Pragmatic approach to nutrition in the ICU: Expert opinion regarding which calorie protein target

Singer, Pierre; Hiesmayr, Michael; Biolo, Gianni; Felbinger, Thomas W.; Berger, Mette M.; Goeters, Christiane; Kondrup, Jens; Wunder, Christian; Pichard, Claude

doi:10.1016/j.clnu.2013.12.004

Cited by 105 publications

(76 citation statements)

References 42 publications

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“…renal impairment, pressure sores, additional surgery needs, prolonged mechanical ventilation, extended length of stay, nosocomial infections and increased mortality. [1][2][3][4][5]8 The benefits and outcomes of EEF in critically ill trauma patients were investigated in a local study, the first large study in this population in South Africa. It is reported by Löfgren et al in this issue of the SAJCN.…”

Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

“…2,4-8 The concept of early enteral feeding (EEF) refers to the initiation of enteral nutrition within the first 24-48 hours post injury. [4][5][6][7][8][9] Advantages of this approach include a reduction in infectious complications and mortality. 4,[7][8][9] Various additional benefits of EEF have also been reported, including the fact that it lends support to the gastrointestinal tract responses by maintaining gut integrity and improving absorptive capacity, to the immunological profile by modulating the immune response to enhance the systemic immune function, as well as to the associated metabolic responses by improving insulin sensitivity to aid with glucose control.…”

Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

“…However, both protocols seem to be successful in ensuring a better intake without sacrificing gastrointestinal tolerance. 12,13 A few general feeding recommendations which can be applied to critically ill trauma patients include: [1][2][3][5][6][7] • Starting enteral nutrition as soon as possible after ICU admission, increasing it according to gut tolerance, and administering prokinetics, if needed.…”

Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

See 2 more Smart Citations

Should early enteral nutrition be used in the trauma intensive care unit?

Blaauw

2015

South African Journal of Clinical Nutrition

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Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

Section: Should Early Enteral Nutrition Be Used In the Trauma Intensimentioning

confidence: 99%

See 1 more Smart Citation

Should early enteral nutrition be used in the trauma intensive care unit?

Blaauw

2015

South African Journal of Clinical Nutrition

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“…Current recommendations suggest a daily protein administration of 1.5 g/kg body weight [16,17], although some authors support doses up to 2.0-2.5 g/kg [18]. By adding AA infusion to standard nutrition, Doig and colleagues applied protein doses up to 2.0 g/kg/day (averaging 1.8 g/kg/day) as compared to 0.8 g/kg/day in the control group.…”

mentioning

confidence: 99%

Feeding the kidneys in AKI: no appetite for a change in practice

2015

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“…It is definitely not recommended to reduce the dietary protein intake in order to avoid or delay the introduction of renal replacement therapy. It should be stressed that increased supply of proteins in critically ill patients is not identical to increased supply of energy [9]. This means that the Q coefficient, defined as a ratio of supply of extra-protein calories (kcal) to nitrogen (g), should be maintained at a relatively low level (even below 100) in order to prevent complications associated with excessive energy supply (see above).…”

mentioning

confidence: 99%

Practical issues of nutrition during continuous renal replacement therapy

Onichimowski¹,

Goraj²,

Jalali³

et al. 2014

Anaesthesiol Intensive Ther

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Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one's ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro-and macronutrients). In this article, the authors discuss the impact of CRRT on nutritive elements loss, energetic balance and present the principles of adjusting feeding prescriptions to changes implied by CRRT.Anaesthesiology Intensive Therapy 2017, vol. 49, no 4, 309-316 Key words: critical care, nutrition; kidney injury; continuous renal replacement therapy, energy requirements, protein needs Nutritional therapy is one of the basic elements of the multifaceted treatment of patients in intensive care units (ICUs). The Nutrition Day ICU survey, based on a seven-year observation period of nutritional practices in 880 units from 46 countries, has demonstrated that the majority of ICU patients do not receive the recommended amounts of calories and proteins [1]. According to the findings of this survey, as well as of some other studies, an increasing energy-protein deficit is positively correlated with prolonged ICU stay, which in turn increases the risk of infections and death. On the other hand, it should be clearly emphasised that an excessive energy supply may also be associated with complications and increased mortality [1,2]. Adequate tailoring of nutritional therapy is a great challenge; firstly, because the nutritional status of patients on admission to an ICU can differ markedly, ranging from cachexia to morbid obesity while secondly, the critical conditions presented by patients have extremely relevant metabolic implications. Unfortunately, the majority of studies that are the basis for guidelines of nutritional therapy are observational or involve small groups of patients and are therefore characterised by low precision and relatively high changeability over time.Several randomised controlled studies have recently been published which have re-started the discussion on optimal nutritional practices in the ICU setting. One of the issues inadequately described and connected with nutritional therapy in ICU patients, concerns the effects of other elements of the multifaceted treatment of critically ill patients on the efficacy of nutritional interventions. It should be clearly stressed that continuous renal replacement therapy (CRRT) belongs to those interventions which most highly affect the outcomes of nutritional therapy in critically ill pa-310 Anaesthesiol Intensive Ther 2017, vol. 49, no 4, 309-316 tients. Firstly, the use of CRRT facilitates optimal nut...

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Pragmatic approach to nutrition in the ICU: Expert opinion regarding which calorie protein target

Abstract: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.

Cited by 105 publications

References 42 publications

Should early enteral nutrition be used in the trauma intensive care unit?

Should early enteral nutrition be used in the trauma intensive care unit?

Feeding the kidneys in AKI: no appetite for a change in practice

Practical issues of nutrition during continuous renal replacement therapy

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