Jayshil Patel

Jayshil Patel
Medical College of Wisconsin | MCW · Division of Pulmonary and Critical Care Medicine

MD

About

151
Publications
16,978
Reads
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1,607
Citations
Additional affiliations
July 2011 - present
Medical College of Wisconsin
Position
  • Professor (Associate)
July 2011 - present
Medical College of Wisconsin
Position
  • Professor (Associate)

Publications

Publications (151)
Article
Introduction: Real-world evidence on the timing and efficacy of enteral nutrition (EN) practices in intensive care unit (ICU) patients with circulatory shock is limited. We hypothesized early EN (EEN), as compared to delayed EN (DEN), is associated with improved clinical outcomes in mechanically ventilated (MV) patients with circulatory shock. Meth...
Article
We thank Vargas et al (1) for their interest in our recently published study in Critical Care Medicine (2). By analyzing the fragility index (FI) of all randomized controlled trials (RCTs) included in our systematic review and performing a trial sequential analysis (TSA) of our meta-analysis of overall mortality, they agreed with our position that...
Article
The American Society of Parenteral and Enteral Nutrition (ASPEN) held its annual Nutrition Science and Practice Conference in Seattle, Washington from March 26 to March 29, 2022 This article is protected by copyright. All rights reserved.
Article
We thank the authors for their interest in our updates to the critical care nutrition guidelines and appreciate their thoughtful and germane comments. We would like to address each of their concerns, in a point by point manner, with the intention of providing clarity on the 2022 guidelines update. This article is protected by copyright. All rights...
Preprint
Introduction : Real-world evidence on the timing and efficacy of enteral nutrition (EN) practices in Intensive Care Unit (ICU) patients with circulatory shock are limited. We hypothesized early EN (EEN), as compared to delayed EN (DEN), is associated with improved clinical outcomes in mechanically ventilated (MV) patients with circulatory shock. Me...
Article
Adolescents and young adults (AYAs) may be cared for in a pediatric or adult ICU. Specific needs of AYAs differ from those of populations typically found in either ICU. This review identifies research focused on experiences of AYAs in ICUs, their family members, and the health care professionals who care for them, revealing limited research about A...
Article
Vitamin C is an essential micronutrient with antioxidant properties and its use in critical illness has gained interest in recent years.1 Four systematic reviews/meta‐analyses (SRMAs) have been published in 2021 alone (see Table 1 summary).2‐5 These 4 SRMAs included between 8‐43 randomized controlled trials evaluating vitamin C with or without thia...
Article
Background: Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support tea...
Article
Diagnostic errors are considered a blind spot of health care delivery and occur in up to 15% of patient cases. Cognitive failures are a leading cause of diagnostic error and often occur as a result of overreliance on system 1 thinking. This narrative review describes why diagnostic errors occur by shedding additional light on systems 1 and 2 forms...
Article
Full-text available
Importance There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19. Objective To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen. Design, Setting, and Participants CONTAIN COVID-19, a randomized, do...
Article
Full-text available
Background: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods: We searched ME...
Article
Full-text available
Purpose of Review The COVID-19 pandemic has been associated with significant morbidity and mortality worldwide. In addition to those with advanced age and co-morbidities such as heart disease or cancer, obese individuals have also had very high rates of hospitalization, critical illness, need for ventilator support, as well as mortality. A number o...
Article
Background: New randomized controlled trials have been conducted since publication of the 2016 ASPEN/SCCM critical care nutrition guideline. This guideline updates recommendations for foundational questions central to critical care nutrition support. Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process...
Article
Advances in treatment of malignancy including novel pharmacologic therapies and surgical interventions has led to significant improvement in survival. As cancer becomes a chronic disease, nutrition interventions play an increasingly important role in short- and long-term outcomes. The current manuscript presents a case of a 66-year-old male with ne...
Article
Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory failure. At the level of the gut, septic shock impairs epithelial barrier function (EBF), and the gut initiates proinflammatory responses contributing to multiple organ dysfunction...
Article
The worldwide increase in the prevalence of obesity and adiposity-related comorbidities has required a novel approach to cardiometabolic risk mitigation focused on the key mechanistic drivers of disease. The current manuscript presents the case of a 74-year-old male with obesity complicated by coronary artery disease, hypertriglyceridemia, hyperten...
Article
Objectives: To conduct a systematic review and meta-analysis to evaluate the impact of IV vitamin C on outcomes in critically ill patients. Data Sources: Systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Register of Controlled Trials. Study Selection: Randomized controlled trials testing IV vitamin C in critically ill patients....
Article
Full-text available
Purpose of Review To highlight the controversy of fiber use in the current critical care nutrition guidelines; review the effect of fiber on the gut microbiota in the critically ill; and examine the data on fiber and outcomes in the intensive care setting. Recent Findings Fiber is increasingly recognized as a necessary component of colonic health...
Article
Background: COVID-19 has created unique challenges for the intensivist, as high ventilatory demands and prolonged hypermetabolism make it difficult to sustain nutritional status. The purpose of this survey was to determine current practices in nutritional therapy and identify barriers to its delivery. Methods: A survey questionnaire about delive...
Article
Despite a mounting evidentiary base, controversies surrounding critical care nutrition support persist. Anchored by a case of a 60‐year‐old male with esophageal cancer who develops acute hypoxemic respiratory failure and septic shock, five panelists from the ASPEN 2021 Pre‐Conference discuss key clinical dilemmas in critical care nutrition, includi...
Article
To the Editor In their study, Morgan et al¹ asked 723 practitioners to estimate probabilities of disease and concluded that practitioners overestimate disease probability before and after testing. We commend the authors for their work, which provides a window to how practitioners estimate disease probability. Here, we offer a cross-examination of s...
Article
Full-text available
Sarcopenia, defined as loss of muscle mass, can occur with aging. We conducted a single-center retrospective analysis to evaluate the impact of muscle quality in multiple myeloma (MM), a hematologic cancer of older adults, undergoing autologous hematopoietic cell transplantation (autoHCT). Healthy muscle was quantified by measuring the percent of h...
Article
Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations fo...
Article
Purpose of review: Circulatory shock is associated with reduced splanchnic blood flow and impaired gut epithelial barrier function (EBF). Early enteral nutrition (EN) has been shown in animal models to preserve EBF. There are limited human data informing early EN in circulatory shock and critical care nutrition guidelines provide disparate recomme...
Article
Purpose To test the primary hypothesis that a CPR video will reduce ICU patients' surrogates' anxiety when deciding code status, as measured by the Hamilton Anxiety Rating (HAM-A) Scale, as compared to the no video group. Materials and methods This is a prospective randomized control trial. Twenty-seven ICU patients' surrogates were enrolled in th...
Article
Full-text available
The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sour...
Article
Extracorporeal membrane oxygenation (ECMO) is a supportive care system for patients with respiratory or cardiac failure. Patients requiring ECMO are at risk for significant inflammation, prolonged hospitalization, and acquired malnutrition and sarcopenia. Societal guidelines recommend early enteral nutrition in critically ill patients; however, in...
Article
During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops. Design: Prospective pre-/postintervention...
Article
Worldwide, as of July 2020, >13.2 million people have been infected by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus. The spectrum of coronavirus disease 2019 (COVID‐19) ranges from mild illness to critical illness in 5% of cases. The population infected with SARS‐CoV‐2 requiring an intensive care unit admission often requi...
Article
In the midst of a worldwide pandemic of the Coronavirus Disease 2019 (COVID‐19), a paucity of data precludes derivation of COVID‐19‐specific recommendations for nutritional therapy. Until more data are available, the focus needs to center on principles of critical care nutrition modified for the constraints of this disease process, i.e., COVID‐19‐r...
Article
Background: Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associat...
Article
Circulatory shock is one of the most common reasons for an intensive care unit admission, has been shown to impair gut barrier and immune functions, and promotes dysbiosis. The exact timing and dose of enteral nutrition (EN) in circulatory shock remains unclear. In fact, because of fear of complications such as nonocclusive mesenteric ischemia and...
Article
To the Editor In their Clinical Update on metformin, Drs Flory and Lipska succinctly highlighted metformin’s robust safety data and low cost, rendering it a good first-line pharmacologic treatment for type 2 diabetes in most patients.¹ We agree with their conclusion but wish to mention metformin-induced vitamin B12 deficiency, an elusive yet common...
Article
Background: The optimal dose and timing of enteral nutrition (EN) in septic shock are unclear. Methods: We conducted a phase 3 single-center randomized controlled pilot trial comparing early trophic EN with "no EN" in mechanically ventilated adults with septic shock, with the hypothesis that implementing a protocol comparing early trophic EN wit...
Article
Full-text available
Purpose of Review Circulatory shock and subsequent gut hypoperfusion turn on the ‘gut motor,’ which impairs gut barrier function, promotes dysbiosis, and generates immune dysfunction to perpetuate inflammation. Clinicians may be reluctant to commence enteral nutrition in circulatory shock out of concern for bowel ischemia and splanchnic steal syndr...
Article
The role of echocardiography in acute pulmonary embolism (PE) remains incompletely defined. Echocardiography cannot reliably diagnose acute PE, and it does not improve prognostication of patients with low-risk acute PE who lack other clinical features of right ventricular (RV) dysfunction. Echocardiography, however, may yield additional prognostic...
Chapter
The hallmark of chronic critical illness (CCI) and persistent inflammatory, immunosuppressed, catabolic syndrome (PICS) is the continued breakdown of lean muscle leading to profound weakness, decreased capacity for rehabilitation, immunosuppression, and a propensity to develop recurrent nosocomial infections. Better critical care support systems an...
Article
To the Editor Dr Hernández and colleagues conducted a randomized clinical trial (RCT) comparing sepsis resuscitation strategies targeting capillary refill time (CRT) vs lactate clearance.¹ Studies that gauge peripheral perfusion using easy, reproducible, and resource-independent bedside methods are needed. However, we have some concerns about the s...
Article
Vasodilatory shock, as observed in postoperative states and sepsis, is hallmarked by low systemic vascular resistance and low blood pressure compensated by increased cardiac output. Gasotransmitters, such as nitric oxide and hydrogen sulfide, are implicated in the development and perpetuation of vasodilatory shock. Established therapies do not targ...
Article
Background: Computed tomography (CT) methods to estimate sarcopenia in obesity do not differentiate high-attenuating from low-attenuating muscle. The primary purpose of this study was to determine agreement between a CT method using general workstation-derived total and high-attenuating psoas muscle cross-sectional area (CSA) and a commercially av...
Article
The current recommendation for protein dose in critically ill patients is 1.2–2.0 g/kg/d. Despite this recommendation, there is significant variation in the amount of protein prescribed and delivered worldwide. We contend clinical equipoise, or a state of genuine uncertainty about 2 (dosing) strategies, exists because guideline‐based recommendation...
Chapter
Triggers leading to critical illness, including sepsis, respiratory failure, trauma, and burns, stimulate the metabolic response to stress. This response often leads to uncontrolled catabolism, which may culminate in a calorie deficit, proteolysis (and negative nitrogen balance), and anabolic resistance. Nutrition support was historically viewed as...
Article
Malnutrition continues to be highly prevalent in hospitalized and critically ill patients and is associated with significant morbidity and mortality. Additionally, survivors of critical illness have an increased risk for sarcopenia, which leads to weakness and physical debilitation that can persist for years. Nutrition risk assessment tools have be...
Article
To the Editor Dr Cook and colleagues discussed management reasoning, an incompletely understood subset of clinical reasoning.¹ We agree that a diagnosis is a means to an end and that diagnostic reasoning is primarily a classification task. However, we disagree with the implication that diagnostic and management reasoning are 2 distinct processes th...
Article
Current randomized trials and observational studies evaluating higher versus lower protein doses in critically ill patients yield inconclusive results. Because of few studies and methodologic limitations, clinical guidelines suggest a wide range of protein intake based on weak evidence. Clinical equipoise about protein dosing exists. The purpose of...
Article
Full-text available
Purpose of the review: Fish oil (FO) supplementation has historically been used by individuals suffering from cardiovascular disease and other inflammatory processes. However, a meta-analysis of several large randomized control trials (RCTs) suggested FO conferred no benefit in reducing cardiovascular risk. Skeptics surmised that the lack of benef...
Article
Full-text available
With the number of individuals older than 65 years expected to rise significantly over the next few decades, dramatic changes to our society and health care system will need to take place to meet their needs. Age-related changes in muscle mass and body composition along with medical comorbidities including stroke, dementia, and depression place eld...
Article
Rehabilitation after critical illness requires a multidisciplinary effort. Nutrition support of critically ill patients aims to correct the imbalance between protein synthesis and protein degradation to maximize strengthening and muscle mass, whereas physical and occupational therapists focus on optimizing strength and mobility through functional a...
Article
Full-text available
Purpose To identify variables associated with 24-h mortality after inter-hospital transfer. Materials and methods Single center retrospective study of adult patients transferred to a tertiary care medical ICU between 1 January 2010 and 15 April 2014. Demographic, clinical, physiologic, and laboratory data were collected. The Lasso method was used...
Article
Purpose of review: Maintaining gut barrier defenses, modulating immune responses, and supporting the role of commensal microbiota are major factors influencing outcome in critical illness. Of these, maintaining a commensal 'lifestyle' and preventing the emergence of a virulent pathobiome may be most important in reducing risk of infection and mult...
Article
Gwynne’s Grammar¹ is my favorite writing guide. In it, he advocates for precision in the use of language, which is the machine for thinking and necessary for clear judgment and good decisions. Gwynne creates a nine-step argument for the importance of words, even suggesting: “If enough societies in the world crumble as a result of bad decisions take...
Article
Despite recommendations for early enteral nutrition (EN) in critically ill patients, numerous factors contribute to incomplete delivery of EN, including insufficient nutrition risk screening in critically ill patients, underutilization of enteral feeding protocols, fixed rate-based enteral infusion targets with frequent EN interruption, and subopti...