Showcases & Background Setting Bar

Showcases

Background Image

This setting is only taking a look when select color and background.
If you want to set showcase color, background and disable Setting Bar, go to Templates Manager > AT-Templates > Global Tab

 

Critical Care Nutrition at the Clinical Evaluation Research Unit (CERU)

is dedicated to improving nutrition therapies in the critically ill through knowledge generation, synthesis, and translation. We engage in a broad range of research activities and promote a culture of best practices in critical care nutrition. Ultimately, this will result in improved clinical outcomes for critically ill patients and increased efficiencies to our health care systems.

General information:
Over the past decade, there have been significant advances in our understanding of the role of nutrition in general, and key nutrients specifically, in the treatment of critically ill patients. Over 40 years ago, when artificial nutrition was developed, it was conceived of as supportive care, as administering metabolic support while the patient recovers from their underlying illness.  Nutrition support teams were developed, malnourished and catabolic patients were identified, measurements and calculations were done, and artificial nutrition was provided to minimize the loss of protein, calories, and micronutrients associated with inflammatory conditions. During this era, very few large-scale trials informed practice patterns. It seemed that as long as the nutrition interventions ‘restored' deficient substrates or reduced the loss of expended substrates, it was provided to broad, heterogeneous groups of patients, with little regard for its effect on clinically important outcomes.  Debates over energy requirements or protein loss dominated the discussion.  Over the last decade, with the application of meta-analytic techniques, and larger randomized clinical trials, stronger signals of therapeutic effect have appeared. Our nutritional strategies appeared to be making an impact on patient outcomes as recently summarized in the form of clinical practice guidelines (i). What was most illuminating from this review process was that the largest treatment effects on clinically important outcomes were from studies of specific nutrients, such as glutamine, antioxidants, fish oils, and arginine.  Thus, the concept of pharmaconutrition emerged.  Distinct from the historical concepts, this new treatment paradigm embraced the fact that nutrients (and some nutritional strategies) have profound effects on underlying inflammatory, immunological, metabolic, and other pathophysiological processes of critically ill patients. The focus was on understanding the influence of these nutrients on the underlying disease process and subsequent clinical outcomes, and less about nitrogen balance or energy requirements.  We have moved from supporting patients while they recover from their underlying illness to modulating that disease response and improving the chances of survival.



Listen to the Podcast of Dr. Daren Heyland on Pharmaconutrition here, presented by the Society of Critical Care Medicine (SSCM)



Recently published reviews:

  • Jones, N. E. Heyland, D. K. Pharmaconutrition: a new emerging paradigm. Current Opinion in Gastroenterology. 2008: 24: 215-222. Pubmed Abstract
  • Wischmeyer, P. E. Glutamine: role in critical illness and ongoing clinical trials. Current Opinion in Gastroenterology. 2008: 24: 190-197. Pubmed Abstract
  • Heyland DK, Jones N, Cvijanovich NZ, Wong H. Zinc supplementation in critically ill patients: a key pharmaconutrient?  JPEN 2008 32(5):509 19. Pubmed Abstract


See the Presentations section for information on Pharmaconutrition.

See the CPGs for randomized controlled trials in pharmaconutrition.

 


 

 

REDOXS manuscripts have been published!

We are happy to announce that the REDOXS Study has officially been closed and that the results have been published in the New England Journal of Medicine. You may view the article here as well as an accompanying NIBBLE (Nutrition Information Byte), a 2-page concise summary of the impact of REDOXS on the future use of glutamine in critically ill patients. Following the publication of the MetaPlus trial, a second NIBBLE was written regarding glutamine supplementation.

A post-hoc analysis by Heyland et al was published in JPEN re-evaluating the effect of glutamine and antioxidant supplementation after controlling for baseline covariates. Results showed that early high doses of glutamine were not beneficial and may have been associated with increased mortality in the critically ill with multi-organ failure. The most harm was seen with both glutamine and antioxidant supplementation in the critically ill with a diagnosis of multi-organ failure including renal failure at time of study enrollment. 


On behalf of Dr. Heyland, Rupinder Dhaliwal, Janet Overvelde and the Critical Care Nutrition and Clinical Evaluation Research Unit teams, we would like to thank all our participating sites and collaborators for their support over the years! Here are some important highlights of the research related to the REDOXS Study:

  • 2004-2005 REDOXS Dose Escalating Study
  • 2005-2006 REDOXS Pilot Study
  • 2007-2012 REDOXS Multicentre Definitive Study in which
    • 5 countries participated i.e. Canada, US, Germany, Switzerland & Germany
    • 45 sites screened 5639 patients to recruit 1223 patients and collected 355,893 pieces of data!
Thanks for helping us complete this important study which has led to important findings in critical care nutrition.
 
If you have any questions, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..
 

 

The REDOXS© Circular provides invaluable updates on enrollment, data entry, regulatory and pharmacy issues, reminders and Frequently Asked Questions. The REDOXS© Bulletin provides in-depth coverage of current issues of interest.


Frequently Asked Questions featured in REDOXS© circula
r

Frequently Asked Questions

REDOXS© Circular



REDOXS© Bulletin

The resources below have been provided for the sites actively participating in the REDOXS© Study. The information will be useful for Site Investigators, Research Coordinators, Dietitians, Pharmacists and Pharmacy Technicians.
[Right Click on the links: pdf or doc to Save the Target Document.]

Study Procedures Manual

Administration of Study Supplements   pdf
Administration of Study Supplemens - EU version   pdf
Implementation Manual   pdf
Protocol Violations   pdf
Serious Adverse Events*Sept 2008*   pdf
SAE Initial Report Form   pdf
SAE Follow-up Report Form   pdf
Pharmacy Manual   pdf
Pharmacy Manual - EU version   pdf
Pharmacy Worksheets doc pdf
Pharmacy Worksheets - EU version doc pdf
Dietitian Manual   pdf
Research Coordinator Worksheets   pdf
Daily Monitoring Log doc pdf
SF36
English (Canadian)   pdf
French (Canadian)   pdf
Child's class C liver disease   pdf
PF ratio table   pdf
Unit conversion calculator   xls
Algorithm for elevated urea   pdf
Lab Study Manual   pdf
Conversion Table for FiO2 when on Mask or Nasal Cannula   pdf
 
Annotated CRF   pdf
  • Early Enteral Nutrition in the ICU: The Clock is Ticking!
  • NIBBLE: The Importance of Nutritional Adequacy (Or Avoiding Caloric Debt)
  • NIBBLE: Strategies to Deal with GI Intolerance
  • Poster Template for Nutrition Improvement Targets:
Powered by Amazing-Templates.com 2014 - All Rights Reserved.