Propofol sedation substantially increases the caloric and lipid intake in critically ill patients

Charrière, M.; Ridley, Emma J.; Hastings, J. W.; Bianchet, Oliver; Scheinkestel, Carlos; Berger, Mette M.

doi:10.1016/j.nut.2017.05.009

Cited by 29 publications

(41 citation statements)

References 27 publications

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“…EN is the preferred mode of administration . Other caloric sources of calories, also called nonintentional calories, should be taken into account . Mostly these come from medication, and propofol is the most common example.…”

Section: Resultsmentioning

confidence: 99%

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Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

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Section: Resultsmentioning

confidence: 99%

“…1 Other caloric sources of calories, also called nonintentional calories, should be taken into account. [30][31][32] Mostly these come from…”

Section: How Does the Caloric Prescription Need To Be Adapted During mentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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show abstract

“…Meeting higher protein targets while avoiding possible dangers of overfeeding have presented a challenge for clinicians using traditional EN formulas. In addition, use of short‐acting fat‐based sedation as a concurrent treatment in the ICU provides what has been described as “occult” calories that RDs should account for when considering their patient's overall energy intakes . The energy provided from such non‐nutrition sources can pose a challenge to providing adequate protein without excess caloric intake from all sources.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, use of short-acting fat-based sedation as a concurrent treatment in the ICU provides what has been described as "occult" calories that RDs should account for when considering their patient's overall energy intakes. 46,47 The energy provided from such non-nutrition sources can pose a challenge to providing adequate protein without excess caloric intake from all sources. In our project, we demonstrated that use of the 37% protein formula was able to deliver ࣙ80% of prescribed protein in the majority of patients without overfeeding calories, including subgroups of patients who were obese or receiving fat-based sedation ( Table 2).…”

Section: Indications For Formula Usementioning

confidence: 99%

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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Background To meet protein needs in critical illness (CI), guidelines suggest ≥1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. Methods This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m2), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. Results Forty‐four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy‐five percent to 83% of patients received ≥80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat‐based medications. Conclusions We demonstrated in a QI study that a high‐protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.

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“…We chose to explore the influence of propofol on relevant clinical outcomes (mortality, LOS, and duration of MV), given these represent key patient-centered outcomes. While a larger bicentric study focused on the proportion of energy provided as lipid in critically ill patients, the clinical implications of higher contributions of fat to total energy intake, and how this is influenced by propofol sedation, 31 our study focused on the proportion of energy provided as propofol and the effect this had on overall energy balance, protein delivery, and outcomes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Does Propofol Sedation Contribute to Overall Energy Provision in Mechanically Ventilated Critically Ill Adults? A Retrospective Observational Study

Hastings

Ridley

Bianchet

et al. 2017

J Parenter Enteral Nutr

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Propofol sedation substantially increases the caloric and lipid intake in critically ill patients

Cited by 29 publications

References 27 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

Does Propofol Sedation Contribute to Overall Energy Provision in Mechanically Ventilated Critically Ill Adults? A Retrospective Observational Study

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