Full Nutrition or Not?

Stuever, Mary F.; Kidner, Ryan F.; Chae, Floria; Evans, David C.

doi:10.1002/ncp.10101

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…Enteral nutrition’s impact on autophagy has been suggested as a possible mechanism for this harm. Autophagy is a cellular repair process that plays a role in both homeostasis and disease recovery [ 24 , 25 ]. Autophagy is inhibited by increased insulin, glucose, and nutrients, so disruption of autophagy by enteral nutrition could be a mechanism of harm [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Energy balance in obese, mechanically ventilated intensive care unit patients

et al. 2019

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Objectives: The aims of this study were, first, to compare the predicted (calculated) energy requirements based on standard equations with target energy requirement based on indirect calorimetry (IC) in critically ill, obese mechanically ventilated patients; and second, to compare actual energy intake to target energy requirements. Methods: We conducted a prospective cohort study of mechanically ventilated critically ill patients with body mass index ≥30.0 kg/m 2 for whom enteral feeding was planned. Clinical and demographic data were prospectively collected. Resting energy expenditure was measured by open-circuit IC. American Society of Parenteral and Enteral Nutrition (APSPEN)/Society of Critical Care Medicine (SCCM) 2016 equations were used to determine predicted (calculated) energy requirements. Target energy requirements were set at 65% to 70% of measured resting energy expenditure as recommended by ASPEN/SCCM. Nitrogen balance was determined via simultaneous measurement of 24-h urinary nitrogen concentration and protein intake. Results: Twenty-five patients (mean age: 64.5 ± 11.8 y, mean body mass index: 35.2 ± 3.6 kg/m 2 ) underwent IC. The mean predicted energy requirement was 1227 kcal/d compared with mean measured target energy requirement of 1691 kcal/d. Predicted (calculated) energy requirements derived from ASPEN/SCCM equations were less than the target energy requirements in most cases. Actual energy intake from enteral nutrition met 57% of target energy requirements. Protein intake met 25% of target protein requirement and the mean nitrogen balance was −2.3 ± 5.1 g/d. Conclusions: Predictive equations underestimated target energy needs in this population. Further, we found that feeding to goal was often delayed resulting in failure to meet both protein and energy intake goals.

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Section: Discussionmentioning

confidence: 99%

Energy balance in obese, mechanically ventilated intensive care unit patients

et al. 2019

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“…It is associated with hyperglycemia, hyperlipidemia, hypercapnia, infectious complications, impaired immunity, liver steatosis, and increased fat mass [5, 6]. Recently, impairment of autophagy caused by overfeeding is receiving a lot of attention [6, 7]. Because of the complex interplay among autophagy, immune responses, and inflammation [7], overfeeding should be avoided in critically ill patients.…”

Section: Why Is Optimal Calorie Administration Important?mentioning

confidence: 99%

“…Recently, impairment of autophagy caused by overfeeding is receiving a lot of attention [6, 7]. Because of the complex interplay among autophagy, immune responses, and inflammation [7], overfeeding should be avoided in critically ill patients. Contrastingly, underfeeding is defined as energy administration below 70% of the defined target [3].…”

Section: Why Is Optimal Calorie Administration Important?mentioning

confidence: 99%

“…Because the NRS-2002 does not specialize in ICU patients, almost all ICU patients are considered at “risk” just because admission to the ICU (acute physiology and chronic health evaluation [APACHE] II score > 10) adds 3 points. Contrastingly, the NUTRIC score, based on age, APACHE II score, sequential organ failure assessment (SOFA) score, comorbidities, days from hospital admission to ICU admission, and interleukin (IL)-6 levels, identifies patients with scores ≥ 5 as having high risk [7, 8]. Since the measurement of IL-6 levels is not always feasible, a modified NUTRIC (mNUTRIC) score that excludes IL-6 levels is also used [9].…”

Section: What Do the Guidelines Say?mentioning

confidence: 99%

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Strategies for optimal calorie administration in critically ill patients

Yatabe

2019

j intensive care

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Nutritional therapy is one of the important treatments in critically ill patients. How to estimate calorie consumption and how to determine an optimal calorie dose are clinical questions of great importance. Although indirect calorimetry is the gold standard for assessing energy expenditure, many intensivists are unable to use this technique. Therefore, the use of formulas, such as the Harris-Benedict equation, or the simple predictive value of 25 kcal/kg/day is reasonable. Several studies and guidelines have shown that the strategies for nutritional therapy depend on the nutritional risk of patients. If patients have low nutritional risks, these estimated values should not be adopted in the acute phase. Until the patient's condition improves, less than 18 kcal/kg/day might be an optimal calorie target. Contrastingly, cumulative negative energy balance can also be harmful to critically ill patients. Thus, it is important to accurately determine the energy requirement and to make the required changes in the administered calorie dose to go from a strategy of "defense" to that of "offense" in a timely manner. In this article, the concepts of optimal calorie administration in critically ill patients were reviewed.

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“…The effect of EN in septic shock on hemodynamic stability, defined by a change in vasopressor dose, is not well defined. In addition, EN dose (trophic vs nontrophic) during critical illness remains debated 8–11 . Studies of septic shock patients receiving early trophic EN suggest benefit, compared with nontrophic dose or no EN 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study

et al. 2020

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Background: Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours. Methods: This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours. Results: Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27-69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5-75.5). No serious complications occurred. Conclusion: The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.

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Full Nutrition or Not?

Cited by 8 publications

References 30 publications

Energy balance in obese, mechanically ventilated intensive care unit patients

Energy balance in obese, mechanically ventilated intensive care unit patients

Strategies for optimal calorie administration in critically ill patients

Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study

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