scholarly journals Quantifying Response to Nutrition Therapy During Critical Illness: Implications for Clinical Practice and Research? A Narrative Review

2020 ◽  
Author(s):  
Kate Fetterplace ◽  
Emma J. Ridley ◽  
Lisa Beach ◽  
Yasmine Ali Abdelhamid ◽  
Jeffrey J. Presneill ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Critical Illness ◽  
Nutrition Therapy ◽  
Narrative Review

scholarly journals What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?—A Narrative Review

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 974 ◽  
Author(s):  
Luke E. Grzeskowiak ◽  
Mary E. Wlodek ◽  
Donna T. Geddes
Keyword(s):  
Clinical Practice ◽  
Breast Milk ◽  
Milk Composition ◽  
Narrative Review ◽  
Pharmacological Intervention ◽  
Future Research ◽  
Individual Treatment ◽  
Efficacy And Safety ◽  
Milk Supply ◽  
Insufficient Milk

Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues.

Nutrition support in acute cardiac care

2016 ◽  
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
New Findings ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

Nutrition support in acute cardiac care

2015 ◽  
Author(s):  
Michael P Casaer ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Metabolic Stress ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Critically Ill Patient ◽  
Refeeding Syndrome ◽  
New Findings ◽  
Early Parenteral Nutrition ◽  
And Function

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.

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