Hot off the press: JAMA article and accompanying editorial on pharmaconutrition in acute lung injury
Lauren
American Medical Association, entitled "Enteral Omega-3 Fatty Acid, γ-
Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury."
You can access the article online by clicking here:
http://jama.ama-assn.org/content/306/14/1574.full.pdf+html
There is also an accompanying editorial by Deborah Cook and Daren
Heyland entitled "Pharmaconutrition in Acute Lung Injury," which you
can read here:
http://jama.ama-assn.org/content/306/14/1599.full.pdf+html
Cheers
Lauren
JRCF
-----Original Message-----
From: criticalca...@googlegroups.com [mailto:criticalca...@googlegroups.com] On Behalf Of Melinda Heidebrecht
Sent: Friday, October 14, 2011 8:21 AM
To: criticalca...@googlegroups.com
Subject: RE: [Critical Care Nutrition] Hot off the press: JAMA article and accompanying editorial on pharmaconutrition in acute lung injury
A lot to think about......seems omega 3's may not be the magic bullet that they thought it would be.
Melinda Heidebrecht, RD
Clinical Nutrition, In patient and Health First Ross Memorial Hospital
10 Angeline St. N
Lindsay, ON
K9V 4M8
324-6111 ext 4946
Cheers
Lauren
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Merin Kinikini
I thought Daren's editorial was good, and having been a participant of this study all these concerns are valid. Even Dr. Rice was specific in stating that based on this study, bolus dosing of fish oil was not effective but he could not comment on fish oils within formula.
One thing I will also point out with this study.... the control group mortality was much lower than the usual mortality rate in patients with ARDS. What was different about these patients or their care?
I think we still don't know the right answer with regards to antioxidants and fish oils. In our hospital we use these types of formulas in our critical care patients all the time. They are high-protein (Oxepa is moderate protein), low CHO, contain di-peptides, are relatively fluid restricted, and contain small amounts of soluble fiber rather than standard fiber. The addition of glutamine, fish oils, antioxidants and in many cases arginine have not shown harm in these patients (sepsis and arginine is still a debate). Many studies have shown benefit, and clinically our patients seem to do very well. Why wouldn't you utilize all your resources in caring for these very sick patients?
Finally, our center just finished hosting several physician's as part of the Nestle Fellowship program. We discussed immunonutrition and fish oil, specifically this study. It seems to be the consensus in the literature, and throughout nutrition support teams, to continue to utilize these formulas. We no longer recommend bolus doses of fish oil in critical care, but our cardiology service places many patients on fish oil prior to their elective cases because of the data regarding atrial fibrillation reduction.
Hopefully more centers can become involved in randomized trials and we can get better answers to help guide us in the future.
Merin Kinikini, RD, FNP, CNSC
IMC Nutrition Support Service
Salt Lake City, Utah 84105
-----Original Message-----
From: criticalca...@googlegroups.com [mailto:criticalca...@googlegroups.com] On Behalf Of Melinda Heidebrecht
Sent: Friday, October 14, 2011 6:21 AM
To: criticalca...@googlegroups.com
Subject: RE: [Critical Care Nutrition] Hot off the press: JAMA article and accompanying editorial on pharmaconutrition in acute lung injury
A lot to think about......seems omega 3's may not be the magic bullet that they thought it would be.
Melinda Heidebrecht, RD
Clinical Nutrition, In patient and Health First
Ross Memorial Hospital
10 Angeline St. N
Lindsay, ON
K9V 4M8
324-6111 ext 4946
-----Original Message-----
From: criticalca...@googlegroups.com [mailto:criticalca...@googlegroups.com] On Behalf Of Lauren
Sent: Thursday, October 13, 2011 5:06 PM
To: Critical Care Nutrition
Subject: [Critical Care Nutrition] Hot off the press: JAMA article and accompanying editorial on pharmaconutrition in acute lung injury
Cheryl Sabillo
What high protein low CHO formula do you use for the ARDS patients? May I ask for your omega 3 FA protocol for your cardiac patients? We also have the same issue. We have been trying to put this in place. Our pharmacy cannot find a cost effective product.
Thanks.
Cheryl