septic patients with enteral nutrition and pancreatic enzyme supplementation therapy

Septic patients with enteral nutrition only

Diabetic patients with enteral nutrition and pancreatic enzyme supplementation therapy

Diabetic patients with enteral nutrition only

Patients suffering from cardiac arrest receive both enteral nutrition and pancreatic enzyme supplementation therapy

Patients suffering from cardiac arrest receive enteral nutrition only

Patients with acute renal failure receive both enteral nutrition and pancreatic enzyme supplementation therapy

Patients with acute renal failure receive enteral nutrition only

Blood samples: lactate, hemoglobin, total bilirubin, trypsin, Vit D, etc. Stool samples: 24h fecal fat; fetal elastase-1; Fecal chymotrypsin. Nutrition status: BMI, weight loss, biomarkers such as albumin and prealbumin, etc. Radiological assessments: MRCP & CT scanning.

Critical Illness

Sepsis

Diabetes

Cardiac Arrest

Acute Renal Failure

Shock

All patients enrolled in this study must carry out nutritional support by enteral nutrition

Enteral nutrition (EN)

Tongji Hospital

Shanghai Tenth People's Hospital

Pancreatic Exocrine Insufficiency and Pancreatic Enzyme Supplementation in Critically Ill Adult Patients

The Incidence of Pancreatic Exocrine Insufficiency and the Benefits of Pancreatic Enzyme Supplementation in Critically Ill Adult Patients

The incidence of exocrine pancreatic insufficiency will be evaluated that is based on hyperamylasemia, hyperlipasemia and fecal elastase-1 concentrations. multivariate logistic regression analyses are used to estimate the correlations between exocrine pancreatic insufficiency and clinical events and characteristics, which include APACHE II score, shock, hyperlactacidemia, respiratory failure, anemia, obesity, biliary sludge, hypertriglyceridemia, sepsis, cardiac arrest, cardiopulmonary bypass, severe head injury, acute stroke, post-neurosurgery, diabetes, inflammatory bowel disease, mechanical ventilation, continuous renal replacement therapy and medications such as propofol, valproate, metronidazole and morphine-derived drugs

The incidence of exocrine pancreatic insufficiency and the nutritional status are evaluated by fecal elastase-1 concentrations before pancreatic enzyme supplementation therapy is applied.
Patients are assigned into two groups randomly, the control group is only receiving enteral nutrition without the addition of pancreatic enzyme(CREON), and the PEST group is given both enteral nutrition and pancreatic enzyme supplementation therapy at the same time.
Following two weeks of corresponding treatments, the nutritional status and clinical outcomes are documented in both groups for statistical analysis.

Sheng Wang MD PhD

Associate professor

Shanghai 10th People's Hospital

Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University

The patients with severe OSA (AHI>=30) who do not fulfill the specific exclusion criteria wil be randomized. In the CPAP and diet arm, patients wil receive Continuous Positive air pressure therapy and the regular dietary treatment.

The diet arm wil receive the Conventional diet treatment that usually receive the patients included in the Bariatric Surgery Program

Metabolic Syndrome

Insulin Resistance

Adipokines

Cytokines

Treatment with Continuous Positive Airway Pressure

CPAP

Conventional diet treatment that undergo patients in the Bariatric Surgery Program

hypertriglyceridemia/hypoxia

Pancreatic Exocrine Insufficiency and Pancreatic Enzyme Supplementation in Critically Ill Adult Patients

Impact of Obstructive Sleep Apnea Syndrome on Metabolic Syndrome in Severe Obesity

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