1. 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

2. Role of the Dietitian

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

4. 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)

5. RD manual p 13
SS Manual p 16

6. 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

7. 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 !

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

9. 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

10. 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?

11. 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?

12. 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

13. 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

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