scholarly journals Protein Requirements during Hypocaloric Nutrition for the Older Patient With Critical Illness and Obesity: An Approach to Clinical Practice

2020 ◽  
Vol 35 (4) ◽  
pp. 617-626 ◽  
Author(s):  
Roland N. Dickerson
Keyword(s):  
Clinical Practice ◽  
Critical Illness ◽  
Older Patient ◽  
Protein Requirements

Advances in critical care for the older patient

2013 ◽  
Vol 23 (2) ◽  
pp. 118-130 ◽  
Author(s):  
Diane Monkhouse
Keyword(s):  
Quality Of Life ◽  
Critical Care ◽  
Critical Illness ◽  
General Population ◽  
Acute Illness ◽  
Limited Resources ◽  
Care Practice ◽  
Older Patient ◽  
Life Sustaining Treatment

SummaryAs the proportion of elderly people in the general population increases, so does the number admitted to critical care. In caring for an older patient, the intensivist has to balance the complexities of an acute illness, pre-existing co-morbidities and patient preference for life-sustaining treatment with the chances of survival, quality of life after critical illness and rationing of expensive, limited resources. This remains one of the most challenging areas of critical care practice.

scholarly journals Clinical practice guidelines for older people with multimorbidity and life-limiting illness: what are the implications for deprescribing?

2018 ◽  
Vol 9 (11) ◽  
pp. 619-630 ◽  
Author(s):  
Daniel Okeowo ◽  
Alastair Patterson ◽  
Cynthia Boyd ◽  
Emily Reeve ◽  
Danijela Gnjidic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Older People ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Treatment Resistant ◽  
Older Patient ◽  
Long Term Conditions ◽  
Hypothetical Patient ◽  
Patient Model

Background: The aim of this study was (1) to apply the current United Kingdom (UK) National Institute for Health and Care Excellence (NICE) clinical practice guidelines to a hypothetical older patient with multimorbidity and life-limiting illness; (2) consider how treatment choices could be influenced by NICE guidance specifically related to multimorbidity; and, (3) ascertain if such clinical practice guidelines describe how and when medication should be reviewed, reduced and stopped. Methods: Based upon common long-term conditions in older people, a hypothetical older patient was constructed. Relevant NICE guidelines were applied to the hypothetical patient to determine what medication should be initiated in three treatment models: a new patient model, a treatment-resistant model, and a last-line model. Medication complexity for each model was assessed according to the medication regimen complexity index (MRCI). Results: The majority of the guidelines recommended the initiation of medication in the hypothetical patient; if the initial treatment approach was unsuccessful, each guideline advocated the use of more medication, with the regimen becoming increasingly complex. In the new patient model, 4 separate medications (9 dosage units) would be initiated per day; for the treatment-resistant model, 6 separate medications (15 dosage units); and, for the last-line model, 11 separate medications (20 dosage units). None of the guidelines used for the hypothetical patient discussed approaches to stopping medication. Conclusions: In a UK context, disease-specific clinical practice guidelines routinely advocate the initiation of medication to manage long-term conditions, with medication regimens becoming increasingly complex through the different steps of care. There is often a lack of information regarding specific treatment recommendations for older people with life-limiting illness and multimorbidity. While guidelines frequently explain how and when a medication should be initiated, there is often no information concerning when and how the medications should be reduced or stopped.

scholarly journals Quantifying Response to Nutrition Therapy During Critical Illness: Implications for Clinical Practice and Research? A Narrative Review

2020 ◽  
Author(s):  
Kate Fetterplace ◽  
Emma J. Ridley ◽  
Lisa Beach ◽  
Yasmine Ali Abdelhamid ◽  
Jeffrey J. Presneill ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Critical Illness ◽  
Nutrition Therapy ◽  
Narrative Review

scholarly journals Expert Opinion Percutaneous Coronary Intervention in Older People: Does Age Make a Difference?

2016 ◽  
Vol 11 (2) ◽  
pp. 93 ◽  
Author(s):  
Sami A Omar ◽  
Adam de Belder ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Practice ◽  
Coronary Artery ◽  
Coronary Disease ◽  
Acute Coronary Syndromes ◽  
Older Patients ◽  
Coronary Intervention ◽  
Older Patient ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

As many people are living longer, much older patients are now commonly being seen in clinical practice. The management of coronary disease in this group presents formidable challenges. We review the epidemiology of coronary disease in this population and report on the burden of comorbidity, influence of frailty, problems with polypharmacy, interactions and compliance for the older patient. We discuss the management of stable and acute coronary syndromes, the specific anatomical challenges of the older coronary artery, the outcomes of the limited number of trials involving older patients, and review the guidelines available.

Nutritional support in the critically ill

2018 ◽  
Author(s):  
Matt Wise ◽  
Paul Frost
Keyword(s):  
Stress Response ◽  
Critical Illness ◽  
Nutritional Support ◽  
Nutritional Assessment ◽  
Refeeding Syndrome ◽  
Protein Requirements ◽  
Major Injury ◽  
Underlying Illness ◽  
Parasitic Effect ◽  
Adaptive Stress Response

Major injury evokes a constellation of reproducible hormonal, metabolic, and haemodynamic responses which are collectively termed ‘the adaptive stress response’. The purpose of the adaptive stress response is to facilitate tissue repair and restore normal homeostasis. If critical illness is prolonged, the adaptive stress response may become maladaptive, in essence exerting a parasitic effect leaching away structural proteins and impairing host immunity. Primarily therapy should be directed towards the underlying illness, as nutritional support per se will not reverse the stress response and its sequelae. Nonetheless, adequate nutritional support in the early stages of critical illness may attenuate protein catabolism and its adverse effects. This chapter covers nutritional assessment; detection of malnutrition; energy and protein requirements; monitoring the effectiveness of nutritional replacements; nutritional delivery; complications; and refeeding syndrome.

Optimal protein requirements during the first 2 weeks after the onset of critical illness

1998 ◽  
Vol 26 (9) ◽  
pp. 1529-1535 ◽  
Author(s):  
Nobuya Ishibashi ◽  
Lindsay D. Plank ◽  
Kinya Sando ◽  
Graham L. Hill
Keyword(s):  
Critical Illness ◽  
Protein Requirements

scholarly journals Energy and protein requirements for children with CKD stages 2-5 and on dialysis–clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

2019 ◽  
Vol 35 (3) ◽  
pp. 519-531 ◽  
Author(s):  
Vanessa Shaw ◽  
Nonnie Polderman ◽  
José Renken-Terhaerdt ◽  
Fabio Paglialonga ◽  
Michiel Oosterveld ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Judgment ◽  
Pediatric Nephrology ◽  
Low Grade ◽  
Poor Growth ◽  
Protein Requirements ◽  
Practice Recommendations ◽  
Additional Protein ◽  
The Individual ◽  
Research Recommendations

AbstractDietary management in pediatric chronic kidney disease (CKD) is an area fraught with uncertainties and wide variations in practice. Even in tertiary pediatric nephrology centers, expert dietetic input is often lacking. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, was established to develop clinical practice recommendations (CPRs) to address these challenges and to serve as a resource for nutritional care. We present CPRs for energy and protein requirements for children with CKD stages 2–5 and those on dialysis (CKD2–5D). We address energy requirements in the context of poor growth, obesity, and different levels of physical activity, together with the additional protein needs to compensate for dialysate losses. We describe how to achieve the dietary prescription for energy and protein using breastmilk, formulas, food, and dietary supplements, which can be incorporated into everyday practice. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgment. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

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