Nutritional Support in Critical Illness

2005 ◽  
pp. 43-59
Keyword(s):  
Critical Illness ◽  
Nutritional Support

scholarly journals Nutritional Support of the Critically Ill Pediatric Patient: Foundations and Controversies

2017 ◽  
Vol 8 ◽  
pp. 117956031770110 ◽  
Author(s):  
Iván José Ardila Gómez ◽  
Carolina Bonilla González ◽  
Paula Andrea Martínez Palacio ◽  
Elida Teresa Mercado Santis ◽  
José Daniel Tibaduiza Bayona ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Nutritional Support ◽  
Metabolic Stress ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
The Past ◽  
Nutritional Recommendations ◽  
Response To Stress ◽  
Nutritional Strategies

Critically ill children require nutritional support that will give them nutritional and non-nutritional support to successfully deal with their disease. In the past few years, we have been able to better understand the pathophysiology of critical illness, which has made possible the establishment of nutritional strategies resulting in an improved nutritional status, thus optimizing the pediatric intensive care unit (PICU) stay and decreasing morbidity and mortality. Critical illness is associated with significant metabolic stress. It is crucial to understand the physiological response to stress to create nutritional recommendations for critically ill pediatric patients in the PICU.

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.

scholarly journals Nutritional support in critical illness and recovery

2015 ◽  
Vol 3 (9) ◽  
pp. 734-745 ◽  
Author(s):  
Michael P Casaer ◽  
Thomas R Ziegler
Keyword(s):  
Critical Illness ◽  
Nutritional Support

scholarly journals Protein requirement in critical illness

2016 ◽  
Vol 41 (5) ◽  
pp. 573-576 ◽  
Author(s):  
Leonard John Hoffer
Keyword(s):  
Clinical Trials ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Support ◽  
Clinical Investigation ◽  
Protein Requirement ◽  
The Many ◽  
Normal Health ◽  
Broad Consensus

How much protein do critically ill patients require? For the many decades that nutritional support has been used there was a broad consensus that critically ill patients need much more protein than required for normal health. Now, however, some clinical investigators recommend limiting all macronutrient provision during the early phase of critical illness. How did these conflicting recommendations emerge? Which of them is correct? This review explains the longstanding recommendation for generous protein provision in critical illness, analyzes the clinical trials now being claimed to refute it, and concludes with suggestions for clinical investigation and practice.

scholarly journals Nutritional interventions in critical illness

2007 ◽  
Vol 66 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Jeremy Powell-Tuck
Keyword(s):  
Growth Hormone ◽  
Critical Illness ◽  
Nutritional Support ◽  
Optimal Timing ◽  
High Dose ◽  
Refeeding Syndrome ◽  
Nutritional Interventions ◽  
The Face ◽  
The Subject ◽  
And Function

The metabolism of critical illness is characterised by a combination of starvation and stress. There is increased production of cortisol, catecholamines, glucagon and growth hormone and increased insulin-like growth factor-binding protein-1. Phagocytic, epithelial and endothelial cells elaborate reactive oxygen and nitrogen species, chemokines, pro-inflammatory cytokines and lipid mediators, and antioxidant depletion ensues. There is hyperglycaemia, hyperinsulinaemia, hyperlactataemia, increased gluconeogenesis and decreased glycogen production. Insulin resistance, particularly in relation to the liver, is marked. The purpose of nutritional support is primarily to save life and secondarily to speed recovery by reducing neuropathy and maintaining muscle mass and function. There is debate about the optimal timing of nutritional support for the patient in the intensive care unit. It is generally agreed that the enteral route is preferable if possible, but the dangers of the parenteral route, a route of feeding that remains important in the context of critical illness, may have been over-emphasised. Control of hyperglycaemia is beneficial, and avoidance of overfeeding is emphasised. Growth hormone is harmful. The refeeding syndrome needs to be considered, although it has been little studied in the context of critical illness. Achieving energy balance may not be necessary in the early stages of critical illness, particularly in patients who are overweight or obese. Protein turnover is increased and N balance is often negative in the face of normal nutrient intake; optimal N intakes are the subject of some debate. Supplementation of particular amino acids able to support or regulate the immune response, such as glutamine, may have a role not only for their potential metabolic effect but also for their potential antioxidant role. Doubt remains in relation to arginine supplementation. High-dose mineral and vitamin antioxidant therapy may have a place.

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