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Biomedical subjects

Gordon S Sacks

Publications and source records attributed to Gordon S Sacks.

15 recordsLinked to original sources
PubMed2005

Treatment of electrolyte disorders in adult patients in the intensive care unit.

PURPOSE: The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. SUMMARY: Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. CONCLUSION: Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

Adult↗
PubMed2005

Review of the refeeding syndrome.

Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment.

Humans↗
PubMed2005

Water, water everywhere: dehydration in the elderly.

Dehydration is a common disorder in the frail elderly patient. Understanding the mechanisms by which fluid and electrolyte abnormalities occur, as well as the implications of specific laboratory values, is key to providing optimal diagnosis and treatment. Management of fluid abnormalities relies on gradual rehydration with the proper fluids to restore both fluid and electrolytes.

Journal Article↗
PubMed2004

Enhancing the response to parenteral nutrition in critical care.

Parenteral nutrition (PN) is an essential component in the support of critically ill patients with gastrointestinal dysfunction. Although PN cannot fully reverse hypermetabolism and accelerated skeletal muscle breakdown observed during periods of critical illness, it can prevent the adverse effects associated with malnutrition. The use of PN is not without complications, so care must be taken to ensure successful clinical outcomes with this complex therapy. Strategies have been developed by practitioners to promote safe practices with implementation of PN therapy and optimize a patient's response to PN. Identification of appropriate patient populations, strict glucose control, and manipulation of macro- and micronutrients are techniques being used to augment a patient's response to PN administration. This article will review the novel methods used to enhance benefits received from PN during critical illness.

Journal Article↗
PubMed2003

Controversy of immunonutrition for surgical critical-illness patients.

Specific nutrients such as arginine, glutamine, dietary nucleotides, and omega-3 fatty acids have been shown to influence infectious morbidity, antibiotic use, and hospital length of stay. The combination of these nutrients into one enteral formulation has become known as immune-enhancing diets. Consensus guidelines developed by a number of clinical investigators and published in 2001 concluded that immune-enhancing diets were beneficial in moderate to severely malnourished patients undergoing elective gastrointestinal surgery and patients sustaining severe blunt and penetrating torso trauma. The purpose of this article is to review data published between February 1, 2001, and January 31, 2003, to determine whether new studies substantiated or refuted the current recommendations for the use of immune-enhancing diets in surgical, critically injured, and critically ill patients. Results confirmed the benefits of preoperative administration of immune-enhancing diets in surgical patients but also demonstrated that postoperative administration offered no advantages. Decreased infectious complications were also observed in critically ill patients receiving immune-enhancing diets. Accumulating evidence supports the use of immune-enhancing diets in these specific patient populations.

Arginine↗
PubMed2003

Pneumolysin-dependent and -independent gene expression identified by cDNA microarray analysis of THP-1 human mononuclear cells stimulated by Streptococcus pneumoniae.

Pneumolysin is an important virulence factor of Streptococcus pneumoniae, interacting with the membranes of host cells to elicit a multitude of inflammatory responses. We used cDNA microarrays to identify genes which are responsive to S. pneumoniae in a pneumolysin-dependent and -independent fashion. The THP-1 human monocytic cell line was coincubated for 3 h with medium alone, with the virulent type 2 S. pneumoniae strain D39, or with the isogenic strain PLN, which does not express pneumolysin. RNA was isolated from the monocytes and hybridized on cDNA microarrays. Of 4,133 genes evaluated, 142 were found to be responsive in a pneumolysin-dependent fashion, whereas 40 were found to be responsive independent of pneumolysin. Genes that were up-regulated in cells exposed to D39 relative to those exposed to PLN included genes encoding proteins such as mannose binding lectin 1, lysozyme, alpha-1 catenin, cadherin 17, caspases 4 and 6, macrophage inflammatory protein 1beta (MIP-1beta), interleukin 8 (IL-8), monocyte chemotactic protein 3 (MCP-3), IL-2 receptor beta (IL-2Rbeta), IL-15 receptor alpha (IL-15Ralpha), interferon receptor 2, and prostaglandin E synthase. Down-regulated genes included those encoding complement component receptor 2/CD21, platelet-activating factor acetylhydrolase, and oxidized low-density lipoprotein receptor 1 (OLR1). Pneumolysin-independent responses included down-regulation of the genes encoding CD68, CD53, CD24, transforming growth factor beta2, and signal transducers and activators of transcription 1. These results demonstrate the striking effects of pneumolysin on the host cell upon exposure to S. pneumoniae.

Bacterial Proteins↗
PubMed2003

Maintaining mucosal immunity during parenteral feeding with surrogates to enteral nutrition.

Pneumonia and intra-abdominal abscesses are significantly lower in trauma patients receiving enteral feeding compared with those receiving parenteral feeding. Extensive experimental evidence suggests that this is related to maintenance of the mucosal-associated lymphoid tissue, which provides immunologic protection for both the gastrointestinal and respiratory tracts against microbial flora and infectious pathogens. This system is exquisitely sensitive to the route and type of nutrition delivery that affects its functional effectiveness. Although parenteral nutrition decreases the effectiveness of this extraintestinal mucosal immunity, specialty nutrients like glutamine and neuropeptides such as gastrin-releasing peptide and cholecystokinin are capable of preventing some of the immune defects associated with parenteral nutrition. This review examines the mechanisms associated with the mucosal immunity and role of both glutamine and neuropeptides in normalizing defects induced by parenteral feeding. Based upon evolving data, specific nutrients and products of the enteric nervous system show promise as adjuncts to parenteral feeding that are capable of maintaining immune function in patients unable to be fed via the gastrointestinal tract.

Journal Article↗
PubMed2002

Comparison of continuous vs intermittent nasogastric enteral feeding in trauma patients: perceptions and practice.

Enteral nutrition support (ENS) may be administered by continuous administration or by intermittent bolus, but few studies have compared the advantages and limitations associated with these methods in the trauma patient population. The purpose of this prospective randomized study was to evaluate the impact of continuous vs intermittent nasogastric enteral feeding on gastrointestinal tolerance, pulmonary aspiration, and nutritional indices. A survey of medical and surgical intensive care unit nursing staff was performed to assess perceptions and attitudes toward these 2 delivery methods. Eighteen trauma patients [Injury Severity Score (ISS) > or = 20] were enrolled in the study; 9 received continuous ENS (CENS) and 9 received intermittent bolus ENS (IENS). Interruption of ENS delivery occurred in more IENS than CENS patients due to elevated residuals and emesis. Diarrhea occurred in more patients (5/9 vs 2/9) and for a longer duration (14/65 vs 6/49 ENS days) in the IENS group compared with the CENS group. Aspiration was detected in 1 IENS patient. Method of nutrient delivery did not seem to influence urine urea nitrogen (UUN) measurements or prealbumin concentrations. Nurses surveyed in the study (n = 25) preferred CENS (84%) compared with IENS (12%). Data from this study suggest that CENS through a nasoenteric feeding tube may facilitate nutrient intake with less gastrointestinal complications in severely injured trauma patients compared with IENS. In addition, the majority of nurses surveyed preferred the continuous method for nutrient delivery.

Journal Article↗
PubMedDate not supplied

Joint Commission for Accreditation of Health Care Organizations guidelines: too late to intervene for nutritionally at-risk surgical patients.

BACKGROUND: Joint Commission for Accreditation of Health Care Organizations (JCAHO) guidelines recommend nutritional screening within 24 hours of hospital admission, with full nutrition assessment if at-risk. This study examines whether these guidelines detect surgical patients who may benefit from preoperative nutrition support. METHODS: A retrospective chart review was conducted for patients undergoing nonemergent esophageal, gastric, pancreatic, or colon surgery between 1996 and 2001 to determine dates of admission, day of surgery, and timing of documented nutrition screening and assessment. RESULTS: Most patients undergo surgery within 24 hours of admission, and undergo initial screening or full assessment after surgery. Twenty percent of patients are admitted for diagnostic testing, preoperative cardiovascular workup, or medical management preoperatively and are assessed 5 to 6 days before surgery, but these are the minority. CONCLUSION: Because of the high incidence of nonemergent surgeries that occur within 24 hours of admission, screening and assessment by JCAHO guidelines cannot detect patients who may benefit from preoperative nutrition support. Systems to identify these patients must be implemented earlier in nutrition screening and assessment.

Elective Surgical Procedures↗
PubMedDate not supplied

Parenteral nutrition safe practices: results of the 2003 American Society for Parenteral and Enteral Nutrition survey.

BACKGROUND: The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently published a revision of its "Safe Practices for Parenteral Nutrition" guidelines. Because there is a paucity of published scientific evidence to support good practices related to ordering, compounding, and administering parenteral nutrition (PN), a survey was performed in the process of the revision to gain insight into the discrepancies between reported practices and previous guidelines. METHODS: A web-based survey consisting of 45 questions was conducted (n = 651) June 1-30, 2003. Respondents were queried about primary practice setting, professional background, processes for writing PN orders, computer order entry of PN orders, problems with PN orders, and adverse events related to PN. RESULTS: There were 651 survey responses, 90% of which were from hospital-based practitioners. Almost 75% of responders processed between 0 and 20 PN orders per day. Overall, physicians (78%) were responsible for writing PN orders, but dietitians and pharmacists had significant involvement. PN base components were most often ordered as percentage final concentration after admixture (eg, 20% dextrose), which is inconsistent with safe practice guidelines of ordering by total amount per day (eg, 200 g/day). There was no consistent method for ordering PN electrolytes. Approximately 45% of responders reported adverse events directly related to PN that required intervention. Of these events, 25% caused temporary or permanent harm, and 4.8% resulted in a near-death event or death. CONCLUSIONS: Although the survey found consistency in PN practices for many areas queried, significant variation exists in the manner by which PN is ordered and labeled.

Dietetics↗
PubMedDate not supplied

Use of parenteral nutrition in patients receiving isolated kidney or simultaneous pancreas/kidney transplantation.

BACKGROUND: There is little information available on the use of parenteral nutrition (PN) in patients after a kidney (KID) or simultaneous pancreas-kidney (SPK) transplantation. This study examined the indications and use of PN in these patients. METHODS: Retrospective study of 25 patients (12M/13F; mean age: 51 +/- 11 years old) receiving PN after KID or SPK transplantation. Patients were divided in 2 groups according to the number of PN days (group A = <7 days and group B = >7 days). RESULTS: Overall mortality was 16% (group A: 0/7; group B: 4/18). Postoperative ileus (n = 7), intestinal fistula (n = 5), and nausea/vomiting (n = 4) were the most common indications for PN. Functional disorders accounted for 56% (14/25) of the indications for PN. Factors differentiating group A (7/25; median = 5 [4-6] days) from group B (18/25; median =9 [7-31] days) included a significantly higher preoperative serum albumin, SPK transplantation for the first time, and diagnosis of ileus as the indication for PN initiation. CONCLUSIONS: Functional disorders of the digestive tract are the primary reason for initiation of PN in isolated KID and SPK transplantation patients. Well-nourished patients undergoing their first SPK transplantation who develop postoperative ileus usually do not need nutrition intervention.

Female↗