Nutrition therapy in critical illness: a review of the literature for clinicians

Lambell, Kate; Tatucu-Babet, Oana A.; Chapple, Lee‐anne S.; Gantner, Dashiell; Ridley, Emma J.

doi:10.1186/s13054-020-2739-4

Cited by 75 publications

(70 citation statements)

References 74 publications

(115 reference statements)

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“…Unfortunately, there is not enough evidence on long term compliance and long term follow up. An INC has benefits in the treatment of many diseases and in this case, it will depend on the type of cancer or its stage ( 9 ). There is evidence the INC well implemented impacts and contributes to improve the prognosis of cancer treatment (chemotherapy and radiotherapy) but there is little evidence in cervical cancer ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Repurposing Individualized Nutritional Intervention as a Therapeutic Component to Prevent the Adverse Effects of Radiotherapy in Patients With Cervical Cancer

Medina-Jiménez

Monroy-Torres

2020

Front. Oncol.

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Worldwide, cervical cancer was the fourth leading cause of cancer death among women, while in Mexico was the second cause (5.28%). Cancer patients receiving chemotherapy and radiotherapy have a high risk of malnutrition secondary to the disease and treatment, affects the patient’s overall, with adverse effects on gastrointestinal symptoms. These use affects the medical therapy. The aim of the present study was to evaluate the benefits on individualized nutritional therapy on decrease weight loss and gastrointestinal adverse effects and to consider these outcomes in pharmacology research, especially in repurposing drugs. We conducted a longitudinal design with two comparation groups with medical diagnosis of cervical cancer and received radiotherapy weekly, 1) the intervention group (nutritional intervention and counseling -INC-) with 20 participants and 2) control group (retrospective cohort -CG-) with 9 participants. Weekly body composition, dietary intake, adverse effects (gastrointestinal symptoms), glucose, hemoglobin, and blood pressure were analyzed during 4 to 5 weeks. Both groups had weight loss weekly (p = 0.013 and p = 0.043 respectively) but the CG vs INC presented loss fat-free mass ≥500g in 67 and of 37% respectively. By the end of the intervention a 25% of the INC group had <10 g/dL of hemoglobin vs 60% for the CG. To compare the dietary intake of vitamins (A and folic acid), fiber (p = 0.006), iron (p = 0.03) and energy (mainly carbohydrates) (p = 0.04) were according to the recommendations in INC group (p>0.05). The number needed to treat was 4 (95% CI, 2 to 13). The nutritional intervention and counseling weekly during radiotherapy in cervical cancer to maintain/improve muscle mass, hemoglobin, and dietary intake above 70% of the recommendations for INC group compared to the evidence. Adequate nutritional status was maintained and decrease the rate of complications, mainly gastrointestinal symptoms, in INC group. The efficacy of drug repurposing can improve through individualized nutritional therapy for preventing adverse effects of radiotherapy in patients with cervical cancer.

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Section: Introductionmentioning

confidence: 99%

Repurposing Individualized Nutritional Intervention as a Therapeutic Component to Prevent the Adverse Effects of Radiotherapy in Patients With Cervical Cancer

Medina-Jiménez

Monroy-Torres

2020

Front. Oncol.

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“…Apesar de estudos observacionais terem demonstrado menor mortalidade na UTI com administração mais elevada de proteína 8,11 , o número de ensaios randomizados controlados é pequeno e com efeitos limitados 12,13 , não permitindo afirmar que uma ingestão proteica muito elevada seja necessária ou mesmo segura. Revisões mais recentes recomendam 1,3 g proteína/kg de peso atual/dia (ou 1,5 g proteína/kg/dia se terapia nutricional enteral) para pacientes sem obesidade 13,14 . Ofertas ≥ 2 g proteína/kg/dia parecem ser mais adequadas aos pacientes em uma fase mais tardia, após alta da UTI ou do hospital e sem situações especiais 13 .…”

Section: Discussionunclassified

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Silvah¹,

Nicoletti²,

Lima³

et al. 2020

Braspen J

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Introduction: The nutritional support of critically ill patients must be individualized and meet the daily energy and protein needs. Despite the fact that health entities publish their respective nutritional therapy recommendations for these patients, guidelines on the use of protein modules are still scarce and controversial. This study aimed to evaluate the protein / energy adequacy of the industrialized enteral formulas existing in the Brazilian market used in the nutritional therapy of adult patients, as well as the need to use protein modules. Methods: 46 enteral formulas found in the Brazilian market were evaluated, by means of mathematical simulations, in relation to the adequacy against protein recommendations, without extrapolating the energy supply (limit of 110% of the daily requirement). For the simulations, comprising the protein module, the energy supply of the module was included in the analysis. Results: The protein / calorie ratio varied between 3.1 and 9.2. For patients without obesity, only the Peptamen Intense - Nestlé formula [protein ratio (g)/100 kcal = 9.2] reaches at least 100% of the protein requirement (1.5 to 2g protein/kg/day), with a volume calculated to 20 to 25 kcal/kg. For patients with BMI between 30 and 36 kg/m2, there is no formula that achieves the recommendation in isolation. The Peptamen Intense - Nestlé formula meets the recommendations for patients with a BMI between 36 and 40 and a BMI> 44 kg/m2. The comparison of the Peptamen Intense - Nestlé formula with the rest of the formulas available on the market plus protein module shows that Fresubin 2 kcal HP - Fresenius needs the lowest volume of the set (enteral formula + protein module) to reach 1000 kcal and 92 g of protein (25.5% less than Peptamen Intense - Nestlé). Conclusion: Most of the enteral formulas available in the Brazilian market are not able to offer, in isolation, an adequate protein supply, without generating excess energy supply (overfeeding). The use of protein modules can bring benefits to the recovery of patients, including those infected by COVID-19.

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“…Cuthbertson’s theory is still frequently cited; however, clinical trials have failed to identify a clear course of energy expenditure in all critically ill patients [ 33 ]. In addition, early aggressive feeding strategies have not had the desired and expected effect.…”

Section: Energy Expenditurementioning

confidence: 99%

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021

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The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.

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Nutrition therapy in critical illness: a review of the literature for clinicians

Cited by 75 publications

References 74 publications

Repurposing Individualized Nutritional Intervention as a Therapeutic Component to Prevent the Adverse Effects of Radiotherapy in Patients With Cervical Cancer

Repurposing Individualized Nutritional Intervention as a Therapeutic Component to Prevent the Adverse Effects of Radiotherapy in Patients With Cervical Cancer

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

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