Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Martindale, Robert G.; McClave, Stephen A.; Vanek, Vincent W.; McCarthy, Mary S.; Roberts, Pamela R.; Taylor, Beth; Ochoa, Juan B.; Napolitano, Lena M.; Cresci, Gail

doi:10.1097/ccm.0000000000001525

Cited by 591 publications

(273 citation statements)

References 377 publications

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“…What is known Variable results have been reported from various studies with various methodologies [90][91][92][93][94]. Despite nutrition support being available for many years, there is limited conclusive evidence favoring any aspect of its use.…”

Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…However, it is less clear what the most appropriate caloric dose is. Based on expert opinion, observational studies and small RCTs [3–7], it has been generally recommended to provide full caloric requirement to critically ill patients [8]. To achieve this goal, interventions to augment caloric intake, such as the implementation of protocols [9, 10], prokineteic agents and postpyloric tube placement [11] have been proposed, even though studies have not demonstrated improvement in clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Although parenteral nutrition (PN) differs from EN in indications, physiologic effects and complications, studies have shown that lower caloric intake with PN was associated with better clinical outcomes [17]. As such the clinical practice guidelines of the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition recommended that mild permissive underfeeding should be considered in critically ill patients receiving PN, at least in certain high-risk groups [8, 18]. On the other hand, the evidence on the relationship between enteral caloric intake and survival remains conflicting and has ignited heated discussion in the critical care literature [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

et al. 2016

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BackgroundThere is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome.MethodsWe reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome.ResultsTwenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838–1.083), ICU mortality (RR 0.885; 95 % CI 0.751–1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878–1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519–0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545–0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials.ConclusionsWe found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1539-3) contains supplementary material, which is available to authorized users.

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“…High arginine-containing immune-modulating diets were recommended to be considered in severe trauma patients by the European Society of Clinical Nutrition and Metabolism [38] and by the Society of Critical Care Medicine/American Society of Enteral and Parenteral Nutrition [39]; on the contrary, routine arginine supplementation was discouraged in severe sepsis by both guidelines [38, 39]. Different responses to exogenous arginine in both arginine deficient states may be related with the predominant induction of arginase I after trauma while iNOS expression is increased in patients with sepsis [4, 5].…”

Section: Discussionmentioning

confidence: 99%

Argininemia and plasma arginine bioavailability – predictive factors of mortality in the severe trauma patients?

et al. 2016

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BackgroundArginine is an amino acid determinant in the metabolic, immune and reparative responses to severe trauma. The present study aims to determine argininemia and plasma arginine bioavailability (PAB) in critical trauma patients and to analyze its correlation with prognosis.MethodsA prospective study of 23 critical trauma patients was undertaken. Aminoacidemias were determined, by ion exchange chromatography, at admission and in the first and third days and compared with those of 11 healthy individuals. PAB was calculated. Severity indexes and outcome parameters were recorded.ResultsValues of argininemia, citrullinemia and ornithinemia at the admission were significantly lower than those of the controls (arginine: 41.2 ± 20.6 versus 56.1 ± 11.9 μmol/L, P = 0.034). Hipoargininemia (<60 μmol/L) prevalence was 82.6 %. Mean PAB was 62.4 ± 25.6 %. Argininemia < 26 μmol/L constituted a significant predictive factor of in-hospital mortality [n = 4 (17.4 %); 75 versus 15.8 %, P = 0.04; odds ratio = 4.7; accuracy = 87 %] and lower actuarial survival (63.5 ± 43.9 versus 256.1 ± 33.3 days, P = 0.031). PAB <42 % [n = 6 (26.1 %)] was associated with higher lactacidemia levels (P = 0.033), higher in-hospital mortality (66.7 versus 11.8 %, P = 0.021; odds ratio = 5.7, accuracy = 82.6 %) and lower actuarial survival (87.2 ± 37.5 versus 261.4 ± 34.7 days, n.s.). Probability of in-hospital mortality was inversely and significantly related with PAB [61.8 ± 8.8 % (95 % CI 50.8–72.7) when PAB <41 % and 2.8 ± 1.9 % (95 % CI 1.9–8.3) when PAB > 81 %, P = 0.0001]. Charlson’s index ≥1, APACHE II ≥19.5, SOFA ≥7.5, and glutaminemia < 320 μmol/L were also predictive factors of actuarial survival.ConclusionsThose results confirm the high prevalence of arginine depletion in severe trauma patients and the relevance of argininemia and PAB as predictive factors of mortality in this context.

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Cited by 591 publications

References 377 publications

Surviving sepsis campaign: research priorities for sepsis and septic shock

Surviving sepsis campaign: research priorities for sepsis and septic shock

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

Argininemia and plasma arginine bioavailability – predictive factors of mortality in the severe trauma patients?

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