Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewBurns: where are we standing with propranolol, oxandrolone, recombinant human growth hormone, and the new incretin analogs?
The hypermetabolic response in critically ill patients is characterized by hyperdynamic circulatory, physiologic, catabolic and immune system responses. Failure to satisfy overwhelming energy and protein requirements after, and during critical illness, results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its associated insulin resistance postburn. ⋯ Novel approaches to the management of critical illness by judicious glucose control and the use of pharmacologic modulators to the hypercatabolic response to critical illness have emerged. Investigation of alternative strategies, including the use of metformin, glucagon-like-peptide-1 and the PPAR-γ agonists are under current investigation.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewBioinformatics assistance of metabolic and nutrition management in the ICU.
To review the domains in which computerized information systems have proven beneficial in facilitating the metabolic and nutritional management ⋯ Computers are needed to analyze the increasing amount of data collected from critically ill patients from monitoring systems, laboratories and other sources. Studies have shown that computerized information systems do facilitate glucose control, helping reducing hypoglycemic events. They also improve nutritional monitoring (energy delivery and balance, protein and fat delivery), and quality of nutrition. They reduce nurse workload associated with the multiple balance calculations and ease visualization of events out of planned targets. Though integrated systems are expensive, they improve work efficiency.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewAdaptive alterations in metabolism: practical consequences on energy requirements in the severely ill patient.
A recent and large multicentre study reports that ICU patients receive less than half of the recommended energy requirement. This review aims at clarifying whether underfeeding is scientifically justified or sustained by evidence-based medicine. ⋯ There is a need to measure energy expenditure in clinical practice. When not possible, the current guidelines on artificial nutrition (i.e. 25 kcal/kg per day) should be applied in order to limit underfeeding.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewOrally fed patients are at high risk of calorie and protein deficit in the ICU.
Malnutrition can lead to serious complications in the ICU. Less than half of patients admitted to ICU require ventilation and for many, their optimal route of feeding is oral medical nutrition therapy, rather than enteral or parenteral nutrition. Inadequate oral intake is a prevalent and often difficult problem within this population, as increased calorie deficits are common in the ICU and associated with worse outcomes. ⋯ Despite evidence-based guidelines directing the delivery of nutrition support in the ICU, there is limited research focused on oral intake during this time of hospitalization. Future research is needed to determine the long-term associations of inadequate versus adequate oral intake in the ICU.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewManaging gastric residual volumes in the critically ill patient: an update.
Gastric residual volumes (GRVs) remain a major deterrent to adequately feeding patients with gastric-delivered enteral nutrition. The purpose of this review was to define the most up-to-date consensus of the utility of the use of GRVs for monitoring tube-feeding intolerance in gastric-fed patients. ⋯ Large GRVs usually result from some impediment in gastrointestinal motility (e.g. gastroparesis). There are numerous methods for measuring GRVs, most of which have not been standardized. It appears that there is little correlation between large GRVs and the development of aspiration pneumonia when tube feeding patients. Prokinetic agents have an inconsistent effect on the GRV size. US guidelines state that GRVs of less than 500 ml should not result in termination of enteral feeding. Allowing larger GRVs will allow patients to receive more calories when gastric fed without a deleterious clinical impact. The use of GRVs as a marker of feeding tolerance is of questionable utility.