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- Angsten, Gertrud, et al.
(författare)
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Improved outcome in neonatal short bowel syndrome using parenteral fish oil in combination With ω-6/9 Lipid Emulsions
- 2012
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Ingår i: JPEN - Journal of Parenteral and Enteral Nutrition. - : Wiley. - 0148-6071 .- 1941-2444. ; 36:5, s. 587-595
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Tidskriftsartikel (refereegranskat)abstract
- Background:Newborn infants with short bowel syndrome (SBS) represent a high risk group of developing intestinal failure-associated liver disease (IFALD) which may be fatal. However, infants have a great capacity for intestinal growth and adaptation if IFALD can be prevented or reversed. A major contributing factor to IFALD may be the soybean oil-based intravenous lipid emulsions used since the introduction of parenteral nutrition (PN) 40 years ago. Methods:This retrospective study compares the outcome in 20 neonates with SBS treated with parenteral fish oil (Omegaven) in combination with omega-6/9 lipid emulsions (ClinOleic) with the outcome in a historical cohort of 18 patients with SBS who received a soybean oil-based intravenous lipid emulsion (Intralipid).Results:Median gestational age was 26 weeks in the treatment group and 35.5 weeks in the historical group. All patients were started on PN containing Intralipid that was switched to ClinOleic/Omegaven in the treatment group at a median age of 39 gestational weeks. In the treatment group, direct bilirubin levels were reversed in all 14 survivors with cholestasis (direct bilirubin >50 umol/). Median time to reversal was 2.9 months. Only 2 patients died of liver failure (10%). In the historical cohort, 6 patients (33%) died of liver failure and only 2 patients showed normalization of bilirubin levels.Conclusions:Parenteral fish oil in combination with omega-6/9 lipid emulsions was associated with improved outcome in premature neonates with SBS. When used instead of traditional soybean-based emulsions, this mixed lipid emulsion may facilitate intestinal adaptation by increasing the IFALD-free period.
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| 3. |
- Ljungqvist, Olle, 1954-
(författare)
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ERAS-enhanced recovery after surgery : moving evidence-based perioperative care to practice
- 2014
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Ingår i: JPEN - Journal of Parenteral and Enteral Nutrition. - : Sage Publications. - 0148-6071 .- 1941-2444. ; 38:5, s. 559-566
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Tidskriftsartikel (refereegranskat)abstract
- ERAS is the acronym for enhanced recovery after surgery, a term often used to describe perioperative care programs that have been shown to improve outcomes after major surgery. This article gives a brief history of the development from fast-track surgery to ERAS. Today, the full meaning of ERAS goes beyond just a protocol for perioperative care with the initiation of a novel multiprofessional, multidisciplinary medical society: the Enhanced Recovery After Surgery Society for Perioperative Care (www. erassociety. org). The ERAS Society is involved in the development of evidence-based guidelines. These guidelines form the basis for an implementation program of the ERAS principles to practice. While ERAS was initially developed for colonic resections, these principles are being used in a range of operations, and there is also a continuous update of care protocols as the fields develop. A key mechanism behind the effectiveness of ERAS is the dampening of the stress responses to the surgical insult combined with the use of treatments that support return of functions that delay recovery in traditional care. The article also gives some insights to why the protocols work and reports the effects of ERAS protocols.
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| 5. |
- Ljungqvist, Olle, 1954-
(författare)
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Jonathan E. Rhoads lecture 2011 : insulin resistance and enhanced recovery after surgery
- 2012
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Ingår i: JPEN - Journal of Parenteral and Enteral Nutrition. - : Sage Publications. - 0148-6071 .- 1941-2444. ; 36:4, s. 389-398
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Forskningsöversikt (refereegranskat)abstract
- This lecture reviews the current understanding of how insulin resistance, as a marker of the metabolic stress, is involved in recovery after major surgery. Insulin resistance develops as a graded response related to the magnitude of the operation. It lasts for weeks after medium-size surgery and affects all parts of body metabolism. Although hyperglycemia develops, muscle and fat uptake is reduced and other non-insulin-sensitive cells have an increase in glucose uptake as a result of the elevated glucose levels. Reduced glucose uptake and storage in muscle along with loss of lean body mass help explain reduced muscle function that will impair mobilization. The increased uptake of glucose in non-insulin-sensitive cells is involved in the development of several of the most common postoperative complications, including infections and cardiovascular problems. Many of the perioperative treatments in use are outdated, and modern care involves a multimodal approach with several treatments, such as preoperative carbohydrate treatment instead of overnight fasting, continuous epidural anesthesia for postoperative pain care, early feeding, and mobilization, all of which affect insulin by reducing the stress and enhancing recovery. Most of the previous mandatory catabolic responses to surgery can be avoided, resulting in substantially faster recovery and fewer complications. Methods to implement these modern treatments have been developed and used in Europe, resulting in improved care and shorter length of stay.
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