Nutrition therapy in critically ill patients- a review of current evidence for clinicians (original) (raw)
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Medical Nutrition Therapy for the Critically Ill
Nutritional support has been an often neglected but essential and crucial element in management of critically ill. The medical nutrition therapy is fast replacing the concept of supportive nutrition in critically ill patients. Adequate and proper nutrition therapy has the potential to positively impact patient outcomes and length of hospital stay. It is relatively inexpensive compared to other treatments, and is being increasingly identified as a marker of quality ICU care.
Nutrition therapy for critically ill and injured patients
European Journal of Trauma and Emergency Surgery, 2013
Background Nutrition support has undergone significant advances in recent decades, revolutionizing the care of critically ill and injured patients. However, providing adequate and optimal nutrition therapy for such patients is very challenging: it requires careful attention and an understanding of the biology of the individual patient's disease or injury process, including insight into the consequent changes in nutrients needed. Objective The objective of this article is to review the current principles and practices of providing nutrition therapy for critically ill and injured patients. Methods Review of the literature and evidence-based guidelines.
Current Trends in Critical Care Nutrition
Current Gastroenterology Reports, 2011
Nutrition in the intensive care setting is a vital part of patient care, and may even be referred to as "nutritional therapy". Current nutritional practices have progressed a lot over the past few years, and draw from a large body of accumulating evidence. Yet, as with other trends in critical care, there are a lot of variations in the way nutrition is approached between institutions, as well as between individual physicians. This review attempts to look at some of these differences and provide recommendations based upon the available literature.
Common Controversies in Critical Care Nutrition: Review of Latest Evidences
Journal of Cardiac Critical Care TSS, 2019
Context Critical care nutrition favorably influences patient prognosis and remains an essential component of overall patient care. Various guidelines and literature discuss the modalities, benefits, and other finer details of nutrition in intensive care units. Critical care nutrition is still an emerging modality and hence, ambiguity/subjectivity exists in various aspects. Clear recommendations are not there, especially when it comes to diverse topics such as nutrition screening/assessment, underfeeding patients, types of nutrition formulae, monitoring nutrition adequacy, and tolerance and likewise. This article is an attempt to address couple of these concerns and review the latest evidences/guidelines in context of nutrition screening/assessment and monitoring tolerance by measuring gastric residual volumes (GRVs). Evidence Acquisition Various literature including existing guidelines, original articles, and review articles published till September 2019 and discussing the specifics...
Journal of the Academy of Nutrition and Dietetics, 2012
Patients requiring mechanical ventilation in an intensive care unit commonly fail to attain enteral nutrition (EN) infusion goals. We conducted a cohort study to quantify and compare the percentage of energy and protein received between standard care (n=24) and intensive medical nutrition therapy (MNT) (n=25) participants; to assess the percentage of energy and protein received varied by nutritional status, and to identify barriers to EN provision. Intensive MNT entailed providing energy at 150% of estimated needs, using only 2.0 kcal/cc enteral formula and 24-hour infusions. Estimated energy and protein needs were calculated using 30 kcal/kg and 1.2 g protein/kg actual or obesity-adjusted admission body weight. Subjective global assessment was completed to ascertain admission intensive care unit nutritional status. Descriptive statistics and survival analyses were conducted to examine time until attaining 100% of feeding targets. Patients had similar estimated energy and protein needs, and 51% were admitted with both respiratory failure and classified as normally nourished (n=25/49). Intensive MNT recipients achieved a greater percentage of daily estimated energy and protein needs than standard care recipients (1,198±493 vs 475±480 kcal, respectively, P<0.0001; and 53±25 vs 29±32 g, respectively, P=0.007) despite longer intensive care unit stays. Cox proportional hazards models showed that intensive MNT patients were 6.5 (95% confidence interval 2.1 to 29.0) and 3.6 (95% confidence interval 1.2 to 15.9) times more likely to achieve 100% of estimated energy and protein needs, respectively, controlling for confounders. Malnourished patients (n=13) received significantly less energy (P=0.003) and protein (P=0.004) compared with normally nourished (n=11) patients receiving standard care. Nutritional status did not affect feeding intakes in the intensive MNT group. Clinical management, lack of physician orders, and gastrointestinal issues involving ileus, gastrointestinal hemorrhage, and EN delivery were the most frequent clinical impediments to EN provision. It was concluded that intensive MNT could achieve higher volumes of EN infusion, regardless of nutritional status. Future studies are needed to advance this methodology and to assess its influence on outcomes.
Nutrition in the Intensive Care Unit
Critical Care, 2005
Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more knowledge of the cost-benefit and cost effectiveness of nutritional support in the critically ill.
Nutrition and Nutritional Support in Critically Ill Patients
Journal of Intensive Care Medicine, 1993
The use of intravenous nutritional support has increased dramatically in the last 20 years. Although it is not without controversy, administration of nutritional support is common practice in hospitalized patients including critically ill patients. Malnutrition continues to be reported in a significant number of hospitalized patients. The incidence of malnutrition in critically ill patients may be even higher than that reported in hospitalized patients overall. The consequences of malnutrition in a critically ill patient may be severe. Nutritional assessment and nutritional support can present special challenges to the intensivist. Techniques of nutritional assessment in critically ill patients are evaluated. Guidelines for the determination of the nutritional needs of these patients are outlined. Methods of delivery of nutritional support in critically ill patients are reviewed. Complications of nutritional support are discussed.