Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Review Guideline
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: cardiac patient.
Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. ⋯ Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure.
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Review Guideline
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: multiple trauma patient.
Patients with polytrauma can be viewed as paradigmatic of the critically-ill patient. These previously healthy patients undergo a life-threatening aggression leading to an organic response that is no different from that in other types of patients. The profile of trauma patients has changed and currently corresponds to patients who are somewhat older, with a higher body mass index and greater comorbidity. ⋯ Therefore, early nutritional support, preferentially through the enteral route, with appropriate protein intake and glutamine supplementation, provides advantages over other routes and types of nutritional formula. To avoid overnutrition, reduced daily calorie intake can be considered in obese patients and in those with medullary lesions. However, little information on this topic is available in patients with medullary lesions.
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Randomized Controlled Trial Comparative Study
Paper and pencil vs online self-administered food frequency questionnaire (FFQ) applied to university population: a pilot study.
To test the reliability of dietary intake data measured with an online food frequency questionnaires (FFQ) applied to a university population by comparing the results with those from a paper and pencil version. ⋯ The pilot testing showed that this online FFQ is a useful tool for estimating the intake of food groups in this university population. On the other hand, the differences found in the results of the absolute quantities of energy and nutrients intakes were not clear. These differences could be due to the problems that the participants had for reporting portion size in the paper and pencil FFQ as photographs of portion sizes were not presented.
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A primary goal of nutritional support is to provide the energy requirements needed to sustain metabolic processes, maintain body temperature and tissue repair. The beginnings of artificial nutrition were characterized by high calorie nutritional formulae. The assimilation of physiological concepts, accumulating research data and clinical experience led to a progressive reduction of this intake. ⋯ There is also a clear need to deepen the knowledge about the optimal caloric intake in the non-critically ill patient requiring artificial nutrition. It is of great importance that these new concepts, which will arise undoubtedly, are incorporated quickly in the design of nutritional formulas produced by the pharmaceutical industry. Finally, it is important to encourage active participation in continuous educational activities in the field of Nutrition for achieving a rapid incorporation in daily practice of these new concepts of optimal caloric intake.
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Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. ⋯ Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.