Daren K Heyland's research while affiliated with Queen's University and other places

Publications (688)

Article
Background: On the basis of low-quality evidence, international critical care nutrition guidelines recommend a wide range of protein doses. The effect of delivering high-dose protein during critical illness is unknown. We aimed to test the hypothesis that a higher dose of protein provided to critically ill patients would improve their clinical out...
Article
Importance: Selenium contributes to antioxidative, anti-inflammatory, and immunomodulatory pathways, which may improve outcomes in patients at high risk of organ dysfunctions after cardiac surgery. Objective: To assess the ability of high-dose intravenous sodium selenite treatment to reduce postoperative organ dysfunction and mortality in cardia...
Article
Inflammation and oxidative stress represent physiological response mechanisms to different types of stimuli and injury during critical illness. Its proper regulation is fundamental to cellular and organismal survival and are paramount to outcomes and recovery from critical illness. A proper maintenance of the delicate balance between inflammation,...
Article
Over the past decade, the use of supraphysiologic doses of micronutrients (also called metabolic resuscitation) in critically ill patients has gained significant attention. Building upon preclinical and observational human data, numerous randomized controlled trials have tested the impact of multiple micronutrients on various outcomes in critically...
Article
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Aims To describe the characteristics of hospital‐based, patient‐mediated interventions and their impact on patient, clinician and organization outcomes. Design Systematic review. Data Sources Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. Review Method...
Article
Introduction: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. Method: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill p...
Article
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Background: Prehabilitation is gaining increasing interest and shows promising effects on short- and long-term outcomes among patients undergoing major surgery. The effect of multimodal, interdisciplinary prehabilitation has not yet been studied in patients with severe heart failure scheduled for the implantation of a left-ventricular assist device...
Article
Objective People are living longer than ever before. Many arrive at a later stage of life in poor health and with inadequate financial and social resources. The purpose of this paper is to describe people’s general state of preparedness for their future as older persons, identify specific attitudes towards ageing and key characteristics that porten...
Article
BACKGROUND Glutamine is thought to have beneficial effects on the metabolic and stress response to severe injury. Clinical trials involving patients with burns and other critically ill patients have shown conflicting results regarding the benefits and risks of glutamine supplementation. METHODS In a double-blind, randomized, placebo-controlled tria...
Article
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Background: The clinical significance of vitamin D administration in critically ill patients remains inconclusive. The purpose of this systematic review with meta-analysis was to investigate the effect of vitamin D and its metabolites on major clinical outcomes in critically ill patients, including a subgroup analysis based on vitamin D status and...
Article
Background Elevated hydrogen sulfide (H2S) contributes to vasodilatation and hypotension in septic shock and traditional therapies do not target this pathophysiologic mechanism. High-dose intravenous (IV) hydroxocobalamin (IV-HOC) scavenges and prevents H2S formation, which may restore vascular tone and accentuate recovery. No experimental human st...
Article
Objectives: Concise definitive review of how to read and critically appraise a systematic review. Data sources: None. Study selection: Current literature describing the conduct, reporting, and appraisal of systematic reviews and meta-analyses. Data extraction: Best practices for conducting, reporting, and appraising systematic review were su...
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
Background: Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. Methods: In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU...
Article
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Following publication of the original article [1], the authors identified an error in the co-first authors. The cofirst authors indicated wasn’t correct. The incorrect co-first authors: †Co-first author: Jayshil J. Patel and James Zelten The correct co-first authors are: †Co-first author: Luis Ortiz‑Reyes and Jayshil J. Patel The co-first authors h...
Article
Background Vitamin K activates matrix Gla protein (MGP), a key inhibitor of vascular calcification. There is a high prevalence of sub-clinical vitamin K deficiency in patients with end stage kidney disease. Methods A parallel randomized placebo-controlled pilot trial designed to determine whether 10 mg of phylloquinone thrice weekly versus placebo...
Article
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Background L-carnitine (L-C), a ubiquitous nutritional supplement, has been investigated as a potential therapy for cardiovascular disease, but its effects on human atherosclerosis are unknown. Clinical studies suggest improvement of some cardiovascular risk factors, whereas others show increased plasma levels of pro-atherogenic trimethylamine N-ox...
Preprint
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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...
Poster
Introduction: Among critically ill patients, cardiac surgery patients are at increased risk for inadequate medical nutrition therapy (MNT) leading to iatrogenic undernutrition during their stay in an intensive care unit (ICU). This study aimed to evaluate current MNT practices in critically ill patients after cardiac surgery. Methods: An internatio...
Article
Objectives: Ongoing risk of death and poor functional outcomes are important consequences of prolonged critical illness. Characterizing the catabolic phenotype of prolonged critical illness could illuminate biological processes and inform strategies to attenuate catabolism. We aimed to examine if urea-to-creatinine ratio, a catabolic signature of...
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...
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Introduction: Traditional advance care planning focuses on end-of-life planning in the context of a certain or imminent death. It is not tailored for serious illness planning, where the 'death' outcome is uncertain. The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them...
Article
Background: Lessening Organ Dysfunction with VITamin C (LOVIT) is a blinded multicentre randomized clinical trial that compared high-dose intravenous vitamin C to placebo in patients admitted to the intensive care unit with proven or suspected infection as the main diagnosis and receiving a vasopressor. Objective: To describe a pre-specified sta...
Preprint
BACKGROUND The LOVIT (Lessening Organ Dysfunction with Vitamin C) trial is a blinded multicenter randomized clinical trial comparing high-dose intravenous vitamin C to placebo in patients admitted to the intensive care unit with proven or suspected infection as the main diagnosis and receiving a vasopressor. OBJECTIVE We aim to describe a prespeci...
Article
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Background: Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods: A systematic search of MEDLI...
Article
Background: Systemic inflammation and oxidative stress remain the main cause of complications in heart failure patients receiving a left ventricular assist device (LVAD). Selenoproteins are a cornerstone of antioxidant defense mechanisms for improving inflammatory conditions. Methods: We conducted a monocentric double-blinded, randomized pilot t...
Article
Purpose This scoping review sought to identify objective factors to assist clinicians and policy-makers in making consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable. Materials and methods Review of guidelines and tools used in ICUs, hospital wards and emergency departments on how t...
Article
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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
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
Background A previous study suggested an association between low caloric intake(CI), negative nitrogen balance, and poor outcome after subarachnoid hemorrhage(SAH). Objective of this multinational, multicenter study was to investigate whether clinical outcomes vary by protein intake(PI) or CI in SAH patients adjusting for the nutritional risk as ju...
Article
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The concepts and elements determining quality of care at the End of Life may vary across professional groups but there is consensus that high-quality care at the End of Life is beneficial for the patient, families, health systems and society at large. This scoping review aimed to elucidate gaps in the delivery of this specific type of care in older...
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
Recently, sedentary behavior recommendations have been included in the public health guidelines of multiple countries, pointing to new opportunities for prevention of chronic disease as well as a potential strategy for initiating long-term behavior change. Objective: To propose an evidence-informed approach to physical activity counseling that st...
Article
Background: The correlation between gastric residual volumes (GRV) and markers of gastric emptying (GE) in critically ill patients is unclear. This is especially true for ICU surgical patients as they are underrepresented in previous studies. Methods: We conducted a post-hoc analysis of a multicenter trial that investigated the effectiveness of...
Article
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Objective To evaluate the feasibility and efficacy of a serious illness decision aid (Plan Well Guide) in increasing the engagement of substitute decision-makers (SDM) in advance care planning (ACP). Methods This trial was conducted (2017–2019) in outpatient settings in Ontario, Canada, aiming to recruit 90 dyads of patients aged 65 years and olde...
Article
Background Nutrition risk, sarcopenia, and frailty are distinct yet inter-related. They may be due to suboptimal or prevented by optimal nutrition intake. The combination of nutrition risk (modified nutrition risk in the critically ill [mNUTRIC]), sarcopenia (SARC-CALF) and frailty (clinical frailty scale [CFS]) in a single score may better predict...
Article
Background: Whether nutrition therapy benefits all burn victims equally is unknown. To identify patients who will benefit the most from optimal nutrition, the modified Nutrition Risk in Critically Ill (mNUTRIC) Score has been validated in the Intensive Care Unit. However, the utility of mNUTRIC in severe burn victims is unknown. We hypothesized th...
Article
Background and Aims Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study’s objective was to determine whe...
Article
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Background: Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize th...
Article
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Background People are living longer than ever before. However, with living longer comes increased problems that negatively impact on quality of life and the quality of death. Tools are needed to help individuals assess whether they are practicing the best attitudes and behaviors that are associated with a future long life, high quality of life, hig...
Article
Background: Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize t...
Article
Background & Aims Some critically ill patients are at high nutritional risk, and early identification of these patients is needed to reduce morbidity and mortality related to underfeeding. The Modified NUTrition Risk in Critically ill (mNUTRIC) score is the first nutritional risk assessment tool developed and validated specifically for ICU patients...
Article
Background Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.Objective To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to us...
Article
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The data article refers to the paper titles “Impact of malnutrition on long-term survival in adult patients after elective cardiac surgery” [1]. The data refer to the analysis of the relationship between baseline malnutrition and long-term mortality after cardiac surgery. Baseline demographic, nutritional, and medical history data were collected fo...
Article
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Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, pros...
Article
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The authors thank the readers for pointing out the issues [1] in their publication [2], and wish to make a correction in the published version of their paper as the response of the readers' Comment. p-values have been corrected in the following parts of the paper.
Article
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The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Contemporary observational studies have exposed the pervasive undernutrition of critically ill patients and its a...
Article
Objectives: To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients. Design: Analysis of International Nutrition Survey database collected prospectively from 20...
Article
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Background Tools for advance care planning (ACP) are advocated to help ensure patient values guide healthcare decisions. Evaluation of the effect of tools introduced to patients in clinical settings is needed. Objective To evaluate the effect of the Canadian Speak Up Campaign tools on engagement in advance care planning (ACP), with patients attend...
Article
Introduction The aim of this study was to investigate the relationship between malnutrition and long-term survival in patients that underwent cardiopulmonary bypass (CPB). Materials and Methods : This study analyzed the long-term survival data of mixed cohort of 1187 cardiac patients previously enrolled in a prospective observational study of nutr...
Article
Purpose: To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand. Materials and methods: The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptatio...
Article
Introduction There is a need to improve the efficiency of clinical trials in burn care. The objective of this study was to validate “Persistent Organ Dysfunction” (POD) plus death as endpoint in burn patients and to demonstrate its statistical efficiency. Methods This secondary outcome analysis of a dataset from a prospective international multice...
Preprint
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As the world struggles with the COVID-19 pandemic, health service demands have increased to a point where healthcare resources may prove inadequate to meet demand. Guidelines and tools on how to best allocate intensive care beds and ventilators developed during previous epidemics can assist clinicians and policy-makers to make consistent, objective...
Article
Background: The modified Nutrition Risk in Critically ill (mNUTRIC) score was developed to identify patients most likely to benefit from nutritional therapies and to stratify or select study subjects for clinical trials. The score is not validated in trauma victims in whom adequate nutritional support is important and difficult to achieve. We soug...
Article
Background & Aims In critically ill patients, direct measurement of skeletal muscle using bedside ultrasound (US) may identify a patient population that might benefit more from optimal nutrition practices. When US is not available, survey measures of nutrition risk and functional status that are associated with muscle status may be used to identify...
Article
Although nutritional support belongs to the key components of intensive care treatment, it still remains largely inadequate in the postoperative treatment of cardiac surgery patients. Ong et al demonstrated in their observational study that patients with complicated postoperative courses had an increased need for an intense postoperative nutrition...
Article
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COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the...
Article
While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the ICU stay, combined EN and parenteral nutrition (PN) may represent an effe...
Article
Background Studies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal...
Article
Background and Aims The leading cause of mortality for patients with end-stage kidney disease (ESKD) is cardiovascular disease (CVD). This is due, in part, to vascular calcification (VC) where calcium becomes deposited within arterial walls causing narrowing of the arteries and altering their flexibility. Matrix Gla protein (MGP), a vitamin k-depen...
Article
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Background The impact of prior advance care planning (ACP) documentation on substitute decision-makers’ (SDMs) knowledge of values for end-of-life (EOL) care, and its correlation with SDM satisfaction with EOL care provision, have not been assessed in long-term care (LTC). Methods A cross-sectional survey of 2,595 SDMs from 27 LTC homes assessed:...
Article
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Background: Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improv...
Article
Background & aims Burn patients pose a number of clinical challenges for doctors and dietitians to achieve optimal nutrition practice. The objective of this study was to describe nutrition practices in burn center intensive care units (ICUs) compared to the most recent ESPEN and SCCM/ASPEN guidelines (hereafter referenced as “the Guidelines”) and h...
Article
Background: Recent studies have shown substantial deficiencies in the quality or quantity (or both) of communication and decision-making during serious illness. We evaluated the efficacy of a novel decision support intervention, the Plan Well Guide, in increasing completion of a standard medical order form for advance medical care planning and imp...
Article
Introduction The fourth most common injury worldwide are burn injuries. The uncontrolled inflammation, hyper-catabolism, and nutrient deficiencies associated with burn injuries can translate into worse clinical outcomes. Accordingly, CPGs recommends increasing energy requirements from 25–35 kcal/kg/day and provide 1.5–2 grams of protein/kg/day. Thu...
Article
Introduction We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients. Methods We used data from The International Nutrition Survey database collected from 2007–2014. Included patients we...
Article
Introduction Very few burn care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs) focusing on long-term clinically relevant outcomes. There is a need to improve the efficiency of RCTs in burn care so that more definitive high quality RCTs can be completed with the available resources. Persistent...
Article
Introduction Nutrition is an essential therapy in burn victims. However, whether nutrition therapy provide benefits equally to all burn victims is unknown. The NUTRIC score identifies patients who may not benefit more from aggressive nutrition therapy (score < 5) and those who may benefit more from aggressive nutrition (High score ≥ 5). It can be e...
Article
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Purpose: Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare.org), at home and evaluate the changes in advance care planning engagement among patients attending outpatient clinics....
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
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Background Poor quality communication about goals of care with seriously ill, hospitalized patients is associated with substantial discordance between prescribed medical orders for life-sustaining treatment and patients’ stated preferences. Designing tailored solutions to this discordance requires a better understanding of this communication proces...
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...
Preprint
Full-text available
Background Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people’s expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve...
Article
Full-text available
Background: Satisfaction with care is an important outcome measure in end-of-life care. Validated instruments are necessary to evaluate and disseminate interventions that improve satisfaction with care at the end of life, contributing to improving the quality of care offered at the end of life to the Portuguese population. The purpose of this stud...
Article
Background & aims: The quantity and quality of skeletal muscle and adipose tissue is an important prognostic factor for clinical outcomes across several illnesses. Clinically acquired computed tomography (CT) scans are commonly used for quantification of body composition, but manual analysis is laborious and costly. The primary aim of this study w...
Article
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Background: Sepsis is a health problem of global importance; treatments focus on controlling infection and supporting failing organs. Recent clinical research suggests that intravenous vitamin C may decrease mortality in sepsis. We have designed a randomized controlled trial (RCT) to ascertain the effect of vitamin C on the composite endpoint of d...
Article
Objectives: To evaluate the effect of esophageal stimulation on nutritional adequacy in critically ill patients at risk for enteral feeding intolerance. Design: A multicenter randomized sham-controlled clinical trial. Setting: Twelve ICUs in Canada. Patients: We included mechanically ventilated ICU patients who were given moderate-to-high do...
Article
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Background: There is a need to demonstrate a proof of principle that proteomics has the capacity to analyze plasma from breast cancer versus other diseases and controls in a multisite clinical trial design. The peptides or proteins that show a high observation frequency, and/or precursor intensity, specific to breast cancer plasma might be discove...