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Michael P. Casaer - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Sascha Verbruggen, Pieter J Wouters, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Dieter Mesotten, Ilse Vanhorebeek, Michael P. CasaerAbstract:Recent trials have questioned the benefit of early Parenteral nutrition in adults. The effect of early Parenteral nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral nutrition for 1 week (i.e., providing late Parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral nutrition, Parenteral nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral nutrition, Parenteral nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral nutrition, as compared with 18.5% in the group receiving early Parenteral nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral nutrition for 1 week in the ICU was clinically superior to providing early Parenteral nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Sascha Verbruggen, Pieter J Wouters, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Dieter Mesotten, Ilse Vanhorebeek, Michael P. CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral nutrition in adults. The effect of early Parenteral nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral nutrition for 1 week (i.e., providing late Parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral nutrition, Parenteral nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral nutrition, Parenteral nutrition was not provided until the morning o...
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Impact of Early Parenteral Nutrition on Metabolism and Kidney Injury
Journal of The American Society of Nephrology, 2013Co-Authors: Jan Gunst, Pieter J Wouters, Jasperina Dubois, Miet Schetz, Greet Hermans, Ilse Vanhorebeek, Michael P. Casaer, Kathleen Claes, Greet Van Den BergheAbstract:A poor nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early Parenteral nutrition to supplement insufficient enteral nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding Parenteral nutrition for 1 week. Whether early versus late Parenteral nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of Parenteral nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early Parenteral nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late Parenteral nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early Parenteral nutrition. In conclusion, early Parenteral nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early Parenteral nutrition.
Thomas Hartung - One of the best experts on this subject based on the ideXlab platform.
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Assessment of pyrogenic contaminations with validated human whole-blood assay
Nature Protocols, 2009Co-Authors: Mardas Daneshian, Sonja Von Aulock, Thomas HartungAbstract:We present an internationally validated protocol for the evaluation of pyrogenic contaminations using human whole blood. In the in vitro pyrogen test (IPT) the sample is incubated with fresh or cryopreserved human whole blood, and the proinflammatory cytokine interleukin-1β (IL-1β) is detected by enzyme-linked immunosorbent assay (ELISA). In addition to detecting pyrogenic contaminations in aqueous samples, e.g., Parenteral drugs; adaptations allow the assessment of lipidic, toxic or immunomodulatory substances; detection of low-grade contaminations in large-volume Parenterals, e.g., dialysis water and fluids; pyrogenicity assessment of solid materials, e.g., medical devices; and evaluation of airborne pyrogenic burden. In contrast to the rabbit pyrogen test and the limulus amoebocyte lysate (LAL) test, it requires no components of animal origin. In comparison with the LAL, it also detects nonlipopolysaccharide pyrogens. In comparison with other monocyte activation tests it requires no cell preparation steps or cell culture facilities. The procedure takes 21–35 h to complete.
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Assessment of pyrogenic contaminations with validated human whole-blood assay
Nature Protocols, 2009Co-Authors: Mardas Daneshian, Sonja Von Aulock, Thomas HartungAbstract:We present an internationally validated protocol for the evaluation of pyrogenic contaminations using human whole blood. In the in vitro pyrogen test (IPT) the sample is incubated with fresh or cryopreserved human whole blood, and the proinflammatory cytokine interleukin-1β (IL-1β) is detected by enzyme-linked immunosorbent assay (ELISA). In addition to detecting pyrogenic contaminations in aqueous samples, e.g., Parenteral drugs; adaptations allow the assessment of lipidic, toxic or immunomodulatory substances; detection of low-grade contaminations in large-volume Parenterals, e.g., dialysis water and fluids; pyrogenicity assessment of solid materials, e.g., medical devices; and evaluation of airborne pyrogenic burden. In contrast to the rabbit pyrogen test and the limulus amoebocyte lysate (LAL) test, it requires no components of animal origin. In comparison with the LAL, it also detects nonlipopolysaccharide pyrogens. In comparison with other monocyte activation tests it requires no cell preparation steps or cell culture facilities. The procedure takes 21–35 h to complete.
Thérèse Rouleau - One of the best experts on this subject based on the ideXlab platform.
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Reduced bile flow associated with Parenteral nutrition is independent of oxidant load and Parenteral multivitamins
Journal of pediatric gastroenterology and nutrition, 2005Co-Authors: Jean-claude Lavoie, Philippe Chessex, Cindy Gauthier, Emile Levy, Fernando Alvarez, Patrick St-louis, Thérèse RouleauAbstract:ABSTRACTBackground:Reduction in bile flow is a characteristic of cholestasis related to Parenteral nutrition. Light exposure of Parenteral multivitamin preparations is the major source of peroxides contaminating Parenteral nutrition solutions. They may contribute to local oxidative stress. Oxidants
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Photoprotection of solutions of Parenteral nutrition decreases the infused load as well as the urinary excretion of peroxides in premature infants.
Seminars in Perinatology, 2001Co-Authors: Philippe Chessex, Sophie Laborie, Jean-claude Lavoie, Thérèse RouleauAbstract:Light exposure and multivitamins are contributing factors to the generation of peroxides in solutions of Parenteral nutrition. This article verifies if peroxides infused with Parenteral nutrition are of biological significance in neonates. The mechanisms responsible for the generation of peroxides in total Parenteral nutrition solutions are reviewed. The consequences of infused peroxides on an index of oxidant stress and on levels of a central antioxidant are evaluated in an animal model. The effect of photoprotection of Parenteral nutrition on a biological marker of redox imbalance is evaluated in the urine of premature infants. Parenteral multivitamins produce a drop in glutathione and an oxidant stress similar to peroxides in the lungs of newborn guinea pigs. Infused peroxides elicited an increased urinary peroxide excretion in infants receiving Parenteral nutrition exposed to light. Photoprotection reduced levels of infused and excreted peroxides. The results suggest that peroxides infused with total Parenteral nutrition are not fully quenched by premature infants.
Mardas Daneshian - One of the best experts on this subject based on the ideXlab platform.
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Assessment of pyrogenic contaminations with validated human whole-blood assay
Nature Protocols, 2009Co-Authors: Mardas Daneshian, Sonja Von Aulock, Thomas HartungAbstract:We present an internationally validated protocol for the evaluation of pyrogenic contaminations using human whole blood. In the in vitro pyrogen test (IPT) the sample is incubated with fresh or cryopreserved human whole blood, and the proinflammatory cytokine interleukin-1β (IL-1β) is detected by enzyme-linked immunosorbent assay (ELISA). In addition to detecting pyrogenic contaminations in aqueous samples, e.g., Parenteral drugs; adaptations allow the assessment of lipidic, toxic or immunomodulatory substances; detection of low-grade contaminations in large-volume Parenterals, e.g., dialysis water and fluids; pyrogenicity assessment of solid materials, e.g., medical devices; and evaluation of airborne pyrogenic burden. In contrast to the rabbit pyrogen test and the limulus amoebocyte lysate (LAL) test, it requires no components of animal origin. In comparison with the LAL, it also detects nonlipopolysaccharide pyrogens. In comparison with other monocyte activation tests it requires no cell preparation steps or cell culture facilities. The procedure takes 21–35 h to complete.
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Assessment of pyrogenic contaminations with validated human whole-blood assay
Nature Protocols, 2009Co-Authors: Mardas Daneshian, Sonja Von Aulock, Thomas HartungAbstract:We present an internationally validated protocol for the evaluation of pyrogenic contaminations using human whole blood. In the in vitro pyrogen test (IPT) the sample is incubated with fresh or cryopreserved human whole blood, and the proinflammatory cytokine interleukin-1β (IL-1β) is detected by enzyme-linked immunosorbent assay (ELISA). In addition to detecting pyrogenic contaminations in aqueous samples, e.g., Parenteral drugs; adaptations allow the assessment of lipidic, toxic or immunomodulatory substances; detection of low-grade contaminations in large-volume Parenterals, e.g., dialysis water and fluids; pyrogenicity assessment of solid materials, e.g., medical devices; and evaluation of airborne pyrogenic burden. In contrast to the rabbit pyrogen test and the limulus amoebocyte lysate (LAL) test, it requires no components of animal origin. In comparison with the LAL, it also detects nonlipopolysaccharide pyrogens. In comparison with other monocyte activation tests it requires no cell preparation steps or cell culture facilities. The procedure takes 21–35 h to complete.
Tom Fivez - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Sascha Verbruggen, Pieter J Wouters, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Dieter Mesotten, Ilse Vanhorebeek, Michael P. CasaerAbstract:Recent trials have questioned the benefit of early Parenteral nutrition in adults. The effect of early Parenteral nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral nutrition for 1 week (i.e., providing late Parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral nutrition, Parenteral nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral nutrition, Parenteral nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral nutrition, as compared with 18.5% in the group receiving early Parenteral nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral nutrition for 1 week in the ICU was clinically superior to providing early Parenteral nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Sascha Verbruggen, Pieter J Wouters, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Dieter Mesotten, Ilse Vanhorebeek, Michael P. CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral nutrition in adults. The effect of early Parenteral nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral nutrition for 1 week (i.e., providing late Parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral nutrition, Parenteral nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral nutrition, Parenteral nutrition was not provided until the morning o...
