Malnutrition is one of the main burdens of disease in cystic fibrosis (CF) along with lung disease. Data from the most recent Cystic Fibrosis Foundation registry report show the prevalence of malnutrition is decreasing in the CF population primarily from interventions focusing on preventing malnutrition. Despite success of interventions and decreased prevalence of malnutrition in this population, prevention of malnutrition in CF patients remains a dilemma that must be managed throughout the life cycle. The pathogenesis of malnutrition in CF can be further categorized into 3 main areas: increased energy losses, increased energy needs, and inadequate calorie intake. The purpose of this review is to further explore the causes of malnutrition and explain current research to prevent malnutrition in the CF population.
Lung transplantation is the final therapeutic option for children with end-stage lung disease and malnutrition increases risk of mortality post operatively. The purpose of this study was to evaluate nutritional status in children admitted to the intensive care unit (ICU) at the time of lung transplantation (LTx) and somatic growth during the first year thereafter. Methods: Retrospective chart review of patients who underwent lung transplant (1/11-8/14). Nutritional status on admission to the ICU and for the first year after lung transplant were assessed by height for age (HFA: stunting) z-scores according to the WHO/CDC growth charts. Hospital and ICU length of stay (LOS), readmissions, rejection episodes and duration of mechanical ventilation were obtained. Results: Fifty-three children (19 males) were included: age 10.9 years (3.8-16; median (IQR)); Hospital LOS, 21(12-71) days; ICU LOS: 4.2 (3-5) days; duration of mechanical ventilation, 1 (1-2) days. The prevalence of stunting at time of LTx was 69.8%. Patients with cystic fibrosis (CF) (n= 25) had on admission a HFA z-scores of-1.98±1.10 vs-1.03±1.56 (p < 0.05) for non CF patients, respectively. CF patients had higher admission rates and higher incidence of rejection (55% and 67% respectively) compare to non CF patients (44% and 33%). Weight, height, and HFA z-score at LTX and at 12 months were: 29±18, 34±19 kg;122±34,127±32 cm;-1.46±1.46,-2.04±1.40, respectively, all comparisons p < 0.05. There was no association between stunting and longer hospital and ICU LOS and duration of mechanical ventilation. Two patients died during the first year after LTx. Conclusion: Patients with cystic fibrosis had a higher prevalence of stunting compared to non cystic fibrosis patients, higher rates of readmissions, and more episodes of rejection. Patients had an improvement on anthropometric variables with increased height after LTX, but at a lower than expected rate for age leading to worsening stunting.
a significant decrease in median IL-6 levels pg/mL (pre 1.3 (1.1-1.7); post 1.2 (0.8-1.4), p= 0.037) and possible improvements in self-reported dyspnea (ES= 0.23, p= 0.17), depressive symptoms (ES= 0.26, p= 0.07) and HRQOL (ES= 0.40, p= 0.13) post intervention. Conclusion: Eight weeks of slow-paced respiration therapy was feasible and associated with a significant decrease in IL-6 levels and possible improvements in sleep disturbance, dyspnea, depressive symptoms and HRQOL. A larger randomized clinical trial is needed to determine if slow-paced respiration therapy is effective in PAH.
Postoperative acute renal failure (POARF) is one of the most serious complications of cardiac surgery, developing in 5-30% of patients. POARF is an abrupt reduction in renal function, as evidenced by an increase in serum creatinine and a decrease in glomerular filtration rate (GFR). To date, there is no precise method of identifying patients at risk of developing POARF. Accurately identifying patients at risk and implementing preoperative renal protective strategies may reduce the incidence of POARF. The objective of this retrospective chart review was to determine the accuracy of a preoperative renal scoring index in predicting POARF in cardiac surgery patients who underwent facilitated recovery techniques. Methods: Data were collected via a retrospective chart review on patients, who had cardiac surgery at a single site in Ontario, Canada between February and March, 2008. Data abstraction was done by one author. Inconsistencies in abstracted data were clarified by a second author. The renal scoring index included information on GFR, ejection fraction, diabetes, previous cardiac surgery, urgency of surgery, other procedures and preoperative use of the intra-aortic balloon pump. Other preoperative [age, sex, weight, height, BMI and co-morbid factors] and intra-operative variables [type of surgery, aortic cross clamp time, cardiopulmonary bypass (CPB) and OR duration] were included. The RIFLE classification was used to identify POARF [risk, injury, failure, loss and end stage kidney disease (ESKD)]. Statistical analyses were undertaken using SPSS ® (version 15). Results: The mean age of the sample (n=46) was 64 + 11 years and most were male (n=33, 72%). Preoperative renal index scores indicated 48% (n=22) of the sample were low risk, 41% (n=19) were intermediate risk, and 11% (n=5) were at high risk of developing POARF. As per the RIFLE classification, 59% (n=27) had no POARF, 24% (n=11) were at risk, 13% (n=6) had injury, 2% (n=1) had failure, and no patient had loss or ESKD. There was a significant correlation between the preoperative renal index score and postoperative RIFLE class (r = 0.36, p = 0.02). Moreover, the preoperative renal index score was the only significant predictor of POARF (t = 3.05, p = 0.004). Conclusions: The preoperative renal scoring index accurately predicted POARF in a sample of cardiac surgery patients who underwent facilitated recovery techniques. Identifying high risk patients could assist in: a) preoperative teaching/counseling, b) development of preoperative renal protective strategies, and c) the proper allocation of intra-operative and postoperative resources.
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