Current opinion in clinical nutrition and metabolic care
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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.
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Curr Opin Clin Nutr Metab Care · Mar 2011
ReviewRefeeding in the ICU: an adult and pediatric problem.
To describe the etiology and complications of the refeeding syndrome. ⋯ The refeeding syndrome remains a significant issue in critically ill patients. Knowledge of the risk factors and the clinical signs of the refeeding syndrome is important to optimize outcomes.
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Curr Opin Clin Nutr Metab Care · Nov 2010
ReviewVitamin B12: the forgotten micronutrient for critical care.
To analyse the anti-inflammatory and antioxidant properties of vitamin B12 and evaluate current evidence on vitamin B12 status in the critically ill with systemic inflammation. ⋯ Despite evidence from animal studies, so far there are no clinical intervention trials that have studied vitamin B12 as a pharmaconutrient strategy for critical care. Well designed animal and clinical studies are required to clarify several outstanding questions on the optimal posology, safety, and efficacy of high-dose vitamin B12 in the critically ill.