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| From: | Fri Dec 07 0:00:00 PST 2012 |
| To: | Fri Dec 07 8:00:00 PST 2012 |
| nephondemand | #ecuimres #grandrounds 12/7: Periop Nutrition Intervention in Gastrointestinal Cancer Surgery by J Ochoa; profile here http://t.co/wKFLuMVw | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: nutrition is a medical therapy essential 4 all surgical pts; it is not a supportive therapy at all | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: colorectal sx outcomes from the SCOAP database is unacceptable http://t.co/5EzJD0bs | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: nutrition isn't intuitive; nutritional intervention should b done throughout the entirety of pt care | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: u can actually harm some pts w/nutritional intervention | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: albumin is the single most important discriminator 4 how pts will do p surgery: JPEN 2003 27:1-9 | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: 7 d of TPN periop will reduce post-op complications from 45% to 5% p < 0.03; NEJM 1991 325(8):525 | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: but TPN is difficult 2 manage. If TPN used in NON-malnourished pts, infxn rate triples! NEJM 325(8) | |
| ecuimchiefs | #ecuimres #grandrounds http://t.co/aPmjLsGL | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: in fact enteral nutrition is better than TPN 2 decr post-op complications Ann Surg 1993 Vol 217 | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: so we know that malnourished pts absolutely need a nutritional intervention prior 2 surgery | |
| ecuimchiefs | #ecuimres #grandrounds Dr Ochoa asks "is there nutrition intervention that would benefit non-malnourished patients?" | |
| nephondemand | #ecuimres #grandrounds 12/7: Ochoa hypothesizes that restoration of nutritional state will improve t-lymphocytes & microcirculation | |
| ecuimchiefs | #ecuimres #grandrounds Discovery of Myeloid cells expressing arginase: http://t.co/5nkxfbXN | |
| ecuimchiefs | #ecuimres #grandrounds Nitric oxide levels differ in septic patients (high) vs trauma patients (low). http://t.co/QlmK5qmF | |
| ecuimchiefs | #ecuimres #grandrounds Dr Ochoa enforces that arginine levels influence T-cell function. | |
| FMCNA | RT @nephondemand: #ecuimres #grandrounds 12/7 by J Ochoa: so we know that malnourished pts absolutely need a nutritional intervention pr ... | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: shows a variety of mouse studies which indicate myeloid cells req Arginine 2 fxn; | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: in a meta analysis overall use of Arginine decr risk of Infxn: RR 0.6 p < 0.0001; Drover et al JACS | |
| ecuimchiefs | #ecuimres #grandrounds Arginine + omega fatty acids pre-op and post-op has beneficial effects on pts INDEPENDENT of nutritional status. | |
| nephondemand | #ecuimres #grandrounds 12/7: Arginine supplementation is best given in PERIop period & is independent of baseline nutritional status | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: Arginine is best administered with omega 3 fatty acid | |
| nephondemand | #ecuimres #grandrounds 12/7: nutritional bundle=smoking cessation, ensure med compliance, adequate blood sugar control, & take Arginine | |
| ecuimchiefs | #ecuimres #grandrounds Nutrition Intervention cannot work without full "bundle" ie: blood sugar control, tobacco cessation, med compliance | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: this nutritional bundle should b executed in all pts undergoing elective surgery 5-14 d preop | |
| ecuimchiefs | #ecuimres #grandrounds http://t.co/it9rHqa0 | |
| nephondemand | #ecuimres #grandrounds 12/7 by J Ochoa: periop nutritional intervention algorithm here Current Opinion in Anesthesiology 2011 24:339-348 |
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