Hospital Pharmacy - July/August 2018 - 243
243
Dickerson et al
study.29 The benefit of reduced mortality associated with
nutrition support beyond 7 days in ALI patients is worth further exploration in a larger study sample. Older age may have
been a contributing factor, as another much larger study with
slightly younger ALI patients did not see a difference in
60-day mortality.34 Trials to determine the ideal energy and
protein requirements in the first 7 days compared with after 7
days in ventilated ICU patients are warranted.
4.
Diamond et al: Preventing the progression of intestinal failure-associated liver disease in infants using a
composite lipid emulsion: a pilot randomized controlled trial of SMOFlipid.8
Pediatric patients with short bowel syndrome (SBS) or intestinal failure (IF) on long-term PN are at risk for developing
intestinal failure-associated liver disease (IFALD).35 Several
factors influence this risk; however, ILEs, specifically soybean oil-based ILEs, have been identified as an independent
risk factor when provided at standard doses (up to 3 g/kg/d)
due to the presence of phytosterols and omega-6 fatty
acids.36,37 Alternative ILE products have recently entered the
US market, although not specifically Food and Drug
Administration (FDA) approved for use in pediatric patients,
and are receiving attention for the potential management of
IFALD. This prospective, multicenter, parallel-group,
blinded, randomized controlled pilot trial compared conventional ILE (Intralipid, Baxter, Deerfield, Illinois) with composite ILE (SMOFlipid, Fresenius Kabi, Lake Zurich,
Illinois) in 24 PN-dependent (≥40% calories from PN) pediatric patients (≤24 months of age) with early IFALD in the
absence of sepsis (serum conjugated bilirubin [CB] ≥1-3 mg/
dL). The SMOFlipid is an alternative ILE that contains 30%
medium-chain triglycerides, 30% soybean oil, 25% olive oil,
and 15% fish oil. The primary outcome measure was evaluation of progression of IFALD, evidenced by change in CB.
Eligible patients received Intralipid (n = 13) or SMOFlipid (n
= 11) for up to 12 weeks, when full enteral tolerance was
achieved, or if progressive liver disease was observed.
After adjusting for 1 statistical outlier, the mean CB, was
lower at the end of the trial for those patients receiving
SMOFlipid (mean: 1.3 ± 1.1 mg/dL) compared with those
receiving Intralipid (4 ± 1.2 mg/dL); mean difference is −2.7
mg/dL (−4.3 to −1.2 mg/dL), P = .001. Study subjects in the
SMOFlipid group were also more likely to achieve a CB of 0
mg/dL than those receiving Intralipid over the entire study
period-HR: 10.6; 95% CI: 1.3-86.9; P = .006. No statistically significant differences in unconjugated bilirubin or
transaminases between the 2 groups were observed; however, patients in the SMOFlipid group had significantly
higher γ-glutamyl transferase at trial completion, P = .04. No
significant differences existed in immunologic function
between the 2 groups. With respect to essential fatty acid
profiles, patients in the SMOFlipid group had a lower proportion of omega-6:omega-3 fatty acids compared with the
Intralipid group at trial completion, P = .05. No differences
in safety outcomes were observed.
The authors conclude that SMOFlipid, when compared
with Intralipid at the same conventional dose (up to 3 g/
kg/d), reduces the risk of progressive IFALD in PN-dependent
children ≤24 months of age. This study is the first randomized trial evaluating SMOFlipid for the prevention of progression of IFALD in children and is strengthened by the fact
that similar doses were compared for up to 12 weeks. The
study has several limitations including small sample size, the
need to exclude 1 statistical outlier from the analysis as well
as strict exclusion criteria that precluded evaluation of preterm and low-birth weight infants who are traditionally at
risk of progressive IFALD. This pilot study provides the
basis of future trials to more definitively determine
SMOFlipid's role for PN-dependent pediatric patients. These
trials should focus on seeking answers to the several remaining questions related to the optimal provision of ILE to pediatric patients at risk of developing IFALD including, but not
limited to, SMOFlipid compared with reduced soybean oil-
based ILE dosing, preventative rather than treatment interventions, the role various ILEs play in the development of
essential fatty acid deficiency, and the long-term growth,
development, and neurodevelopmental outcomes associated
with differing management approaches.
5.
Wischmeyer et al: A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial.9
This study demonstrates another attempt to evaluate optimal
protein and energy delivery in critically ill patients. One
aspect of this study is that it separates patients into low BMI
(<25 kg/m2) and high BMI (>35 kg/m2) based on the hypothesis that increased energy is associated with reduced mortality in these populations. This was an open-label, randomized,
control pilot study aimed to determine the feasibility of
increasing calorie and protein delivery to patients by about
30% the first week of ICU stay, with the use of EN plus supplemental PN (SPN) versus EN alone. Secondary outcomes
included mortality, infection complications, functional indices, and quality of life. A total of 125 adult medical or surgical ICU patients with a BMI <25 or >35 kg/m2 were enrolled.
In the control arm, patients received a standard polymeric
EN formula (~1.2 kcal/mL), whereas in the intervention arm,
patients received current EN and SPN, with daily SPN
adjustment to keep caloric intake at 100% of the prescribed
calories. The PN solution utilized was a commercially available 3-compartment bag supplied by the manufacturer
(OLIMEL-N9, Baxter, Deerfield, Illinois), with a high protein content (14.2%) and 1.1 kcal/mL caloric density. Both
EN and SPN were initiated at 20 mL/h and increased by 20
mL/h every 4 hours, either as tolerated or until the goal rate
was reached. Patients were excluded if, at the time of screening, they received ≥60% estimated caloric needs via EN with
Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2018
Ed Board
TOC
Antibiotic Stewardship: The Health of the World Depends on It
ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
ISMP Adverse Drug Reactions
Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Angiotensin II
RxLegal: A Rapid Review of Right-To-Try
New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Lyme Carditis: A Case Report and Review of Management
Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - Cover1
Hospital Pharmacy - July/August 2018 - Cover2
Hospital Pharmacy - July/August 2018 - 201
Hospital Pharmacy - July/August 2018 - 202
Hospital Pharmacy - July/August 2018 - 203
Hospital Pharmacy - July/August 2018 - 204
Hospital Pharmacy - July/August 2018 - 205
Hospital Pharmacy - July/August 2018 - Ed Board
Hospital Pharmacy - July/August 2018 - 207
Hospital Pharmacy - July/August 2018 - TOC
Hospital Pharmacy - July/August 2018 - 209
Hospital Pharmacy - July/August 2018 - 210
Hospital Pharmacy - July/August 2018 - 211
Hospital Pharmacy - July/August 2018 - 212
Hospital Pharmacy - July/August 2018 - 213
Hospital Pharmacy - July/August 2018 - Antibiotic Stewardship: The Health of the World Depends on It
Hospital Pharmacy - July/August 2018 - 215
Hospital Pharmacy - July/August 2018 - 216
Hospital Pharmacy - July/August 2018 - ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
Hospital Pharmacy - July/August 2018 - 218
Hospital Pharmacy - July/August 2018 - 219
Hospital Pharmacy - July/August 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - July/August 2018 - 221
Hospital Pharmacy - July/August 2018 - 222
Hospital Pharmacy - July/August 2018 - Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Hospital Pharmacy - July/August 2018 - 224
Hospital Pharmacy - July/August 2018 - Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Hospital Pharmacy - July/August 2018 - 226
Hospital Pharmacy - July/August 2018 - 227
Hospital Pharmacy - July/August 2018 - 228
Hospital Pharmacy - July/August 2018 - 229
Hospital Pharmacy - July/August 2018 - Angiotensin II
Hospital Pharmacy - July/August 2018 - 231
Hospital Pharmacy - July/August 2018 - 232
Hospital Pharmacy - July/August 2018 - 233
Hospital Pharmacy - July/August 2018 - RxLegal: A Rapid Review of Right-To-Try
Hospital Pharmacy - July/August 2018 - 235
Hospital Pharmacy - July/August 2018 - New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Hospital Pharmacy - July/August 2018 - 237
Hospital Pharmacy - July/August 2018 - 238
Hospital Pharmacy - July/August 2018 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Hospital Pharmacy - July/August 2018 - 240
Hospital Pharmacy - July/August 2018 - 241
Hospital Pharmacy - July/August 2018 - 242
Hospital Pharmacy - July/August 2018 - 243
Hospital Pharmacy - July/August 2018 - 244
Hospital Pharmacy - July/August 2018 - 245
Hospital Pharmacy - July/August 2018 - 246
Hospital Pharmacy - July/August 2018 - Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Hospital Pharmacy - July/August 2018 - 248
Hospital Pharmacy - July/August 2018 - 249
Hospital Pharmacy - July/August 2018 - 250
Hospital Pharmacy - July/August 2018 - 251
Hospital Pharmacy - July/August 2018 - 252
Hospital Pharmacy - July/August 2018 - 253
Hospital Pharmacy - July/August 2018 - 254
Hospital Pharmacy - July/August 2018 - 255
Hospital Pharmacy - July/August 2018 - Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Hospital Pharmacy - July/August 2018 - 257
Hospital Pharmacy - July/August 2018 - 258
Hospital Pharmacy - July/August 2018 - 259
Hospital Pharmacy - July/August 2018 - 260
Hospital Pharmacy - July/August 2018 - 261
Hospital Pharmacy - July/August 2018 - 262
Hospital Pharmacy - July/August 2018 - Lyme Carditis: A Case Report and Review of Management
Hospital Pharmacy - July/August 2018 - 264
Hospital Pharmacy - July/August 2018 - 265
Hospital Pharmacy - July/August 2018 - Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Hospital Pharmacy - July/August 2018 - 267
Hospital Pharmacy - July/August 2018 - 268
Hospital Pharmacy - July/August 2018 - 269
Hospital Pharmacy - July/August 2018 - 270
Hospital Pharmacy - July/August 2018 - 271
Hospital Pharmacy - July/August 2018 - Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - 273
Hospital Pharmacy - July/August 2018 - 274
Hospital Pharmacy - July/August 2018 - 275
Hospital Pharmacy - July/August 2018 - 276
Hospital Pharmacy - July/August 2018 - Cover3
Hospital Pharmacy - July/August 2018 - Cover4
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