Articles: critical-illness.
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Critical care medicine · Jul 1994
ReviewDoes the formulation of enteral feeding products influence infectious morbidity and mortality rates in the critically ill patients? A critical review of the evidence.
To examine the relationship between the formulation of enteral nutrition and nosocomial infection in critical illness. ⋯ Insufficient experimental data exist to permit conclusions that enteral nutrition formulations or supplements reduce infectious morbidity and mortality rates, but results are promising enough to warrant further research.
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Nutritional support of the seriously ill patient has evolved with time and reflects new developments in the field of critical care. Current information suggests that optimal nutritional support can be provided by supplying at least 80% of energy requirements with at least 70% of the energy given as carbohydrate and the remaining 30% or less administered as fat (with > or = 3% of energy requirements as essential fatty acids). The caloric load may be reduced to 50% of requirements if growth factors (e.g., growth hormone) are utilized and the patient has adequate fat stores. ⋯ Nutrients should be administered early in the catabolic course, especially glucose, sodium, potassium, vitamins, and minerals. Over time (approximately 7 days) amino acids should be added and approximately 50% of caloric support should be provided. Finally, full nutritional support should be provided (by 7 to 10 days) if the catabolic course is expected to continue.
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Overfeeding occurs when the administration of calories and/or specific substrate exceeds the requirements to maintain metabolic homeostasis. These requirements are substantially altered during periods of injury-induced acute metabolic stress. Excess nutritional delivery during this period can further increase the metabolic demands of acute injury and place an added burden on the lungs and liver. ⋯ In these acutely-stressed infants, measured energy expenditure constitutes the total energy requirement, and caloric delivery in excess of this amount should be avoided until metabolic stress parameters indicate resolution of the acute injury state. Enteral delivery should be used in preference to parenteral feeding. Even if total caloric delivery cannot be achieved enterally, the provision of a small amount of the total energy budget via the enteral route is generally possible and is likely advantageous.(ABSTRACT TRUNCATED AT 250 WORDS)
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It is clear that amino acid-based nutritional support beneficially affects nitrogen balance. Less clear is the optimal composition of amino acids for nutritional support of the catabolic patient. ⋯ We discuss the concept of conditionally indispensable amino acids and review the requirements for histidine, serine, arginine, taurine, cysteine, tyrosine, and glutamine. The use of dipeptides for parenteral support of critically ill patients is reviewed and proposed changes in amino acid content for the catabolic patient are advanced.