Can an adequate energy intake be able to reverse the negative nitrogen balance in mechanically ventilated critically ill patients?

Japúr, Camila Cremonezi; Monteiro, Jacqueline Pontes; Marchini, Júlio Sérgio; Diez‐Garcia, Rosa Wanda; Basile-Filho, Aníbal

doi:10.1016/j.jcrc.2009.05.009

Cited by 35 publications

(30 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While it's true that energy expenditure increases roughly proportionately to the intensity of the protein-catabolic response, calorie provision that exceeds ϳ50% of energy expenditure improves nitrogen balance very little further (Dickerson 2005), especially in critical illness (Behrendt et al 1990;Frankenfield et al 1997;Japur et al 2010), even as it increases the risk of hyperglycemia and other adverse outcomes. Some level of nonprotein calorie provision may indeed be important in the early phase of critical illness, but it is unlikely that total calorie provision has to exceed 50% to 70% of energy expenditure in the early phase of critical illness as long as protein provision is increased to compensate for the mild reduction in the efficiency of protein retention induced by the hypocaloric state (Hoffer andBistrian 2012, 2013a).…”

Section: Cognitive Biasesmentioning

confidence: 99%

Protein requirement in critical illness

Hoffer

2016

Appl. Physiol. Nutr. Metab.

View full text Add to dashboard Cite

How much protein do critically ill patients require? For the many decades that nutritional support has been used there was a broad consensus that critically ill patients need much more protein than required for normal health. Now, however, some clinical investigators recommend limiting all macronutrient provision during the early phase of critical illness. How did these conflicting recommendations emerge? Which of them is correct? This review explains the longstanding recommendation for generous protein provision in critical illness, analyzes the clinical trials now being claimed to refute it, and concludes with suggestions for clinical investigation and practice.Key words: bias, calories, critical care, critical illness, energy, enteral nutrition, nutritional support, nutrition requirements, parenteral nutrition, protein requirements. Résumé :On s'interroge sur la quantité requise de protéines pour les patients en phase critique. Durant les nombreuses décennies au cours desquelles on a apporté un soutien nutritionnel, il y avait un large consensus selon lequel les patients en phase critique avaient besoin de plus de protéines que ce qui était admis pour une santé normale. De nos jours, toutefois, des chercheurs en clinique recommandent de limiter l'approvisionnement en macronutriments durant les premiers stades de la phase critique. D'où proviennent ces recommandations conflictuelles? Quelles sont les bonnes? Cette analyse documentaire explique la recommandation de longue date au sujet de l'apport généreux en protéines en phase critique, analyse les essais cliniques qui revendiquent de l'abandonner et propose en conclusion des suggestions de recherche clinique et de pratique. [Traduit par la Rédaction]

show abstract

Section: Cognitive Biasesmentioning

confidence: 99%

Protein requirement in critical illness

Hoffer

2016

Appl. Physiol. Nutr. Metab.

View full text Add to dashboard Cite

show abstract

“…42 If nutrition support is not initiated at the appropriate time, depending on the nutritional risk of the patient, then a critical energy debt (one that cannot be repaid) can result that negatively impacts clinical outcome. 43,44 Providing improper amounts of nutrition is associated with poor outcomes. Studies of nutrition support in the ICU have confirmed the frequency of over-(25-58%) and underfeeding (12-35%).…”

Section: General Remarksmentioning

confidence: 99%

“…41 Sedation, analgesics, and neuromuscular blocking agents reduce REE, while pressors raise REE. 44,64 The magnitude of alteration in REE varies widely between critically ill patients, ranging from hyper-to iso-to hypometabolic, making indirect calorimetry a useful tool to calculate energy needs. Green et al 65 reported energy requirements of 25.6 -57.6 kcal/kg/d in mechanically ventilated critically ill patients.…”

Section: Indirect Calorimetry Versus Predictive Equations To Titrate mentioning

confidence: 99%

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Schulman

Mechanick²

2012

Respir Care

View full text Add to dashboard Cite

Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population is needed to validate this current approach.

show abstract

“…Outra situação a ser considerada é a superalimentação, que acontece pelo cálculo superestimado do GET e que pode levar o paciente a desenvolver alterações metabólicas e respiratórias, como hipercapnia, aumento do tempo de VM, esteatose hepática, hiperglicemia, acidose metabólica, hipertrigliceridemia e síndrome de realimentação 35,36 .…”

Section: I S C U S S ã Ounclassified

Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética

2012

View full text Add to dashboard Cite

OBJETIVO: O objetivo deste estudo foi avaliar a adequação energética dos pacientes politraumatizados em suporte ventilatório internados na unidade de terapia intensiva de um hospital público de Porto Alegre (RS), por meio da comparação entre as calorias prescritas e as efetivamente administradas, assim como entre as calorias estimadas pela equação de Harris-Benedict e a prescrição energética de cada paciente. MÉTODOS: Estudo de coorte prospectivo de pacientes politraumatizados, simultaneamente sob ventilação mecânica e terapia nutricional enteral. Verificou-se o tempo de permanência sob ventilação mecânica e a oferta energética durante o período de terapia nutricional enteral. A associação entre as variáveis quantitativas foi avaliada através do teste de correlação de Spearman devido à assimetria das variáveis. RESULTADOS: Foram acompanhados 60 pacientes, na faixa etária de 18 a 78 anos, sendo 81,7% do sexo masculino. Os tempos medianos de internação hospitalar, permanência na unidade de terapia intensiva e ventilação mecânica foram de 29, 14 e 6 dias, respectivamente. A média do percentual de dieta administrada foi de 68,6% (DP=18,3%). Da amostra total, 16 (26,7%) pacientes receberam no mínimo 80% de suas necessidades diárias. Não houve associação estatisticamente significativa entre o valor energético total administrado e os tempos de ventilação mecânica (r s=0,130; p=0,321), de unidade de terapia intensiva (r s=-0,117; p=0,372) e de internação hospitalar (r s=-0,152; p=0,246). CONCLUSÃO: Os pacientes incluídos neste estudo não receberam com precisão o aporte energético prescrito, ficando expostos aos riscos da desnutrição e seus desfechos clínicos desfavoráveis.

show abstract

Can an adequate energy intake be able to reverse the negative nitrogen balance in mechanically ventilated critically ill patients?

Cited by 35 publications

References 35 publications

Protein requirement in critical illness

Protein requirement in critical illness

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética

Contact Info

Product

Resources

About