Enhanced Recovery After Esophageal Resection

Publication date: Available online 7 August 2018Source: Cirugía Española (English Edition)Author(s): Peter Vorwald, Marcos Bruna Esteban, Sonia Ortega Lucea, Jose Manuel Ramírez Rodríguez, Grupo de Trabajo de Cirugía Esofagogástrica del Grupo Español de Rehabilitación Multimodal (GERM)AbstractEnhanced recovery after surgery (ERAS) is a multimodal perioperative care program which replaces traditional practices concerning analgesia, intravenous fluids, nutrition, mobilization as well as a number of other perioperative items, whose implementation is supported by evidence-based best practices. According to the RICA guidelines published in 2015, a review of the literature and the consensus established at a multidisciplinary meeting in 2015, we present a protocol that contains the basic procedures of an ERAS pathway for resective esophageal surgery. The measures involved in this ERAS pathway are structured into three areas: preoperative, perioperative and postoperative. The consensus document integrates all the analyzed items in a unique time chart. ERAS programs in esophageal resection surgery can reduce postoperative morbidity, mortality, hospitalization and hospital costs.ResumenLa rehabilitación multimodal constituye un conjunto de medidas perioperatorias que sustituye prácticas tradicionales respecto a la analgesia, la fluidoterapia, la nutrición y la movilización, entre otros. Su implementaci&...
Source: Cirugia Espanola - Category: Surgery Source Type: research

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A co-infusion of parenteral nutrition (PN) and other drugs is often necessary in patients with a limited number of vascular access sites. This practice increases the risk of interaction between drugs and PN admixtures that may be manifested as drug precipitation or lipid emulsion destabilization. The present study aimed to determine the compatibility between vancomycin (VMC) and five ready-to-use PN admixtures utilized worldwide (Kabiven, Nutriflex Lipid Special, Olimel N9E, Nutriflex Omega Special, and Smofkabiven) in order to assess the possibility of their co-administration via Y-sites.
Source: Clinical Nutrition - Category: Nutrition Authors: Tags: Original article Source Type: research
ConclusionInitiation of a stepwise approach for excess nonhemorrhagic pleural drainage based on the amount and rate of drainage achieve a favorable outcomes.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSIONS: In this study, immunonutrition failed to reduce the incidence rates of oral mucositis, diarrhea, or esophagitis but was conducive to significantly improving the severity of oral mucositis and diarrhea esophagitis and reducing the rate of body weight loss. PMID: 31709589 [PubMed - as supplied by publisher]
Source: JPEN Journal Of Parenteral And Enteral Nutrition - Category: Nutrition Authors: Tags: JPEN J Parenter Enteral Nutr Source Type: research
Abstract The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched. Sixty-one randomized controlled trials were included. Immunonutrition was associated with a significantly reduced risk of postoperative infectious complications (risk ratio [RR] 0.71 [95% CI, 0.64-0.79]), including a reduced risk of wound infection (RR 0.72 [95% CI, 0.60-0.87]), respiratory tract infection (RR 0.70 [95% CI, 0.59-0.84]), and urinary tract infection (...
Source: JPEN Journal Of Parenteral And Enteral Nutrition - Category: Nutrition Authors: Tags: JPEN J Parenter Enteral Nutr Source Type: research
Abstract A critically ill patient requiring continuous venovenous hemofiltration therapy received parenteral nutrition through the same commonly used intravascular device. The inclusion of injectable lipid emulsion had an adverse effect on hemofilter function. This was successfully managed first by using lipid-free parenteral nutrition and then by administering the total nutrient admixture via a separate central venous access device. PMID: 31713249 [PubMed - as supplied by publisher]
Source: JPEN Journal Of Parenteral And Enteral Nutrition - Category: Nutrition Authors: Tags: JPEN J Parenter Enteral Nutr Source Type: research
AbstractPurposeIncreased systemic cortisol availability during adult critical illness is determined by reduced binding-proteins and suppressed breakdown rather than elevated ACTH. Dynamics, drivers and prognostic value of hypercortisolism during pediatric critical illness remain scarcely investigated.MethodsThis preplanned secondary analysis of the PEPaNIC-RCT (N = 1440), after excluding 420 children treated with corticosteroids before PICU-admission, documented (a) plasma ACTH, (free)cortisol and cortisol-metabolism at PICU-admission, day-3 and last PICU-day, their prognostic value, and impact of withholding...
Source: Intensive Care Medicine - Category: Intensive Care Source Type: research
Conclusion Patients undergoing laparoscopic CDO repair at our institution benefited from shorter time to full enteral feeds, and reduced the need for PN as well as postoperative pain medication. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research
ConclusionManagement of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.
Source: Obesity Surgery - Category: Surgery Source Type: research
This article summarises some of the important reasons to prioritise breast milk feeding and introduces the Christchurch Neonatal Intensive Care Human Milk Bank. This Milk Bank was opened in 2014 to support babies and their families with the provision of pasteurised donor milk. The primary goals were to support mothers while they established their own milk supply, reduce exposure to parenteral nutrition and formula and reduce the risk of necrotising enterocolitis in this vulnerable population. PMID: 31697667 [PubMed - in process]
Source: New Zealand Medical Journal - Category: General Medicine Tags: N Z Med J Source Type: research
Abstract BACKGROUND: Early introduction of enteral nutrition (EN) in postoperative infants improves intestinal adaptation, reducing the risk of intestinal failure-associated liver disease (IFALD). Our objective was to determine whether guideline use reduces feeding variability and improves outcomes in the neonatal intensive care unit (NICU). METHODS: In a cohort study, surgical infants at risk for IFALD were evaluated pre and post implementation of feeding guidelines at 2 NICUs. A total of 167 guideline infants (2013-2018) were compared with 242 historical controls (2007-2013). Adherence was measured with tim...
Source: JPEN Journal Of Parenteral And Enteral Nutrition - Category: Nutrition Authors: Tags: JPEN J Parenter Enteral Nutr Source Type: research
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