Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis.

Mechanically ventilated patients are unable to take food orally and therefore are dependent on enteral nutrition for provision of both energy and protein requirements. Enteral nutrition is supportive therapy and may impact patient outcomes in the intensive care unit. Early enteral nutrition has been shown to decrease complications and hospital length of stay and improve the prognosis at discharge. Nutrition support is unique for patients on mechanical ventilation and, as recently published literature shows, should be tailored to the individuals' underlying pathology. This review will discuss the most current literature and recommendations for enteral nutrition in patients receiving mechanical ventilation. (Nutr Clin Pract. 2019;34:540-557)

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Purpose of Review To discuss the different forms of enteral nutrition, while outlining available evidence for its use in specific conditions and how enteral nutrition composition may or may not influence relevant outcomes. Recent Findings Enteral nutrition formulas were originally conceived as a liquid form of nutrition for individuals who otherwise could not consume adequate calories through solid food. Over time, the emergence of specialty formulas marketed to benefit specific diseases or conditions has led to a broad range of potentially confusing options. While most options have theoretical benefit for their marketed conditions, the evidence demonstrating practical benefit is not consistent. Summary Overall, the certainty of evidence for specialty formulas remains low or very low. In most instances, one could begin with standard polymeric formula, except in cases where disease-specific formulas are recommended. Much research is nonetheless still needed to clarify whether some disease-specific formulas are truly beneficial or merely theoretical features.

Recent clinical trials have challenged the concept that aggressive full feeding as close to goal requirements as possible is necessary in the first week following admission to the intensive care unit. While the data suggesting that permissive underfeeding is better than full feeds are methodologically flawed, other data do indicate that in certain well-defined patient populations, outcomes may be similar. The most important issues for clinicians in determining optimal nutrition therapy for critically ill patients are to carefully determine nutrition risk and differentiate nutrition from nonnutrition benefits of early enteral feeding. Management decisions in the first week of hospitalization should be made in the context of both short- and long-term outcomes. Patients at highest nutrition risk may require advancement to goal feeds as soon as tolerated to maximize benefit from nutrition therapy.

Chronic obstructive pulmonary disease (COPD) represents an important global public health concern. Malnutrition is common in patients with COPD and often leads to worse outcomes for these patients. Recognition of overall nutrition status for patients with COPD is an important aspect of their care and treatment. Several methods have been studied that move beyond the standard/frequent use of body mass index alone. The purpose of this review is to summarize the current evidence for other tools to evaluate nutrition status in patients with COPD and highlight patients who may benefit from nutrition interventions. (Nutr Clin Pract. 2019;34:330-339)