The REDOXS© Study REducing Deaths from OXidative Stress Part 2 of 3

Slides:

Advertisements

Similar presentations

Professor of Medicine Queen’s University, Kingston General Hospital Kingston, Ontario Daren K. Heyland, MD, MSc, FRCPC.

Advertisements

PEP uP Powerpoint - Long Version

Protocol The. I’M HUNGRY! Adequate Nutrition Provides fuel for cellular metabolism Prevents protein/muscle wasting Decreases ventilator time Helps prevent.

The Impact of Enteral Feeding Protocols on Enteral Nutrition Delivery: Results of a multicenter observational study Rupinder Dhaliwal, RD Daren K. Heyland,

The PEP uP Protocol. I’M HUNGRY!! Adequate Nutrition  Provides fuel for cellular metabolism  Prevents protein/muscle wasting  Decreases ventilator.

MAIN FEATURES OF THE PEP uP PROTOCOL All patients will receive Peptamen ® Bariatric initially All patients will start on Beneprotein ® -2 packets (14.

The REDOXS © Study REducing Deaths from OXidative Stress Dietitian and Pharmacy Training March 2009 Study Chair Dr. Daren Heyland, MD, FRCPC Project Leaders.

The REDOXS © Study REducing Deaths from OXidative Stress Sponsor Dr. Daren Heyland, MD, FRCPC Project Leader Rupinder Dhaliwal, BASc, RD.

The REDOXS © Study REducing Deaths from OXidative Stress Study Chair Dr. Daren Heyland, MD, FRCPC Project Leader Rupinder Dhaliwal, BASc, RD.

The REDOXS © Study REducing Deaths from OXidative Stress PART 4 of 4 Sponsor Dr. Daren Heyland, MD, FRCPC Project Leader Rupinder Dhaliwal, BASc, RD.

Protein in Critical illness Evidence and Current Practices Rupinder Dhaliwal, RD Manager, Research & Networking Clinical Evaluation Research Unit Queens.

The PEP uP Protocol. I’M HUNGRY!! Adequate Nutrition  Provides fuel for cellular metabolism  Prevents protein/muscle wasting  Decreases ventilator.

Elena Kuchler BSN, RD, MHA..  The Joint Commission on Hospital Accreditation has guidelines in place to provide appropriate care to all patients admitted.

Parenteral Nutrition Designing the Solution Mark H. DeLegge, MD, FACG, AGAF, FASGE Digestive Disease Center Medical University of South Carolina.

Objectives: To optimize the delivery of EN by implementing the PEP uP protocol in sites across North America. We provide practitioners the opportunity.

Optimizing Nutrition Therapy

Nutrition Information Byte (NIBBLE) Brought to you by and your ICU Dietitianwww.criticalcarenutrition.com Thanks for nibbling.

A RandomizEd Trial of ENtERal Glutamine to MinimIZE Thermal Injury Study Sponsors Dr. Paul Wischmeyer (US) Dr. Dominique Garrel (Canada) Clinical Evaluation.

Parenteral Nutrition This session will provide an overview of parenteral nutrition. Please see the associated chapter in the Manual, titled Parenteral.

Study Procedures & Operational Issues Start-up Meeting March 25, 2010 Kingston, ON.

-- Aim for a healthy weight. -- Become physically active each day. -- Let the (Food Guide) Pyramid guide your food choices. -- Eat a variety of grains.

Nutrition Information Byte (NIBBLE) Brought to you by and your ICU Dietitianwww.criticalcarenutrition.com Several observational.

The REDOXS © Study REducing Deaths from OXidative Stress Part 3 of 3 Sponsor Dr. Daren Heyland, MD, FRCPC Project Leader Rupinder Dhaliwal, BASc, RD.

International Critical Care Nutrition Survey 2009: Defining Gaps in Practice Naomi E Cahill, RD MSc Project Leader Queen’s University and Clinical Evaluation.

Barriers and Facilitators To making it Happen! Daren K. Heyland Professor of Medicine Queen’s University, Kingston General Hospital Kingston, ON Canada.

Metabolic Stress KNH 413 Level of injury depends on amount of calories and protein.

Chapter 9 Enteral Nutrition. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Enteral Tubes An enteral tube is a catheter, stoma, or tube.

Enteral Nutrition Support Fluid and electrolyte requirements. Calculate enteral and parenteral nutrition formulations.

The REDOXS© Study REducing Deaths from OXidative Stress PART 1 of 4

Man’s Food NUTRITIONAL HISTORY Part B NUTRITIONAL HISTORY Part B.

Nutrition Information Byte (NIBBLE) Brought to you by and your ICU Dietitianwww.criticalcarenutrition.com Several observational.

The Impact of Enteral Feeding Protocols on Enteral Nutrition Delivery: Results of a multicenter observational study Rupinder Dhaliwal, RD Daren K. Heyland,

REDOXS Training: Introduction & Site Investigator

+ What to Do When Early Enteral Feeding is Not Possible in Critically Ill Patients? Results of a Multicenter Observational Study Naomi E Cahill RD MSc.

Lecture 10b 21 March 2011 Parenteral Feeding. Nutrients go directly into blood stream bypassing gastrointestinal tract Used when a patient cannot, due.

Role of Dietitian Utilizing the Standardization of Nutrition Practices Assessing Energy needs upon admission to Acute Care Unit (ACU) Assessing Protein.

Nutrition Information Byte (NIBBLE) Brought to you by and your ICU Dietitianwww.criticalcarenutrition.com Thanks for nibbling.

A RandomizEd Trial of ENtERal Glutamine to MinimIZE Thermal Injury: A multicenter Pragmatic RCT (definitive study) Study Sponsor Dr. Daren Heyland Clinical.

Volume-Based Feeding: Remember not to reduce rate of enteral feeding unless the gastric residual volume is >300 ml.

1 بسم الله الرحمن الرحيم. 2 The importance of Enteral Nutrition in critically ill patients Dr Mohammad Safarian.

Therapeutics IV Tutoring Nutrition

Lecture 10b 18 March 2013 Parenteral Feeding. Parenteral Feeding (going around ie circumventing the intestine) Nutrients go directly into blood stream.

Dr Amit Gupta Associate Professor Dept.of Surgery

Total Parenteral Nutrition

Enteral Nutrition & Medications

REducing Deaths due to OXidative Stress

Frontier Lifeline Hospital , Chennai , India Peri-operative Nutrition Supplementation in Congenital Heart Surgery- A clinical audit and plan for Quality.

Nutrition Management of Maple Syrup Urine Disease

The REDOXS© Study REducing Deaths from OXidative Stress Part 1 of 3

Nutrition Guidelines for Pressure Ulcer Prevention and Treatment:

Enteral Feeding Protocol

Pharmcokinetics Allie punke.

Nutrient Delivery To determine Kcal and protein needs, along with appropriate diet medical nutrition therapy is needed SCREEN is a series of nutrition.

REducing Deaths due to OXidative Stress: The REDOXS© Study: Can we provide adequate enteral nutrition to patients with Shock? Rupinder Dhaliwal John.

ICU RAPID RESOURCE 3: TPN TIPS (pg 1) Parenteral Nutrition Orders

International Critical Care Nutrition Survey Defining Gaps in Practice

Nibble The Importance of Nutritional Adequacy

REDOXS Training: Introduction & Site Investigator

1. Volume-Based Feeds: (most patients)

It’s Time to Get PEPPED UP!

Improvement Targets High Performance

The REDOXS© Study REducing Deaths from OXidative Stress

Nibble The Importance of Nutritional Adequacy

The REDOXS© Study REducing Deaths from OXidative Stress PART 2 of 4

The PEP uP Trial Has Begun.

DETERMINING ENERGY REQUIREMENTS: CALORIE CALCULATOR

Nibble Strategies to deal with GI Intolerance Issue 2

1. Volume-Based Feeds: (most patients)

PEP uP Trial starts February 2009

The REDOXS© Study REducing Deaths from OXidative Stress PART 3 of 4

Presentation transcript:

The REDOXS© Study REducing Deaths from OXidative Stress Part 2 of 3 REDOXS Training The REDOXS© Study REducing Deaths from OXidative Stress Part 2 of 3 Sponsor Dr. Daren Heyland, MD, FRCPC Project Leader Rupinder Dhaliwal, BASc, RD October 2007

Role of the Dietitian

Optimizing Enteral Nutrition Canadian CPGs www.criticalcarenutrition.com Feeding Protocol Glycemic Protocol Elevate the Head of the Bed Motility Agents Small Bowel Feeding

Maximize EN nutrient and nutrition delivery RD Manual p 12-17 Maximize EN nutrient and nutrition delivery use of feeding protocols small bowel feeding Minimize interruptions, make up volume Other enteral formulas with supplemental glutamine, vitamins, minerals not allowed No supplements with high amounts of Zinc (5 mg max) Renal Dysfunction Switch to lower protein formula Restrict fluid Refer to appendix (p 14) Pilot study: Interruptions due to high urea only in 2% patient days (9% patients)

RD manual p 13 SS Manual p 16

Baseline Nutrition Dietitian to collect RD Manual p 5,6 Imp Manual p 29,30 Dietitian to collect Prescribed kcal and protein (baseline) Type of nutrition support Start and stop date and times Refer to Dietitian Manual

Collection in real time essential ! Daily Nutrition Data RD Manual p 7,11 Imp Manual p 37-39 Dietitian to collect (for max 30 days): Energy protein intake Add propofol Interruptions Type of enteral formula + location of feeding tube (daily data Collection in real time essential !

Dietitian Checklist Imp Manual: Tools RD Manual: 19,20

Study Supplement Compliance Study coordinator collects Received MUST = prescribed volumes Inform Study Coordinator of interruptions Work with bedside RN Protocol Violation Protocol Deviation Imp Manual p 34

Case study: High GRVs Mr. Smith who is 4 days post laporotomy (findings show bowel is not compromised) has had high gastric residual volumes > 500 mls for the last 48 hours. His enteral feeds have been interrupted several times and are now on hold. The MD in charge has also stopped the enteral study supplements to give the gut a rest and he now wishes to start parenteral nutrition. What to do?

FAQs Do I calculate the calories from propofol if patients are not receiving enteral or parenteral nutrition? What if the prescribed calories and protein changes over the 28 days of the study duration? How do I get a prescribed calorie/protein level if the dietitian has not assessed this?

Case Study: Dosing error REDOXS Pharmacist away for weekend and returns on Monday and after reviewing logs realizes that Mr. J.S accidentally received the wrong supplements. Should have received GLN but received GLN+AOX instead for the last 18 hours. What to do? Stop the infusion immediately Inform research coordinator ASAP, maintain blinding Notify CERU immediately, Note to File Steps to prevent recurrence

FAQs Pharmacy Keep vials of returned/destroyed products? One password for all Pharmacists/technicians? Pharmacist or technician that dispenses the supplements? P. Manual page 16

REDOXS© Circular and Bulletin Questions?? Imp Manual Tools REDOXS© Circular and Bulletin