Invited Speakers

Biography

Paul E. Wischmeyer, MD, EDIC, FCCM, FASPEN is a critical care, perioperative and nutrition physician who serves as a Professor with Tenure of Anesthesiology and Surgery at Duke University School of Medicine. He also serves as the Associate Vice Chair for Clinical Research in the Dept. of Anesthesiology & Director of the Nutrition Team at Duke Hospital. Dr. Wischmeyer’s clinical and research focus is focused helping patients prepare and recover from critical illness and surgery. His research interests include surgical and ICU nutrition and exercise rehabilitation therapy, parenteral nutrition and personalized nutrition trials, perioperative optimization, post-illness muscle mass and functional recovery, and role of probiotics/microbiome in illness, specifically COVID-19 prevention/treatment. Dr. Wischmeyer has received significant funding from the National Institutes of Health and DOD as well as numerous awards for his work from national and international societies, including the Jeffrey Silverstein Award and Memorial Lecture for Humanism in Medicine from the American Delirium Society, Fellow of the Society of Critical Care Medicine (FCCM), the John M. Kinney Award for the most significant contribution to the field of general nutrition, the Stanley Dudrick Research Scholar Award of the American Society for Parenteral and Enteral Nutrition where he is also an honorary Fellow of ASPEN (FASPEN). In 2020 he received the ASPEN George Blackburn Clinical Nutrition Mentorship Award, as well as the Excellence in Nutrition Support Education Award from the American Society for Parenteral and Enteral Nutrition, and he has received the Lifetime Achievement Award of the International Parenteral Nutrition Education and Methodology Advancement for significant contributions to the field of nutrition. He has over 200 publications (H index-70 and 50 papers with > 100 citations) in nutrition, critical care, and perioperative care, including publications in New England Journal of Medicine. He has been an invited speaker at numerous national/international medical meetings, delivering over 1000 invited presentations in his career. Finally, he is an advocate and lecturer for improving the patient experience and teaching provider’s to keep CARE as the focus of healthcare.

Topic: Muscle loss for patients undergoing surgery and its clinical implications

Muscle loss and sarcopenia is are significant pre-operative risk factors for adverse outcomes and mortality in virtually all major surgeries. Further, ongoing muscle loss is a significant consequence of the post-surgery period from bedrest and the underlying disease process leading to the need for surgery, as well as the surgical stress. It is critical that muscle mass and muscle quality is assessed in the preoperative setting to assess risk and for an objective and accurate diagnosis as muscle mass is now an essential component of malnutrition diagnosis in the new GLIM criteria for malnutrition. Muscle-assessment techniques such as CT scan, ultrasound, and BIA are essential for muscle mass assessment and accurate malnutrition diagnosis. Further, ongoing muscle mass assessment following surgery is essential to assess the adequacy and effect of nutrition delivery as well as help guide the need for rehabilitation post-surgery. This lecture will utilize a compelling patient case study to assist in the discussion. The lecture will cover new data for the critical role of muscle mass assessment in predicting the outcome from surgery. Further, existing and new cutting-edge techniques for muscle mass assessment before and after surgery will be discussed. Finally, new and exciting personalized pre-habilitation and post-surgical exercise rehabilitation techniques will be discussed to improve muscle mass and fitness for surgery.

Topic: Parenteral Nutrition In Overweight ICU Patients

Evidence for the safety and benefit of early parenteral nutrition (ePN) has changed significantly in past 10 years. Recent data and recommendations now indicate PN does not carry any increased risk of infection i.e. it is just as safe to put PN through a central line as saline. Further, recent data in abdominal surgery show early supplemental PN significantly reduced infections post-operatively. Further, recent guidelines indicate ePN use is equally safe as early EN and may be used interchangeably based on patient need. While early EN is always preferred, data indicates we routinely fail to feed even 50-60% of energy/protein targets for 12 days, even in ICU. Thus, it is critical ePN start sooner, especially in malnourished patients where it should be started at hospital/ICU admission if EN/oral goals are not reached within 48 h. Even in well-nourished patients, ePN can be started safely when not reaching energy/protein targets in 48-72 h. This emphasizes the challenge of nutritional assessment and when to start PN in obese patients. It is critical to realize obese subjects have impaired physiological responses to trauma/illness, such that despite having large calorie reserves in adipose, they are very inefficient in mobilizing stores and waste muscle mass faster than lean patients, leading to greater muscle mass loss. Further, many obese patients have undetected low muscle mass/sarcopenia and thus are at greater complication risk. Thus, it is critical to utilize GLIM malnutrition criteria via objective muscle measures to assess nutritional status such as muscle ultrasound or CT scan. The old adage- “obese patients should be put on a diet” in ICU must END! It is essential accurate feeding targets utilizing new-generation indirect calorimeters (IC) is employed. IC-use is shown to reduce mortality in ICU and is especially critical in obesity where predictive equations are highly inaccurate. Thus, in obese patients: 1) It is critical nutrition status is determined via objective method per GLIM (i.e. muscle u/s or CT; 2) Nutrition targets set via indirect calorimetry as predictive equations are inaccurate; 3) Early PN may be used safely and interchangeably with EN to meet protein/calorie targets.