Nutrition in Trauma and Critically Ill Patients

Joseph, Bellal; Wynne, Julie; Dudrick, Stanley J.; Latifi, Rifat

doi:10.1007/s00068-010-9213-y

Cited by 12 publications

(9 citation statements)

References 24 publications

(27 reference statements)

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“…Increased metabolic rate, fever, hyperglycemia, amino acid, and free fatty acid mobilization contribute to a net negative nitrogen balance, which, if prolonged, is detrimental for the patient. [ 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

Rugéles¹,

Rueda²,

Díaz³

et al. 2013

Indian Journal of Critical Care Medicine

103

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Introduction:Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients, particularly on severity of organic failure measured with the Sequential Organ Failure Assessment (SOFA).Materials and Methods:In a double blind clinical trial, 80 critically ill adult patients were randomized to hyperproteic hypocaloric or to isocaloric enteral nutrition; all patients completed follow-up of at least 4 days. Prescribed caloric intake was: Hyperproteic hypocaloric enteral nutrition (15 kcal/kg with 1.7 g/kg of protein) or isocaloric enteral nutrition (25 kcal/kg with 20% of the calories as protein). The main outcome was the differences in delta SOFA at 48 h. Secondary outcomes were intensive care unit (ICU) length of stay, days on ventilator, hyperglycemic events, and insulin requirements.Results:There were no differences in SOFA score at baseline (7.5 (standard deviation (SD) 2.9) vs 6.7 (SD 2.5) P = 0.17). The total amount of calories delivered was similarly low in both groups (12 kcal/kg in intervention group vs 14 kcal/kg in controls), but proteic delivery was significantly different (1.4 vs 0.76 g/kg, respectively P ≤ 0.0001). The intervention group showed an improvement in SOFA score at 48 h (delta SOFA 1.7 (SD 1.9) vs 0.7 (SD 2.8) P = 0.04) and less hyperglycemic episodes per day (1.0 (SD 1.3) vs 1.7 (SD 2.5) P = 0.017).Discussion:Enteral hyperproteic hypocaloric nutrition therapy could be associated with a decrease in multiple organ failure measured with SOFA score. We also found decreased hyperglycemia and a trend towards less mechanical ventilation days and ICU length of stay.

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Section: Introductionmentioning

confidence: 99%

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

Rugéles¹,

Rueda²,

Díaz³

et al. 2013

Indian Journal of Critical Care Medicine

103

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“…Se emplearán dosis de 0.2-0.3 g/kg al día en los primeros 5 días en la NE, con la posibilidad de extenderse hasta por 10-15 días. En pacientes con > 20% de la superficie corporal total quemada se deben administrar 0.3-0.5 g/kg al día por 10-15 días al inicio de la NE 28 .…”

Section: Nutrición Enteralunclassified

“…A pesar de que la NE tiene menos complicaciones, la NP es un tratamiento importante y vital para proporcionar sustratos nutricionales en los pacientes que no cuentan con un tracto gastrointestinal funcional 28 . En ocasiones no es factible la NE, ya sea porque no se tolera la dosis completa en la primera semana de la UTI, por presentar alguna contraindicación (como falla intestinal o fístulas enterocutáneas de alto gasto) o por ser insuficiente para proporcionar los nutrimentos apropiados de acuerdo con la demanda corporal, por lo que debe considerarse el uso de NP.…”

Section: Nutrición Parenteralunclassified

Terapia médico-nutricional en pacientes politraumatizados: una carrera contra el tiempo

Padilla-Rubio¹,

Robledo-Valdez²,

Morante-Ruiz³

et al. 2023

CIRU

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El paciente politraumatizado se define como aquel que tiene múltiples lesiones que involucran diferentes órganos y sistemas, suelen ser graves y conllevan una disfunción respiratoria o circulatoria que pone en riesgo la vida. El estrés traumático en el paciente politraumatizado da lugar a muchos cambios metabólicos que son evidentes desde los primeros días, pero suelen persistir durante semanas y exigen un adecuado soporte nutricional, ya que influyen en los desenlaces. El tratamiento nutricional debe ser una prioridad en el tratamiento integral de los pacientes politraumatizados, porque atenúa la respuesta metabólica al trauma y evita el deterioro de las reservas corporales (cabe mencionar que algunos pacientes presentan riesgo nutricional previo). La intervención nutricional debe considerarse al mismo nivel que cualquier otra terapia que apoye las funciones orgánicas, sobre todo en pacientes en la unidad de terapia intensiva. La intervención nutricional en pacientes politraumatizados es un pilar en el tratamiento que tiene múltiples beneficios y puede mejorar el pronóstico. Todo esfuerzo debe ir encaminado a la detección temprana de pacientes desnutridos o en riesgo nutricional, y proporcionar de manera oportuna terapias que mejores los desenlaces clínicos.

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“…An important aspect in the pathophysiology of critically ill polytrauma patients is represented by the negative nitrogen balance [48][49][50]. One of the main responses to severe injury is represented by the accentuation of protein catabolism and by the loss of urinary nitrogen and phosphorus.…”

Section: Molecular and Pathophysiological Aspects Of Metabolismmentioning

confidence: 99%

Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

et al. 2019

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The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.

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Nutrition in Trauma and Critically Ill Patients

Cited by 12 publications

References 24 publications

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

Terapia médico-nutricional en pacientes politraumatizados: una carrera contra el tiempo

Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

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