Your SlideShare is downloading. ×
ESPEN 2008.
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

ESPEN 2008.

521

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
521
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. 30th Congress of ESPEN Firenca, 13.-16.09. 2008. Dr. Mladen Ivanovski, dr. Helga Komen
  • 2. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 3. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 4. Main Topics of ESPEN 2008 •The chronic critically ill patient •Oxygen delivery and tissue metabolism in sepsis•Metabolic therapies in ICU: controversies or consensus? •The impact of anesthesia on metabolism •Phytochemicals and cancer •Obesity and cancer risk •Nutrition-related cancer risk •Tumor-specific metabolic changes •Fatty acids modulation of anti-cancer therapy •Preventing cancer-related malnutrition •Protein kinetics in the elderly •Metabolomics and proteomics in nutrition •Chronic intestinal failure •Growing up on parenteral nutrition •Strategies to prevent hepatosteatosis •Brain metabolism and nutrition •Nutritional support in wounds and pressure ulcers •Nutritional control of immunity •Amino acid metabolism in the gastrointestinal tract 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 5. Frailty syndrom eng. frailty - krhkost, neotpornostFrailty syndrome: A condition, seen particularly in older patients,characterized by low functional reserve, easy tiring, mood disturbance,accelerated osteoporosis, decreased muscle strength, and high susceptibility todisease.Frailty is based on cutoffs in 5 components - Muscle weakness, weight loss, lowphysical activity, exhaustion, and slow walking speed. Subjects below certaincutoffs on 3 or more components are deemed frail, those with 1-2 componentsbelow cutoffs are deemed intermediately or moderately frail, and those scoringhigher than cut points on all 5 measures are deemed non-frail or robust. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 6. Increasing recognition in literature 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 7. Frailty Syndrome Epidemiology  3 or more of 5 criteria  6.7% of community residing elderly  3 year incidence —7%  Increases with age: 3%-65; 26% - 85-89 Fried L, et al J Gerontol Med Sci 2001: 560: M146-M156 M146- 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 8. Treatment of Frailty Prevent dwindles Early detection of acute illness and polypharmacy (Geriatric Giants or atypical presentation) Assess cognition and mood Optimize sensory inputs Mobilize – Bed is BAD – Minimize Muscle Wasting Improve nutrition 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 9. EARLY ENERGY SUPPLY DECREASES ICU ANDHOSPITAL MORTALITY: A MULTICENTRE STUDY IN A COHORT OF 1209 PATIENTS C Pichard et al.. University Hospital Geneva, Switzerland• Early (< 3 day) vs. delayed nutrition (enteral and/or parenteral)• > 1500 kcal/d• Lower mortality in ‘early’ group (18,7% vs. 24,2%) Supplemental parenteral nutrition combined with enteral nutrition can be considered to cover the energy and protein targets when enteral nutrition alone fails to achieve the caloric goal. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 10. Oxygen delivery and tissue metabolism in sepsis Leverve X. et al.. Université Joseph Fourier, Grenoble, France, xavier.leverve@ujf-grenoble.fr.• Laktati nisu dobar pokazatelj anaerobnog metabolizma u sepsi• Klirens laktata je smanjen (240 → 4), a produkcija nije značajno povećana (10 → 20)• Svaki antioksidans u suvišku počinje se ponašati kao slobodni radikal• Vitamin E• Vitamin C (je najbolji antioksidans) → 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 11. Fatty acids and inflammationPhilipe Calder, Institute of Human Nutrition and School of Medicine,University of Southampton, Tremona Road, Southampton SO16 6YD, UK. pcc@soton.ac.uk • Human immune cells are typically rich in arachidonic acid • Arachidonic acid and EPA contents can be altered through oral administration of those fatty acids • Changing the fatty acid composition of immune cells affects phagocytosis, T-cell signaling and antigen presentation capability ∀ ↓ immune response ∀ ↓ incidence of MODS 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 12. Hydration in surgical patientsLobo DN at al.. Division of Gastrointestinal Surgery, Section of Surgery, E Floor,West Block, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK. dileep.lobo@nottingham.ac.uk • The goal of fluid therapy in the elective setting is to maintain the effective circulatory volume while avoiding interstitial fluid overload • Weight gain in elective surgical patients should be minimized in an attempt to achieve a zero fluid balance status‘ • Avoid the need to resuscitate fluid-depleted patients in the anaesthetic room or after the induction of anaesthesia • It could take 3 weeks to excrete overloaded water • Oedema – eyes, face, ancle, lower leg, forearm 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 13. Clinical use of glutamine supplementation.Wernerman J., Department of Anesthesia and Intensive Care Medicine,Karolinska University Hospital Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden. jan.wernerman@karolinska.se • Endogenous production of glutamine may become insufficient during critical illness. The major part of endogenously produced glutamine comes from skeletal muscle – Decrease in plasma concentration, is a prognostic factor for poor outcome in sepsis • Exogenous glutamine supplementation is necessary • i.v. glutamine supplementation to critically ill patients on parenteral nutrition must be regarded as the standard of care (adding 20-25 g/24 h) • There are no reported adverse or negative effects attributable to glutamine supplementation. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 14. Influence of early antioxidant supplements on clinicalevolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Berger MM et al. Department of Intensive Care Medicine & Burns Centre, UniversityHospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Mette.Berger@chuv.ch. • Micronutrients contributing to the antioxidant (AOX) defense exhibit low plasma levels during critical illness • Intravenous supplements for 5 days (selenium 270 mug, zinc 30 mg, vitamin C 1.1 g, and vitamin B1 100 mg) • The AOX intervention did not reduce early organ dysfunction but significantly reduced the inflammatory response 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 15. Oxepa® Therapeutic Nutrition for Modulating Inflammation in Sepsis, ARDS, and ALI• OXEPA is clinically shown to modulate the inflammatory response in critically ill, mechanically ventilated patients, including those with sepsis, SIRS (systemic inflammatory response syndrome), ALI (acute lung injury), or ARDS (acute respiratory distress syndrome).• Calorically dense (1.5 Cal/mL)• Contains 4.6 g/L of EPA and 4 g/L of GLA- to help modulate inflammation• Elevated levels of antioxidants-to help prevent free radical damage• Meets or exceeds 100% of the RDI for 24 essential vitamins and minerals in 1420 Cal (946 mL)• Gluten-Free, Lactose-Free, Low-Residue EPA = eicosapentaenoic acid, GLA = gamma-linolenic acid 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 16. Oxepa® Therapeutic Nutrition for Modulating Inflammation in Sepsis, ARDS, and ALI• ......beneficial effects of OXEPA on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the incidence of new organ failures. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 17. Bodystat® Illness & Dehydration Index MarkerTM for for Clinical assessment MONITORING of HYDRATION BODY CELL HEALTH STATUS of STATUS and as a in PREDICTOR OF OUTCOME COMPETETIVE ATHLETES in seriously ill patients using BIA multi-frequency technology impedance valuesat 5 kHz and 200 kHz ONLY andindependent of weight, age and sex. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 18. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 19. LLL – Life Long Learning• The Life Long Learning (LLL) programme in Nutrition is an extremelyeffective educational programme for medical doctors and health specialistsoffering training On-line and at Live courses.• On-line courses are freely accessible after registration• http://www.lll-nutrition.com/ed/ 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 20. Nutrigenomics• Nutrigenomics is the study of molecular relationships between nutrition and the response of genes.• Nutrigenomics focuses on the effect of nutrients on the genome.• Nutrigenomics has been associated with the idea of personalizednutrition based on genotype. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 21. ESPEN 2009. - Beč. AustrijaESPEN 2010. - Nica, Francuska 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 22. www.nutritioncare.org www.espen.org http://pen.sagepub.com/ www.ccmjournal.comhttp://abbottnutrition.com/ www.fresenius.com 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 23. 30th Congress of ESPEN, Firenca, 13.-16.09.200
  • 24. 30th Congress of ESPEN, Firenca, 13.-16.09.200

×