Current opinion in clinical nutrition and metabolic care
-
Curr Opin Clin Nutr Metab Care · Mar 2005
ReviewHypocaloric feeding of obese patients in the intensive care unit.
Given the increased awareness of the detrimental complications of overfeeding, particularly hyperglycemia, the safety and efficacy of specialized nutritional support for the critically ill obese patient is of major concern. The intent of this review is to provide the scientific foundation, supporting and conflicting literature, for the implementation of hypocaloric, high-protein specialized nutritional support for acutely ill, hospitalized patients with obesity. ⋯ The current literature indicates that hypocaloric, high-protein enteral or parenteral nutrition is promising as the standard of practice for the metabolic support of the critically ill obese patient. The achievement of net protein anabolism and the avoidance of overfeeding complications are the primary goals, with fat weight loss a welcome secondary benefit.
-
Curr Opin Clin Nutr Metab Care · Mar 2005
ReviewIs there a case for n-3 fatty acid supplementation in cystic fibrosis?
This review evaluates our current knowledge on the association of fatty acid abnormalities in cystic fibrosis with the disease process, and makes a case for a well-designed clinical trial to evaluate the clinical efficacy of long chain n-3 fatty acids. ⋯ The restoration of abnormal fatty acid profiles may be beneficial in cystic fibrosis, but this approach has not been evaluated in studies with a suitable design to permit firm conclusions to be drawn. There is a need for a long-term randomized controlled study to evaluate the therapeutic benefit of fish oil supplementation in cystic fibrosis.
-
Curr Opin Clin Nutr Metab Care · Mar 2005
ReviewThe role of the dietitian in the intensive care unit.
The role of the intensive care unit registered dietitian has evolved over the past few years to become a vital component of the intensivist-led multidisciplinary intensive care unit team. The purpose of this review is to define the level of clinical practice and skill set of the intensive care unit dietitian, which defines them as a clinician, educator and researcher worthy to practice alongside their colleagues on the intensive care unit team. ⋯ The scope of practice of intensive care dietitians defines them as clinicians, educators and researchers. Their skill set is a unique and vital component of the intensivist-led multidisciplinary intensive care unit team.
-
Clinical anaesthesia and analgesia address a growing number of elderly surgical patients. Ageing modifies physiology, pharmacokinetics and pharmacodynamics, and comorbidity is a common occurrence in the elderly. Therefore, based on recent information regarding perioperative outcome, indications and techniques should be individualized. ⋯ Postoperative cognitive dysfunction (POCD) is quite frequent. If late POCD seemed not related to the type of anaesthesia and analgesia provided, early POCD (interval delirium) was found to be related to perioperative haematocrit and transfusion requirement and to postoperative pain. Epidural analgesia using local anaesthetics and/or opioids was found to be probably better than parenteral opioids for the control of postoperative pain and the prevention of postoperative morbidity and mortality. However, well implemented protocols of parenteral analgesics could be nearly as efficient.
-
Curr Opin Clin Nutr Metab Care · Jan 2005
ReviewNutrition and the chronically critically ill patient.
It has been recently recognized that patients of chronic critical illness (CCI) - those who have stabilized after an acute critical illness but remain dependent on life-support - manifest a distinct set of clinical attributes. This unique patient population is often dismissed as hopeless, with aggressive medical therapies considered futile. In fact, with meticulous care, many CCI patients can be liberated from mechanical ventilation and graduated to a rehabilitation program. The nutritional approach to CCI patients is presented here as part of a comprehensive metabolic program to increase their survival and quality of life. ⋯ Nutritional assessment and support of the CCI patient must be implemented upon admission to the respiratory care unit (RCU). Enteral nutrition (EN) with semi-elemental formulas is preferred. Parenteral nutrition is used to supplement EN when necessary. Overfeeding is avoided and tight glycemic control maintained. Diarrhea is aggressively managed. By correcting proximal etiologic events (infection, inflammatory, injuries), avoiding iatrogenic complications and devoting careful attention to nutritional status, CCI patients can potentially overcome their pulmonary compromise and debilitated state, to fully recover.