Lipid emulsions in parenteral nutrition: does it matter?
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2023-06
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Recently, clinicians have shown interest in switching patients to nonsoybean-based intravenous lipid emulsion (ILE) formulas for parental nutrition (PN) due to adverse outcomes related to high Omega-6 content in soybean oil (SO) ILE's. This review summarizes recent literature on improved clinical outcomes with new Omega-6 lipid-sparing ILE's in PN management.Recent findings
Although there is a paucity of large-scale studies directly comparing Omega-6 lipid sparing ILE's with SO-based lipid emulsion use in PN in ICU patients, there is strong translational and meta-analysis evidence to suggest that lipid formulations containing fish oil (FO) and/or olive oil (OO) have favorable effects on immune function and improve clinical outcomes in ICU populations.Summary
More research is needed to directly compare omega-6-sparing PN formulas with FO and/or OO versus traditional SO ILE's. However, current evidence is promising for improved outcomes using newer ILE's including reduced infections, shorter lengths of stay, and reduced costs.Type
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Haines, Krista, Braylee Grisel, Laura Gorenshtein and Paul E Wischmeyer (2023). Lipid emulsions in parenteral nutrition: does it matter?. Current opinion in critical care, Publish Ahead of Print. 10.1097/mcc.0000000000001058 Retrieved from https://hdl.handle.net/10161/28309.
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Scholars@Duke
Krista Lynn Haines
Paul Edmund Wischmeyer
Paul Wischmeyer, MD, EDIC, FASPEN, FCCM is a nutrition, exercise, critical care, and perioperative physician-researcher who specializes in enhancing preparation and recovery from surgery, critical care and COVID-19. He serves as a Tenured Professor of Anesthesiology and Surgery at Duke. He also serves as the Director of the Duke Clinical Nutrition Fellowship, Director of the TPN/Nutrition Team at Duke and Director of The DUKE STRONGER Prehab/Rehab Service- Surgical and ICU Therapy for Rehabilitation, Optimization, Nutrition, Growth (Muscle), Endurance, and Recovery (STRONGER) Service/Clinic. The Duke STRONGER service and clinic is a unique multi-disciplinary initiative focused on helping surgical, organ transplant, cancer, and ICU patients regain strength, muscle, endurance, nutrition status, and cognition via use of personalized nutrition, exercise and anabolic agent/nutrient interventions— before, during and after their hospital journey. Its focus is on how we help our patients not just survive, but recover stronger.
Dr. Wischmeyer earned his medical degree with honors at The University of Chicago Pritzker School of Medicine, where he was elected into the honor society of Alpha Omega Alpha for outstanding academic achievement. He completed his pediatric internship at University of Colorado Children’s Hospital and his anesthesiology/critical care residency training at the University of Chicago. He also completed a Clinical Pharmacology fellowship and the NIH K30 Clinical Research Scientist Training Program while at University of Chicago.
Dr. Wischmeyer’s clinical and research focus is on helping patients prepare and recover from critical illness, injury, and surgery. His research interests include personalized surgical and ICU nutrition and exercise rehabilitation therapy, oral, enteral, and parenteral nutrition and personalized nutrition-intervention trials, perioperative optimization, post-illness muscle mass and functional recovery, and role of probiotics/microbiome in illness. Dr. Wischmeyer’s research group has been awarded multiple NIH, DOD, and other peer-reviewed grants to perform research ranging from basic mechanistic cell work to large-scale multi-center clinical trials in the fields of critical care, perioperative medicine, nutrition, illness metabolism, microbiome/probiotics, and exercise interventions to improve functional outcomes. For his research work and clinical work, Dr. Wischmeyer has received numerous awards from national and international societies including, The Jeffrey Silverstein Award and Memorial Lecture for Humanism in Medicine from the American Delirium Society, The John M. Kinney Award for the most significant contribution to field of general nutrition, the Stanley Dudrick Research Scholar Award and the 2025 Bruce Bistrian Award for Clinical Nutrition Mentorship by the American Society for Parenteral and Enteral Nutrition and The Lifetime Achievement Award of the International Parenteral Nutrition Society (IPENEMA) for significant contributions to the field of nutrition. Dr. Wischmeyer has over 260 peer-reviewed publications in critical care, anesthesiology, and nutrition, including in the New England Journal of Medicine. Finally, he has been an invited speaker at numerous national and international medical meetings delivering over 1000 invited presentations over his career. He has an H-index of 80 with over 21,500 citations to his work, including 1 publication with > 1000 citations and >25 papers with >200 citations, and >65 publications with > 100 citations. He is also the founder and Director of the Duke Online Clinical Nutrition Fellowship, an international fellowship to provide clinical nutrition training to healthcare providers worldwide, as well as unique scholarship opportunities for healthcare providers in developing nations.
Dr. Wischmeyer passion for helping patients recover from illness and surgery arises from his personal experiences as both doctor and patient in the ICU. Dr. Wischmeyer has undergone over 27 major surgeries and personally experienced multiple ICU stays due to a childhood GI illness that took more than half of his intestinal tract. Thus, preparation for surgery/critical care and recovery from illness are a way of life for Dr. Wischmeyer that he is passionate about teaching his patients and other caregivers worldwide.
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