Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines

Abstract

The group of patients most frequently in need of nutritional support are intensive care patients. This year (i.e., 2019), new European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines of clinical nutrition in intensive care were published, updating and gathering current knowledge on the subject of this group of patients. Planning the right nutritional intervention is often a challenging task involving the necessity of the choice of the enteral nutrition (EN) or parenteral nutrition (PN) route of administration, time of initiation, energy demand, amino acid content and demand as well as the use of immunomodulatory nutrition. The aim of this study was to specify and discuss the basic aspects of the clinical nutrition of critically ill patients recommended by ESPEN guidelines. Clinical nutrition in intensive care seems to be the best-studied type of nutritional intervention. However, meta-analyses and clinical studies comparing EN and PN and their impact on the prognosis of the intensive care patients showed ambiguous results. The nutritional interventions, starting with EN, should be initiated within 24–48 h whereas PN, if recommended, should be implemented within 3–7 days. The recommended method of calculation of the energy demand is indirect calorimetry, however, there are also validated equations used worldwide in everyday practice. The recommended protein intake in this group of patients and the results of insufficient or too high supply was addressed. In light of the concept of immunomodulatory nutrition, the use of appropriate amino acid solutions and lipid emulsion that can bring a positive effect on the modulation of the immune response was discussed.

Rationing of Nursing Care in Intensive Care Units

“…In intensive care units (ICUs), patients who are critically ill, or on the verge of life and death, are treated. The main role of nurses working at ICUs is 24-h monitoring of patients’ vital functions, nutritional treatment to prevent the development of malnutrition in unconscious patients [ 2 , 3 ], ensuring proper personal hygiene, and keeping records of hospitalized patients [ 2 , 4 ].…”

Adequação calórico-proteica, nutrição enteral precoce e tempo de permanência de pacientes críticos em uma unidade de terapia intensiva / Caloric-protein fitness, early enteral nutrition and time of stay for critical patients in an intensive care unit

“…(MARTINS, 2018) É consenso que o emprego da TNE precoce, iniciada nas primeiras 24 a 48 horas da internação hospitalar, pode diminuir a incidência de complicações infecciosas, bem como reduzir o tempo de internação e a mortalidade dos pacientes. (CHELKEBA, et al, 2017;COVELLO, et al, 2020;DAVARI et al, 2019;GOSTYŃSKA, et al, 2019;MCCLAVE, et al, 2016;PADILLA, et al, 2019;PAZ;COUTO, 2016;SINGER, et al, 2018) A implementação deste suporte ocorreu em 69,6% dos pacientes, tal resultado foi inferior à achados na literatura. (AZEVEDO, et al, 2019;JOSÉ, et al 2018;NUNES, et al, 2018;WEI, et al, 2015) No atual trabalho, a oferta de dieta em período precoce nos pacientes internados foi associada a uma maior adequação calórico-proteica durante a primeira semana de internamento e a um menor tempo de permanência na UTI.…”

“…(COVELLO, et al, 2020) O início precoce da TNE, dentro de 24 a 48 horas após a admissão, em pacientes hemodinamicamente estáveis, tem sido amplamente recomendado. (BLASER, et al, 2017;FISCHER, et al, 2018;GOSTYŃSKA, et al, 2019;PAZ;COUTO, 2016;SINGER, et al, 2018) Evidencias sugerem que a intervenção nutricional precoce leva a melhores resultados clínicos, mantém a integridade da mucosa intestinal, bem como reduz tempo de internação e mortalidade. (COVELLO, et al, 2020;DAVARI et al, 2019;GOSTYŃSKA, et al;LI et al, 2020;PADILLA, et al, 2019) Entretanto, pacientes em terapia intensiva frequentemente apresentam inadequações no suporte nutricional, tanto pela sub ou superestimação das necessidades energéticas diárias (PATKOVA, et al, 2017) quanto pela introdução tardia da TNE e interrupções para procedimentos.…”

“…o planejamento nutricional alguns aspectos devem ser considerados, como tempo de início da terapia, via de administração e estimativa energética e proteica apropriadas (GOSTYŃSKA, et al, 2019). Contudo, sabe-se que suspensão da dieta por complicações gastrintestinais, a sub ou superestimação das necessidades nutricionais diárias do paciente, a introdução tardia da nutrição enteral podem impedir que o paciente receba o aporte nutricional adequado.…”

Co-Administration of Drugs and Parenteral Nutrition: In Vitro Compatibility Studies of Loop Diuretics for Safer Clinical Practice

“…The recommended dose of amino acid is 1.3 g per kg bodyweight. The use of immunomodulatory nutrition in intensive therapy is debatable, but it seems that the advantages of this type of preparation outweigh the risk of their use [ 7 ].…”