Biomedical subjects

D J Bryg

Publications and source records attributed to D J Bryg.

3 recordsLinked to original sources

PubMed2000

An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients.

OBJECTIVE: To determine whether early enteral feeding in a septic intensive care unit (ICU) population, using a formula supplemented with arginine, mRNA, and omega-3 fatty acids from fish oil (Impact), improves clinical outcomes, when compared with a common use, high protein enteral feed without these nutrients. DESIGN: A prospective, randomized, multicentered trial. SETTING: ICUs of six hospitals in Spain. PATIENTS: One hundred eighty-one septic patients (122 males, 59 females) presenting for enteral nutrition in an ICU. INTERVENTIONS: Septic ICU patients with Acute Physiology and Chronic Health Evaluation (APACHE) II scores of > or =10 received either an enteral feed enriched with arginine, mRNA, and omega-3 fatty acids from fish oil (Impact), or a common use, high protein control feed (Precitene Hiperproteico). MEASUREMENTS AND MAIN RESULTS: One hundred seventy-six (89 Impact patients, 87 control subjects) were eligible for intention-to-treat analysis. The mortality rate was reduced for the treatment group compared with the control group (17 of 89 vs. 28 of 87; p < .05). Bacteremias were reduced in the treatment group (7 of 89 vs. 19 of 87; p = .01) as well as the number of patients with more than one nosocomial infection (5 of 89 vs. 17 of 87; p = .01). The benefit in mortality rate for the treatment group was more pronounced for patients with APACHE II scores between 10 and 15 (1 of 26 vs. 8 of 29; p = .02). CONCLUSIONS: Immune-enhancing enteral nutrition resulted in a significant reduction in the mortality rate and infection rate in septic patients admitted to the ICU. These reductions were greater for patients with less severe illness.

APACHE↗

PubMed1999

Immunonutrition in the critically ill: a systematic review of clinical outcome.

OBJECTIVE: To perform a meta-analysis addressing whether enteral nutrition with immune-enhancing feeds benefits critically ill patients after trauma, sepsis, or major surgery. DATA SOURCES: Studies were identified by MEDLINE search (1967 to January 1998) for original articles in English using the search terms "human," "enteral nutrition," "arginine," "nucleotides," "omega-3 fatty acids," "immunonutrition," "IMPACT," and "Immun-Aid." Additionally, the authors of the studies and the manufacturers of the feeds were contacted for additional information. Access to original databases was obtained for the three largest studies. STUDY SELECTION: Fifteen randomized controlled trials comparing patients receiving standard enteral nutrition with patients receiving a commercially available immune-enhancing feed with arginine with or without glutamine, nucleotides, and omega-3 fatty acids were identified by two independent reviewers (Dr. Beale and Dr. Bryg). DATA EXTRACTION: Descriptive and outcome data were extracted independently from the papers by the same two reviewers, one of whom (Dr. Bryg) analyzed the original databases. Three studies were excluded from analysis, leaving 12 studies containing 1,557 subjects, 1,482 of whom were analyzed. Main outcome measures were mortality, infection, ventilator days, intensive care unit stay, hospital stay, diarrhea days, calorie intake, and nitrogen intake. The meta-analysis was performed on an intent-to-treat basis. DATA SYNTHESIS: There was no effect of immunonutrition on mortality (relative risk = 1.05, confidence interval [CI] = 0.78, 1.41; p = .76). There were significant reductions in infection rate (relative risk = 0.67, CI = 0.50, 0.89; p = .006), ventilator days (2.6 days, CI = 0.1, 5.1; p = .04), and hospital length of stay (2.9 days, CI = 1.4, 4.4; p = .0002) in the immunonutrition group. CONCLUSIONS: The benefits of enteral immunonutrition were most pronounced in surgical patients, although they were present in all groups. The reduction in hospital length of stay and infections has resource implications.

Critical Care↗

PubMedDate not supplied

Continuous trees and NEVADA simulation: a quadrature approach to modeling continuous random variables in decision analysis.

This paper introduces an improved technique for modeling risk and decision problems that have continuous random variables and probabilistic dependence. Variables are modeled with mixtures of four-parameter random variables, called "continuous trees." Functions of random variables are calculated using gaussian quadrature in a manner called "Nevada simulation" (NumErical Integration of Variance And probabilistic Dependence Analyzer). This technique is compared with traditional decision-tree modeling in terms of analytic technique, solution-time complexity, and accuracy. Nevada simulation takes advantage of the probabilistic independence in a decision problem while allowing for probabilistic dependence to achieve polynomial computational-time complexity for many decision problems. It improves on the accuracy of traditional decision trees by employing larger approximations than traditional decision analysis. It improves on traditional decision analysis by modeling continuous variables with continuous, rather than discrete, distributions. A Bayesian analysis using a mixed discrete-continuous probability distribution for cigarette smoking rate is presented.

Algorithms↗