About
My passion is research, teaching, clinical care, lecturing, and television reporting on…
Articles by Paul
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Sharing my passion and personal story for improving perioperative care and how we can change the world for patients having surgery!
Sharing my passion and personal story for improving perioperative care and how we can change the world for patients having surgery!
By Paul Wischmeyer
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My Personal Story and New Data on Recognizing Disease Related Malnutrition and its Effects on Recovery From Illness
My Personal Story and New Data on Recognizing Disease Related Malnutrition and its Effects on Recovery From Illness
By Paul Wischmeyer
Activity
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A webinar for compassionate intensivists
A webinar for compassionate intensivists
Liked by Paul Wischmeyer
Experience
Education
Licenses & Certifications
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European Diploma of Intensive Care Medicine Board Certification
European Society of Intensive Care Medicine - ESICM
Issued
Publications
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Are we creating survivors…or victims in critical care? Delivering targeted nutrition to improve outcomes.
Current Opinion in Critical Care
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Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology
Critical Care
Recently, we have significantly reduced hospital mortality from sepsis and critical illness. However, evidence reveals over same period we have tripled number of patients being sent to rehabilitation. Further, given as many as half of deaths in first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 60-80% of “survivors” will suffer functional impairment or ICU-acquired…
Recently, we have significantly reduced hospital mortality from sepsis and critical illness. However, evidence reveals over same period we have tripled number of patients being sent to rehabilitation. Further, given as many as half of deaths in first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 60-80% of “survivors” will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as ICU providers ask: “Are we creating survivors ... or victims?” Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in future employ exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e.,beta-blockers) and anabolic agents (i.e.,oxandrolone) may be essential. In the future, assessing lean body mass at the bedside using ultrasound and ultrasound-measured muscle glycogen could be utilized to guide recovery care. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and to guide a personalized ideal heart rate, assisting in recovery of muscle mitochondrial function and functional endurance post-ICU. In the end, future ICU-AW research must focus on using a combination of modern performance-enhancing nutrition, anticatabolic/anabolic interventions, and muscle/exercise testing so we can begin to create more “survivors” and fewer victims post ICU care.
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Nutrition Modulation of Cardiotoxicity and Anticancer Efficacy Related to Doxorubicin Chemotherapy by Glutamine and ω-3 Polyunsaturated Fatty Acids.
JPEN. Journal of parenteral and enteral nutrition
Doxorubicin (DOX) has been one of the most effective antitumor agents against a broad spectrum of malignancies. However, DOX-induced cardiotoxicity forms the major cumulative dose-limiting factor. Glutamine and ω-3 polyunsaturated fatty acids (PUFAs) are putatively cardioprotective during various stresses and/or have potential chemosensitizing effects during cancer chemotherapy.
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Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?
Forum for Health Economics & Policy
We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability…
We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in
CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets. -
bedside ultrasound measurement of skeletal muscle.
current opinion in clinical nutrition and metabolic care
skeletal muscle and lean body mass may be vital to prognosis and functional recovery in chronic and acute illness, particularly in conditions in which muscle atrophy is prevalent. ultrasound provides a precise and expedient method to measure muscle mass and changes in skeletal muscle at the bedside.
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Left Ventricular Assist Device Effects on Metabolic Substrates in the Failing Heart
PLOS One
Abstract
Background
Heart failure patients have inadequate nutritional intake and alterations in metabolism contributing to an overall energy depleted state. Left ventricular assist device (LVAD) support is a common and successful intervention in patients with end-stage heart failure. LVAD support leads to alterations in cardiac output, functional status, neurohormonal activity and transcriptional profiles but the effects of LVADs on myocardial metabolism are unknown. This study set out…Abstract
Background
Heart failure patients have inadequate nutritional intake and alterations in metabolism contributing to an overall energy depleted state. Left ventricular assist device (LVAD) support is a common and successful intervention in patients with end-stage heart failure. LVAD support leads to alterations in cardiac output, functional status, neurohormonal activity and transcriptional profiles but the effects of LVADs on myocardial metabolism are unknown. This study set out to measure cardiac metabolites in non-failing hearts, failing hearts, and hearts post-LVAD support.
Methods
The study population consisted of 8 non-ischemic failing (at LVAD implant) and 8 post-LVAD hearts, plus 8 non-failing hearts obtained from the tissue bank at the University of Colorado. NMR spectroscopy was utilized to evaluate differences in myocardial energy substrates. Paired and non-paired t-tests were used to determine differences between the appropriate groups.
Results
Glucose and lactate values both decreased from non-failing to failing hearts and increased again significantly in the (paired) post-LVAD hearts. Glutamine, alanine, and aromatic amino acids decreased from non-failing to failing hearts and did not change significantly post-LVAD. Total creatine and succinate decreased from non-failing to failing hearts and did not change significantly post-LVAD.
Discussion
Measured metabolites related to glucose metabolism are diminished in failing hearts, but recovered their values post-LVAD. This differed from the amino acid levels, which decreased in heart failure but did not recover following LVAD. Creatine and the citric acid cycle intermediate succinate followed a similar pattern as the amino acid levels.Other authorsSee publication -
Phosphoinositide 3-Kinase Pathway Activity is Necessary for Glutamine Mediated Heat Shock Protein 70 Enhancement and Cellular Protection in Heat Stressed Intestinal Epithelial Cells.
Journal of Parenteral and Enteral Nutrition
Journal of Parenteral and Enteral Nutrition/ Vol. 35, No. 1, January 2011
Projects
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ICU Microbiome Project
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Honors & Awards
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Jeffrey Silverstein Award and Memorial Lecture for Humanism in Medicine
American Delirium Society
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Best Doctors in America
Best Doctors in America
Elected and Voted on by Peer Physicians Nationwide. Voted Best Doctor in America in Critical Care
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Stanley Dudrick Award for Significant Contributions to Nutrition Research and Field
American Society of Parenteral and Enteral Nutrition
Award for significant contributions to clinical nutrition research and teaching worldwide
More activity by Paul
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Drs Jonathan Gal, MD, MBA, MS, FASA and Basem Abdelmalak will join us faculty at Anesthesia Camp Grand Cayman 2025 January 29 - Feb 1, 2025 at The…
Drs Jonathan Gal, MD, MBA, MS, FASA and Basem Abdelmalak will join us faculty at Anesthesia Camp Grand Cayman 2025 January 29 - Feb 1, 2025 at The…
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As part of my PhD program in the early 2000, I investigated the relationship of obesity, insulin resistance and nutrition among people with type 2…
As part of my PhD program in the early 2000, I investigated the relationship of obesity, insulin resistance and nutrition among people with type 2…
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🙋♂️Does your hospital use Indirect Calorimetry? If not- this data shows why you should work to get one now! 🔎 New study shows in elderly trauma…
🙋♂️Does your hospital use Indirect Calorimetry? If not- this data shows why you should work to get one now! 🔎 New study shows in elderly trauma…
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Train New Trainers (TNT) Primary Care Fellowships fellows conference is underway!! #TNTStrong
Train New Trainers (TNT) Primary Care Fellowships fellows conference is underway!! #TNTStrong
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🙋♂️ Discover how stress and disease impact your gut microbiome with expert insights from my presentation on “The Gut Brain Connection” ❓Does…
🙋♂️ Discover how stress and disease impact your gut microbiome with expert insights from my presentation on “The Gut Brain Connection” ❓Does…
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#Diet, #gut #microbiota and #chronic #inflammation: any promise from #polyphenol-enriched diet? 🥗 🍷 Diet is the main determinant of the gut…
#Diet, #gut #microbiota and #chronic #inflammation: any promise from #polyphenol-enriched diet? 🥗 🍷 Diet is the main determinant of the gut…
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🙋♂️ New paper out today! A Novel Ultrasound Approach in Assessing Muscle Quality(IMAT) in Critically Ill Patients Muscle wasting and associated…
🙋♂️ New paper out today! A Novel Ultrasound Approach in Assessing Muscle Quality(IMAT) in Critically Ill Patients Muscle wasting and associated…
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This course now has a virtual option!!!
This course now has a virtual option!!!
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The ABCDEF Bundle: Part 24 I did a little survey on Instagram. I recognize that my followers are usually bias and more aware of the ABCDEF bundle…
The ABCDEF Bundle: Part 24 I did a little survey on Instagram. I recognize that my followers are usually bias and more aware of the ABCDEF bundle…
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Did you know all freeflex® and freeflex+® IV bags come with innovative, self-sealing ports? Dark blue and white or light blue ports with arrows…
Did you know all freeflex® and freeflex+® IV bags come with innovative, self-sealing ports? Dark blue and white or light blue ports with arrows…
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Just published! Our DINOSAUR study investigates the use of a novel AI-aided ultrasound platform MuscleSound, Inc. to assess muscle quality and…
Just published! Our DINOSAUR study investigates the use of a novel AI-aided ultrasound platform MuscleSound, Inc. to assess muscle quality and…
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