TY - CHAP M1 - Book, Section TI - Nutrition Therapy in the Critically Ill A1 - Heyland, Daren K. A1 - Dhaliwal, Rupinder A1 - McClave, Stephen A. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Nutrients and gastrointestinal structure and function are linked to the pathophysiology of infection, organ dysfunction, and survival in critically ill patients.Nutrition therapy may both positively and negatively influence the morbidity and mortality of critically ill patients.When considering artificial nutrition in critically ill patients, enteral nutrition (EN) should be used in preference to parenteral nutrition (PN).Strategies to optimize delivery of EN (eg, starting EN early, use of a feeding protocol with a high gastric residual volume threshold, use of prokinetic agents, and use of small bowel feeding) and minimize the risks of EN (eg, elevation of the head of the bed) should be considered.For most patient populations in critical care in whom EN is not possible or feasible, the role of PN is controversial. Similarly, when to initiate supplemental PN when hypocaloric EN is not meeting the patient’s calorie or protein requirements is also controversial. Use of PN in these circumstances should be evaluated on a case-by-case basis taking into consideration the underlying nutrition risk of the patient.Nutrition risk in the ICU can be identified by considering preexisting weight loss, decreased oral intake, prior stay in hospital before admission to ICU, preexisting comorbidities, and severity of current illness.When PN is indicated, strategies that maximize the benefit (eg, supplementing with glutamine) and minimize the risks of PN (eg, hypocaloric dose, withholding soy-bean emulsion lipids, continued use of EN, and adequate glycemic control) should be considered. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107715753 ER -