RT Book, Section
A1 Heyland, Daren K.
A1 Dhaliwal, Rupinder
A1 McClave, Stephen A.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107715753
T1 Nutrition Therapy in the Critically Ill
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessmedicine.mhmedical.com/content.aspx?aid=1107715753
RD 2024/04/18
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.