Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM)

Elke, Gunnar; Hartl, Wolfgang H.; Kreymann, K. Georg; Adolph, M.; Felbinger, Thomas W.; Graf, Tobias; Heer, Geraldine de; Heller, Axel R.; Kampa, Ulrich; Mayer, Konstantin; Muhl, Elke; Niemann, Bernd; Rümelin, Andreas; Steiner, Stephan; Stoppe, Christian; Weimann, Arved; Bischoff, Stephan C.

doi:10.1016/j.clnesp.2019.05.002

Cited by 94 publications

(196 citation statements)

References 443 publications

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“…This is associated with the observation that glutamine deficiency is common in ICU patients, but also that routine glutamine supplementation in ICU patients without documented clinical deficiency may result in harmful outcomes [25]. For this reason, routine supplementation of glutamine to all critically ill patients is not recommended by various Societies like ESPEN (European Society for Clinical Nutrition and Metabolism) [32]; ASPEN (American Society for Parenteral and Enteral Nutrition) [33]; and the German Nutrition Guidelines [34]. Although glutamine is thought to have an important role in critically ill patients, the recognized contra-indications to glutamine supplementation must be adhered to, such as the presence of multiple organ failure (especially renal and liver failure) [1,7,10,14,32,34] and patients with septic shock requiring vasopressor support [1,7,10,34].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, routine supplementation of glutamine to all critically ill patients is not recommended by various Societies like ESPEN (European Society for Clinical Nutrition and Metabolism) [32]; ASPEN (American Society for Parenteral and Enteral Nutrition) [33]; and the German Nutrition Guidelines [34]. Although glutamine is thought to have an important role in critically ill patients, the recognized contra-indications to glutamine supplementation must be adhered to, such as the presence of multiple organ failure (especially renal and liver failure) [1,7,10,14,32,34] and patients with septic shock requiring vasopressor support [1,7,10,34]. When supplementing with glutamine, the dose should not exceed 0.5 g/kg body weight per day [7,10,14]; it should not be supplemented during the early acute phase of critical illness [10,34]; it should be administered together with full nutrition support [14] and the glutamine dose should not exceed 30% of the prescribed nitrogen supply [7].…”

Section: Discussionmentioning

confidence: 99%

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Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

2020

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Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420-700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

2020

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“…Nutritional assessment is required when the patient is admitted to the ICU. 29 Trained by dietitian, the intake nurse could make a nutrition plan based on the assessment and start enteral nutrition within 24-48 hours after the haemodynamics become stable. The calorie requirement of critical COVID-19 patients is about 15-30 kcal/kg/day.…”

Section: Providing Care To Patients Requiring Enteral Nutritionmentioning

confidence: 99%

Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU

Chen

2020

Stroke Vasc Neurol

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Coronavirus pandemic is the most important public health event in the world currently. Patients with coronavirus disease 2019 (COVID-19) in a critical state are at risk of progressing rapidly into many serve complications; they require a high level of care from ICU nurses. How to avoid the virus to infect health care worker is also a critical issue. Based on the summarized experience of Chinese health workers, literature review and clinical practice, this article introduced donning and doffing of personal protective equipment (PPE) protocol and some keypoints of nursing critical care in patients with coronavirus disease 2019 (COVID-19): caring of patients requiring intubation and ventilation, venous thromboembolism (VTE) prevention, caring of patients on ECMO, caring for patients requiring enteral nutrition, psychological support and nursing management of COVID-19 ICU. This article introduced a useful protocol of donning and doffing personal protective equipment to protect health care workers, and provided key points for the ICU nurses how to take care of COVID-19 patients.

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“…im Mittelpunkt des vierten Heftes dieses besonderen Jahres steht der CME-Fortbildungsbeitrag von Alexander Koch, Lukas Bündgens und Frank Tacke zum Thema "Ernährungstherapie des Intensivpatienten". Dieses Thema beschäftigt uns regelmäßig in der Aktuellen Ernährungsmedizin, zuletzt als Viewpoint im Heft 3/2020 zur "Ernährung adipöser kritisch kranker Intensivpatienten unter besonderer Beachtung der Proteindosierung" von Karl Georg Kreymann [1] und vor fast zwei Jahren als DGEM-Leitlinie "Klinische Ernährung in der Intensivmedizin" von Gunnar Elke und Co-Autoren [2], die inzwischen auch ins Englische übersetzt und in Clinical Nutrition ESPEN publiziert wurde [3].…”

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Liebe Leserinnen und Leser,

2020

Aktuelle Ernährungsmedizin

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Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM)

Cited by 94 publications

References 443 publications

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU

Liebe Leserinnen und Leser,

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