Nutrition and Nutritional Support in Critically Ill Patients

Abstract

The use of intravenous nutritional support has increased dramatically in the last 20 years. Although it is not without controversy, administration of nutritional support is common practice in hospitalized patients including critically ill patients. Malnutrition continues to be reported in a significant number of hospitalized patients. The incidence of malnutrition in critically ill patients may be even higher than that reported in hospitalized patients overall. The consequences of malnutrition in a critically ill patient may be severe. Nutritional assessment and nutritional support can present special challenges to the intensivist. Techniques of nutritional assessment in critically ill patients are evaluated. Guidelines for the determination of the nutritional needs of these patients are outlined. Methods of delivery of nutritional support in critically ill patients are reviewed. Complications of nutritional support are discussed.

Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU

“…Studies reveal that the use of guidelines leads to better nutrition than when no guidelines are used (Dark & Pingleton 1993, Adam & Batson 1997, Griffiths 1997, Kennedy 1997, Spain et al. 1999, Adam 2000).…”

Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients

“…In critically ill patients, malnutrition is associated with impaired immune function, impaired ventilatory drive, and weakened respiratory muscles, leading to prolonged ventilatory dependence and increased infectious morbidity and mortality. 1 Malnutrition is prevalent in intensive care unit (ICU) patients, has been reported as being as high as 40%, and is associated with increased morbidity and mortality. 2 The benefits of nutrition support in the critically ill include improved wound healing, a decreased catabolic response to injury, improved gastrointestinal (GI) structure and function, and improved clinical outcomes, including a reduction in complication rates and length of stay, with accompanying cost savings.…”

A double-blind, randomized clinical trial comparing soybean oil–based versus olive oil–based lipid emulsions in adult medical–surgical intensive care unit patients requiring parenteral nutrition*

“…Protein-calorie malnutrition is common in critically ill patients (1) and is associated with increased risk of hospital complications and mortality (2-5), longer hospital stay, and hospital costs (6). Improving nutrition status may restore immunologic competence and reduce the frequency and severity of infectious complications in critically ill patients (7-10).…”