nutrition (EN) in the intensive care unit (ICU) is commonly impeded by high gastric residual volumes (GRV). This study evaluated gastric emptying in patients with limited GRV (tolerant group) vs volumes > or =1 ... Full text Link to item Cite

JPEN: State of the Journal.

Journal Article JPEN J Parenter Enteral Nutr · 2008 Full text Link to item Cite

A survey of propofol abuse in academic anesthesia programs.

Journal Article Anesth Analg · October 2007 BACKGROUND: Although propofol has not traditionally been considered a drug of abuse, subanesthetic doses may have an abuse potential. We used this survey to assess prevalence and outcome of propofol abuse in academic anesthesiology programs. METHODS: E-mai ... Full text Link to item Cite

Glutamine: mode of action in critical illness.

Journal Article Crit Care Med · September 2007 A recent editorial in Critical Care Medicine was titled "Glutamine, a life-saving nutrient, but why?" (2003; 31:2555-2556). This review will attempt to utilize new understanding of gene-nutrient interactions and molecular medicine to address potential mech ... Full text Link to item Cite

Glutamine's protection against sepsis and lung injury is dependent on heat shock protein 70 expression.

Journal Article Am J Physiol Regul Integr Comp Physiol · May 2007 Glutamine (GLN) has been shown to protect against inflammatory injury and illness in experimental and clinical settings. The mechanism of this protection is unknown; however, laboratory and clinical trial data have indicated a relationship between GLN-medi ... Full text Link to item Cite

Optimizing the dose of glutamine dipeptides and antioxidants in critically ill patients: a phase I dose-finding study.

Journal Article JPEN J Parenter Enteral Nutr · 2007 BACKGROUND: Supplementation with glutamine and antioxidants may be associated with an improvement in clinical outcomes, but the optimal dose of these substrates is unknown. The purpose of this study was to determine the safety of high doses of glutamine co ... Full text Link to item Cite

Reply to Eisenhut [2]

Journal Article American Journal of Physiology Lung Cellular and Molecular Physiology · January 1, 2007 Full text Cite

Author's response

Journal Article Journal of Parenteral and Enteral Nutrition · December 1, 2006 Cite

Glutamine: role in gut protection in critical illness.

Journal Article Curr Opin Clin Nutr Metab Care · September 2006 PURPOSE OF REVIEW: Recent literature has focused on the role of the gut and increased gut permeability as a driver of systemic inflammation in critical illness. Thus, the therapeutic potential for an agent to prevent gut barrier compromise and attenuate gu ... Full text Link to item Cite

Glutamine's protection against cellular injury is dependent on heat shock factor-1.

Journal Article Am J Physiol Cell Physiol · June 2006 Glutamine (GLN) has been shown to protect cells, tissues, and whole organisms from stress and injury. Enhanced expression of heat shock protein (HSP) has been hypothesized to be responsible for this protection. To date, there are no clear mechanistic data ... Full text Link to item Cite

Glutamine: the first clinically relevant pharmacological regulator of heat shock protein expression?

Journal Article Curr Opin Clin Nutr Metab Care · May 2006 PURPOSE OF REVIEW: It is well known that enhanced heat shock protein expression protects organisms against morbidity and mortality following experimental injury/illness. Presently, chemical/gene therapy based laboratory methods of enhancing heat shock prot ... Full text Link to item Cite

Effects of HSP70.1/3 gene knockout on acute respiratory distress syndrome and the inflammatory response following sepsis.

Journal Article Am J Physiol Lung Cell Mol Physiol · May 2006 Heat shock response has been implicated in attenuating NF-kappaB activation and inflammation following sepsis. Studies utilizing sublethal heat stress or chemical enhancers to induce in vivo HSP70 expression have demonstrated survival benefit after experim ... Full text Link to item Cite

The glutamine story: where are we now?

Journal Article Curr Opin Crit Care · April 2006 PURPOSE OF REVIEW: A recent editorial proclaimed, 'Glutamine, a life saving nutrient, but why?' This review will assess if recent data support glutamine as a life-saving nutrient in critical illness, and, if so, utilize new understanding of gene-nutrient i ... Full text Link to item Cite

Oral glutamine enhances heat shock protein expression and improves survival following hyperthermia.

Journal Article Shock · March 2006 No pharmacologic agent has shown benefit in treating heatstroke. Previous data indicate that enhanced heat shock protein 70 (HSP-70) expression can improve survival postexperimental heatstroke. Glutamine (GLN) can enhance HSP-70 expression in other injury ... Full text Link to item Cite

Glutamine attenuation of cell death and inducible nitric oxide synthase expression following inflammatory cytokine-induced injury is dependent on heat shock factor-1 expression.

Journal Article JPEN J Parenter Enteral Nutr · 2006 BACKGROUND: Glutamine (GLN) has been shown to improve outcome after experimental and clinical models of critical illness. Enhanced expression of heat shock protein (HSP) has been hypothesized to be responsible for this protection. The heat shock response h ... Full text Link to item Cite

Glutamine-mediated attenuation of cellular metabolic dysfunction and cell death after injury is dependent on heat shock factor-1 expression.

Journal Article JPEN J Parenter Enteral Nutr · 2006 BACKGROUND: Cellular metabolic dysfunction is associated with occurrence of multiple-organ failure after critical illness. Glutamine (GLN) attenuates cellular metabolic dysfunction in critical illness models. The mechanism of this protection is unclear. We ... Full text Link to item Cite

GLUTAMINE PREVENTS ACTIVATION OF NF-kappaB AND STRESS KINASE PATHWAYS, ATTENUATES INFLAMMATORY CYTOKINE RELEASE, AND PREVENTS ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) FOLLOWING SEPSIS.

Journal Article Shock · December 2005 Glutamine (GLN) has been shown to attenuate cytokine release from LPS-stimulated human peripheral blood mononuclear cells; however, the in vivo antiinflammatory effect of GLN in polymicrobial sepsis and ARDS is unknown. This study evaluates the effect of G ... Full text Link to item Cite

GLUTAMINE PREVENTS ACTIVATION OF NF-kappaB AND STRESS KINASE PATHWAYS, ATTENUATES INFLAMMATORY CYTOKINE RELEASE, AND PREVENTS ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) FOLLOWING SEPSIS.

Journal Article Shock (Augusta, Ga.) · December 1, 2005 Glutamine (GLN) has been shown to attenuate cytokine release from LPS-stimulated human peripheral blood mononuclear cells; however, the in vivo antiinflammatory effect of GLN in polymicrobial sepsis and ARDS is unknown. This study evaluates the effect of G ... Cite

Parenteral glutamine increases serum heat shock protein 70 in critically ill patients.

Journal Article Intensive Care Med · August 2005 OBJECTIVE: Heat shock protein 70 (HSP-70) is protective against cellular and tissue injury. Increased serum HSP-70 levels are associated with decreased mortality in trauma patients. Glutamine (Gln) administration increases serum and tissue HSP-70 expressio ... Full text Link to item Cite

Glutamine attenuates lung injury and improves survival after sepsis: role of enhanced heat shock protein expression.

Journal Article Crit Care Med · June 2005 OBJECTIVE: Heat shock protein (HSP) expression is vital to cellular and tissue protection after stress or injury. However, application of this powerful tool in human disease has been limited, as known enhancers of HSPs are toxic and not clinically relevant ... Full text Link to item Cite

Glutamine attenuates endotoxin-induced lung metabolic dysfunction: potential role of enhanced heat shock protein 70.

Journal Article Nutrition · February 2005 OBJECTIVE: Septic shock leads to derangement of cellular metabolism. Enhanced heat shock protein 70 (HSP-70) can preserve cellular metabolism after other forms of cellular stress. Glutamine (GLN) can enhance lung HSP-70 expression after lethal endotoxemia. ... Full text Link to item Cite

Glutamine, heat shock protein, and inflammation - Opportunity from the midst of difficulty

Journal Article South African Journal of Clinical Nutrition · January 1, 2004 Full text Cite

Prevention of chemotherapy and radiation toxicity with glutamine.

Journal Article Cancer Treat Rev · December 2003 GOALS OF THE WORK: Malignancy produces a state of physiologic stress that is characterized by a relative deficiency of glutamine, a condition that is further exacerbated by the effects of cancer treatment. Glutamine deficiency may impact on normal tissue t ... Full text Link to item Cite

Clinical applications of L-glutamine: past, present, and future.

Journal Article Nutr Clin Pract · October 2003 OBJECTIVE: This review will attempt to summarize recent clinical data on glutamine's use. It will present the concept of glutamine as a "drug" or "nutraceutical," given in addition to standard nutrition support. Key references will be discussed, and clinic ... Full text Link to item Cite

Role of L-glutamine in critical illness: new insights.

Journal Article Curr Opin Clin Nutr Metab Care · March 2003 PURPOSE OF REVIEW: This review will attempt to summarize recent clinical and experimental data on glutamine's use in critical illness. It will try to present the concept of glutamine as a 'drug' or 'nutraceutical', given in addition to standard nutritional ... Full text Link to item Cite

Single dose of glutamine enhances myocardial tissue metabolism, glutathione content, and improves myocardial function after ischemia-reperfusion injury.

Journal Article JPEN J Parenter Enteral Nutr · 2003 BACKGROUND: Myocardial ischemia and reperfusion (I/R) injury causes significant morbidity and mortality. Protection against I/R injury may occur via preservation of tissue metabolism and ATP content, preservation of reduced glutathione, and stimulation of ... Full text Link to item Cite

Distance of cecum ligated influences mortality, tumor necrosis factor-alpha and interleukin-6 expression following cecal ligation and puncture in the rat.

Journal Article Eur Surg Res · 2003 BACKGROUND/AIM: A mainstay of laboratory research into new therapies for sepsis has been the cecal ligation and puncture (CLP) model in rodents. Previous data indicate that the number of punctures made in the cecum and needle size utilized are primary dete ... Full text Link to item Cite

Glutamine preserves cardiomyocyte viability and enhances recovery of contractile function after ischemia-reperfusion injury.

Journal Article JPEN J Parenter Enteral Nutr · 2003 BACKGROUND: Glutamine has been shown to protect against cellular injury in in vitro gut epithelial cells and in vivo in the septic rat. Glutamine's effect on the cardiomyocyte has not been explored. We tested the hypothesis that glutamine can enhance heat ... Full text Link to item Cite

Glutamine attenuates tumor necrosis factor-alpha release and enhances heat shock protein 72 in human peripheral blood mononuclear cells.

Journal Article Nutrition · January 2003 OBJECTIVE: Overexpression of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) can contribute to multiple organ dysfunction syndrome and septic shock in critically ill patients. We previously found that glutamine (GLN) can attenuat ... Full text Link to item Cite

Intravenous glutamine administration after major burn injury: Nutrition or pharmacology?

Journal Article International Journal of Intensive Care · December 1, 2002 The use of intravenous nutrition or total parenteral nutrition (TPN) has been shown to increase infectious morbidity in severely burned patients. Based on this, the use of intravenous nutrition following burn injury has right-fully fallen out of favour. Ho ... Cite

Glutamine and heat shock protein expression.

Journal Article Nutrition · March 2002 The most basic mechanism of cellular protection involves the expression of a highly conserved family of essential proteins, known as heat shock or stress proteins (HSPs). The expression of these proteins after a sublethal insult can induce "stress toleranc ... Full text Link to item Cite

Intermittent isoflurane does not attenuate hyperoxic lung injury in the rat

Journal Article CRITICAL CARE MEDICINE · December 1, 2001 Link to item Cite

Glutamine administration reduces Gram-negative bacteremia in severely burned patients: a prospective, randomized, double-blind trial versus isonitrogenous control.

Journal Article Crit Care Med · November 2001 OBJECTIVE: To determine the effect of intravenous glutamine supplementation vs. an isonitrogenous control on infectious morbidity in severely burned patients. Previous clinical studies in seriously ill patients suggest a beneficial effect of glutamine on i ... Full text Link to item Cite

Glutamine reduces cytokine release, organ damage, and mortality in a rat model of endotoxemia.

Journal Article Shock · November 2001 Clinical trials have demonstrated that glutamine (GLN) supplementation can decrease infectious morbidity and improve survival in a number of settings of critical illness. The mechanism of this protection remains unclear. The objective of this study was to ... Full text Link to item Cite

Glutamine induces heat shock protein and protects against endotoxin shock in the rat.

Journal Article J Appl Physiol (1985) · June 2001 Enhanced expression of heat shock protein (HSP) has been shown to be protective against laboratory models of septic shock. Induction of HSPs to improve outcome in human disease has not been exploited because laboratory induction agents are themselves toxic ... Full text Link to item Cite

Heat shock protein induction in heart and lung tissue after glutamine infusion

Journal Article ANESTHESIA AND ANALGESIA · February 1, 2000 Link to item Cite

Editors' Introduction

Journal Article Public Choice: Empirical Studies in Comparative Politics · 1998 Cite

Glutamine protects intestinal epithelial cells: role of inducible HSP70.

Journal Article Am J Physiol · April 1997 Glutamine (Gln) protects gut mucosa against injury and promotes mucosal healing. Because the induction of heat shock proteins (HSP) protects cells under conditions of stress, we determined whether Gln conferred protection against stress in an intestinal ep ... Full text Link to item Cite

Glutamine protects intestinal epithelial cells: Role of inducible HSP70

Journal Article AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY · April 1, 1997 Link to item Cite

Chronic pouchitis after ileal pouch-anal anastomosis: responses to butyrate and glutamine suppositories in a pilot study.

Journal Article Mayo Clin Proc · October 1993 Nonspecific, idiopathic inflammation of ileal pouch mucosa ("pouchitis") after ileal pouch-anal anastomosis is a common complication of this surgical approach. The epithelium of the pouch is ileal, but variable degrees of colonic metaplasia are natural seq ... Full text Link to item Cite