A Different Approach to the Nutritional Therapy in Intensive Care Units: Nutrition Software (ICNUS)

Abstract

C ritically ill patients have complex treatment needs, often with multiple organs affected. Critically ill patients are a heterogeneous population, which includes patients with traumatic injuries (e.g. injuries to the skeletal system, brain, thorax, or abdomen) or burns, systemic infections, surgical complications (e.g. major blood loss or respiratory failure) and multiple organ failure. However, a common feature of the most critical illnesses is that they all give rise to severe metabolic stress, and many critically ill patients often develop systemic inflammation. In addition, they also have increased metabolic requirements; therefore, the need for a nutritional support must also be considered (1, 2).In critically ill patients, the stress response directly influences neuroendocrine function. Changes in secretion of numerous hormones/neurotransmitters, such as acetylcholine, growth hormone and cortisol, combine to increase the body's basal metabolic rate, wherein substrates are mobilised to release energy sources (3-7). Hypercatabolism triggered by conditions of severe stress therefore increases the body's requirement for energy and protein. The increased metabolic requirements of critically ill patients are likely to accelerate the development of malnutrition, which must be considered when managing their treatment strategy (7).Compared with healthy individuals, the protein turnover is increased and more often than not, dietary protein intake is considerably reduced. Under conditions of stress, body proteins are broken down rapidly, and urinary nitrogen excretion is increased beyond normal levels. Since amino acids released from the breakdown of protein in the muscles, bones and skin are used to support, in part, to increase synthesis of proteins involved in the stress response (e.g. immunoglobulins, acuteCritically ill patients receive nutritional support in addition to extensive organ support therapies in the intensive care units. The transcription of the data obtained by multiple devices from a wide spectrum of usage areas is a challenging process and is prone to errors. Software specifically designed for usage in intensive care units do offer numerous advantages. Primarily, it facilitates to improve the management of time and workflow for the benefit of patients. Therefore, we believed that a different approach was needed for the nutritional regime of our critically ill patients. Following nearly 2 years of research, we developed and implemented the Intensive Care Nutrition Software (ICNUS), which is explained in this article. Keywords: ICNUS software, intensive care, nutrition Yoğun bakım birimlerinde yoğun organ destekleri almakta olan hastaların aynı zamanda nütrisyon tedavileri de birarada yürütül-mektedir. Çok miktarda kopuk kopuk farklı cihazlardan gelen verilerin kağıt ve dosyalara geçirilmesiyle zorluklar ve yanlış kayıtlar ortaya çıkabilmektedir. Yoğun bakıma özgü bir yazılım sistemi, yoğun bakım hastalarının takip ve tedavisinde büyük avantajlar sağ-lamaktadır. Birimimizde kullanmakta olduğumuz ya...

Use of a software in the ICU

“…• The nutrition window is a section we have spent such a long time for and we decided to give it a separate name: Intensive Care Nutrition Software ICNUS. [10] After getting the daily caloric requirement in Kcal directly from the metabolic monitor, the ICIS automatically calculates calorie and protein needs of patients and clearly demonstrates the daily nutritional aims. Since each product on the market for enteral and parenteral nutrition is in the database of ICNUS with their calorie and protein concentrations, it is also able to calculate the amount of the calories and protein given that day automatically.…”

Adequacy of nutritional support in critically ill patients post implementation of nutritional protocols in surgical intensive care unit of a university hospital

“…Malnutrition is a prevalent consequence in critically ill patients and can be observed due to several reasons, including hyper-metabolism and inadequate energy and protein reserves (2). The surgical intensive care unit (SICU) population includes postoperative patients having undergone major surgical procedures with systemic infections and traumatic injuries, which may include injuries either to the brain, chest, abdomen or multiple fractures leading to surgical complications, such as respiratory failure, massive blood-loss, secondary infections or organ failure (3). However, mechanically ventilated patients in ICUs are unable to consume oral nutrition, and, therefore, artificial nutrition serves as a life-sustaining therapy to meet the nutritional requirements of ICU patients (4).…”

Current Methods Used to Determine Resting Energy Expenditure in Intensive Care Patients

“…Birçok çalışma enerji ve protein alımının yakından izlenmesi gerektiğini vurgulamaktadır. [7][8][9][10] Çünkü hem aşırı beslenme hem de yetersiz beslenme hastalığın seyrini olumsuz yönde etkileyebilir. 1,11 Aslında, yoğun bakım hastalarının enerji gereksinimi erken evrede muhtemel DEH'den düşüktür, zira erken evrede DEH'nin önemli bir kısmı endojen glikoz üretiminden karşılanmaktadır.…”