The route of nutritional support in the critically ill: physiological and economical considerations

Frost, Paul; Bihari, David

doi:10.1016/s0899-9007(97)83045-6

Cited by 35 publications

(23 citation statements)

References 37 publications

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“…Repeated evaluation of caloric needs and administration using best evidence measurement tools and continuous feedback to all involved health care workers are critical issues for providing optimal nutritional care in these patients. In this context, a dedicated nutrition support team may play an important role [33]. Our observations add support to a more systematic use of indirect calorimetry in long-term mechanically ventilated patients.…”

Section: Discussionsupporting

confidence: 60%

Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study

Waele

Spapen

Honoré

et al. 2012

The Scientific World Journal

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Nutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive days in ventilated patients. Adequacy of prescription was estimated by P/N ratio. I/P ratio assessed accuracy of translating a prescription into administered feeding. I/N ratio compared delivered calories with theoretical caloric needs. Fifty patients were prospectively studied in a mixed medicosurgical ICU in a teaching hospital. Basal and total energy expenditure were, respectively, 1361 ± 171 kcal/d and 1649 ± 233 kcal/d. P and I attained 1536 ± 602 kcal/d and 1424 ± 572 kcal/d, respectively. 24.6% prescriptions were accurate, and 24.3% calories were correctly administered. Excessive calories were prescribed in 35.4% of patients, 27.4% being overfed. Caloric needs were underestimated in 40% prescriptions, with 48.3% patients underfed. Calculating caloric requirements by a modified standard formula covered energy needs in only 25% of long-term mechanically ventilated patients, leaving many over- or underfed. Nutritional imbalance mainly resulted from incorrect prescription. Failure of “simple” calculations to direct caloric prescription in these patients suggests systematic use of more reliable methods, for example, indirect calorimetry.

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Section: Discussionsupporting

confidence: 60%

Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study

Waele

Spapen

Honoré

et al. 2012

The Scientific World Journal

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“…There is a growing body of evidence suggesting that nutritional support is clinically beneficial in these patients [5,6]. When the oral route is impossible or insufficient, enteral support provides the nutrients necessary to maintain the gastrointestinal barrier [7]; this has a lower rate of complication [8] and is less expensive than parenteral nutrition [9]. However, it does not prevent the occurrence of multiple-organ failure after sepsis [10], and it is not known whether it improves outcome in the critically ill.…”

Section: Introductionmentioning

confidence: 99%

Parenteral with enteral nutrition in the critically ill

Bauer¹,

Charpentier²,

Bouchet³

et al. 2000

Intensive Care Med

146

104

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“…However underfeeding will cause loss of lean body mass, including cardiac and respiratory muscles, prolonged weaning from mechanical ventilation, delayed wound healing, impaired host defences, and increased infections [31][32][33]. Therefore the current practice at UHBFT is to aim to feed patients in critical care to their energy requirements and meet protein requirements while being careful not to over or underfeed patients.…”

Section: Aim Of Nutritional Interventionmentioning

confidence: 99%