Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support

Huang, Yann-Chang; Yen, Chi-Hua; Cheng, Chun-Wen; Jih, Kuen Shan; Kan, Mee-Nin

doi:10.1054/clnu.1999.0077

Cited by 76 publications

(50 citation statements)

References 33 publications

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“…Therefore, the combination of EN and PN could be an efficient way to increase mean calorie intake in ICU patients and to match energy requirements with delivery. In a study of 49 mechanically ventilated, malnourished critically ill patients, the combined nutrition group experienced an improvement in nutritional status [69].…”

Section: Choice Of Nutritional Support In Patients With Csmentioning

confidence: 99%

Cardiogenic shock and nutrition: safe?

et al. 2010

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Cardiogenic shock is a common diagnosis in patients in the intensive care unit (ICU), and is characterized by a decreased cardiac output in the presence of adequate intravascular volume associated with an inadequate tissue perfusion including a physiological reduction in the splanchnic territory. It may occur in isolation as a reflection of cardiac pathology, or it may be part of a shock syndrome involving other pathogenic mechanisms. As the use of enteral nutrition (EN) is associated with an increase in mesenteric arterial output, EN could be deleterious by overwhelming the mechanisms of mesenteric adaptation. Accordingly, EN has been suspected to increase the risk of mesenteric ischaemia, bacterial translocation and sepsis in ICU patients with cardiogenic shock. International guidelines recommend a cautious use of EN within 72 h following cardiogenic shock. Recent evidence indicates that mesenteric arterial output may decrease during parenteral nutrition administration, suggesting that parenteral nutrition could have a protective effect on splanchnic organs in ICU patients with cardiogenic shock. Contrary to former beliefs, several meta-analyses have shown that parenteral nutrition is not associated with increased mortality. Exclusive EN is associated with negative energy balance and the combination of EN with supplemental parenteral nutrition during the first days following ICU admission has been proposed to prevent negative energy balance. Such a nutritional strategy could also be beneficial for the mesenteric circulation in cardiogenic shock, and consequently may improve the clinical outcome of patients with cardiogenic shock. Clinical trials are warranted to verify these hypotheses.

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Section: Choice Of Nutritional Support In Patients With Csmentioning

confidence: 99%

Cardiogenic shock and nutrition: safe?

et al. 2010

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“…The binding of PLP and PL to serum albumin in the circulation serves to protect it from hydrolysis and allows for the delivery of PLP and PL to other tissues. Critically ill patients often have a compromised protein status (Bassili & Deitel, 1981;Larca & Greenbaum, 1982;Christman & McCain, 1993;Huang et al, 2000). The question has been raised whether vitamin B6 status is affected in these patients.…”

Section: Introductionmentioning

confidence: 99%

Vitamin B6 intakes and status of mechanically ventilated critically ill patients in Taiwan

Huang¹,

Ph²,

Chen³

et al. 2002

Eur J Clin Nutr

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Objective: To assess vitamin B6 intake and status of critically ill patients. The relationship between vitamin B6 status indicators and the severity of illness and outcome in these patients was also examined. Design: Prospective clinical study. Setting: The study was performed at the Taichung Veteran General Hospital, in the central part of Taiwan. Subjects: Ninety-four patients in the intensive care unit (ICU) entered the study and 46 patients successfully completed this study. Interventions: No intervention. Main outcome measures: Vitamin B6 intake was recorded for 14 days. Vitamin B6 status was assessed by direct measures (plasma pyridoxal 5 0 -phosphate (PLP), pyridoxal (PL), and urinary 4-pyridoxic acid (4-PA)) and indirect measures (erythrocyte alanine (EALT-AC) and aspartate (EAST-AC) aminotransaminase activity coefficient). The severity of illness (APACHE II score), the length of ventilation dependency, and the length of ICU and hospital stay were recorded. Results: Patients had an adequate mean vitamin B6 intake (16.26 AE 19.39 mg) during the 14 day study. Mean vitamin B6 intake was significantly higher on day 14 than on day 1 (P < 0.001). However, plasma PLP and PL concentrations significantly decreased at the 14th day after admission (P < 0.05). Erythrocyte alanine aminotransaminase activity coefficient and EAST-AC did not change significantly. Urinary 4-PA significantly increased at the 14th day (P < 0.001). No significant relationships were found between APACHE II scores and clinical outcomes (the length of ICU and hospital stay, the length of ventilation dependency) of patients, vitamin B6 intake or status indicators. Conclusions: Critically ill patients received nutritional support in the ICU, and had sufficient mean vitamin B6 intake and adequate vitamin B6 status. Therefore, the severity of illness and the results should not be affected by vitamin B6 status. However, we have noted that plasma PLP and PL concentrations significantly decreased while vitamin B6 intake significantly increased on day 14. Critical clinical conditions and complex metabolism in the critically ill may account for the reduction of plasma PLP and PL. Since vitamin B6 deficiency causes profound effects on immune system function, dietary or supplemented vitamin B6 intake is suggested for hospitalized patients.

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“…There is a general consensus that excessive hypocaloric or hypercaloric feeding should be avoided, but controversy exists over what the feeding target should be. Some authors advocate for the provision of energy below actual requirements to avoid accentuating the metabolic adaptive response to injury or stress (4,5). In clinical practice in the intensive care unit (ICU), patients commonly fail to receive adequate calories to meet prescribed targets, with studies reporting average energy intakes of 49% to 70% of calculated requirements (6 -12).…”

mentioning

confidence: 99%

Feeding critically ill patients: What is the optimal amount of energy?

Stapleton

Jones

Heyland

2007

Critical Care Medicine

116

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Hypermetabolism and malnourishment are common in the intensive care unit. Malnutrition is associated with increased morbidity and mortality, and most intensive care unit patients receive specialized nutrition therapy to attenuate the effects of malnourishment. However, the optimal amount of energy to deliver is unknown, with some studies suggesting that full calorie feeding improves clinical outcomes but other studies concluding that caloric intake may not be important in determining outcome. In this narrative review, we discuss the studies of critically ill patients that examine the relationship between dose of nutrition and clinically important outcomes. Observational studies suggest that achieving targeted caloric intake might not be necessary since provision of approximately 25% to 66% of goal calories may be sufficient. Randomized controlled trials comparing early aggressive use of enteral nutrition compared with delayed, less aggressive use of enteral nutrition suggest that providing increased calories with early, aggressive enteral nutrition is associated with improved clinical outcomes. However, energy provision with parenteral nutrition, either instead of or supplemental to enteral nutrition, does not offer additional benefits. In summary, the optimal amount of calories to provide critically ill patients is unclear given the limitations of the existing data. However, evidence suggests that improving adequacy of enteral nutrition by moving intake closer to goal calories might be associated with a clinical benefit. There is no role for supplemental parenteral nutrition to increase caloric delivery in the early phase of critical illness. Further high-quality evidence from randomized trials investigating the optimal amount of energy intake in intensive care unit patients is needed.

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Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support

Cited by 76 publications

References 33 publications

Cardiogenic shock and nutrition: safe?

Cardiogenic shock and nutrition: safe?

Vitamin B6 intakes and status of mechanically ventilated critically ill patients in Taiwan

Feeding critically ill patients: What is the optimal amount of energy?

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