For patients who survive the first 48 h of intensive care, sepsis-related multiple organ failure (MOF) is the leading cause for prolonged intensive care unit (ICU) stays and deaths. Several lines of clinical evidence convincingly link gut injury and subsequent dysfunction to MOF [1]. First, patients who experience persistent gut hypoperfusion (documented by gastric tonometry) after resuscitation are at high risk for abdominal compartment syndrome (ACS), MOF, and death [2]. Second, epidemiologic studies have consistently shown that the normally sterile proximal gut becomes heavily colonized with a variety of organisms. These same organisms have been identified to be pathogens that cause late nosocomial infections. Thus, the gut has been called the ‘undrained abscess’ of MOF [3]. Third, gut-specific therapies (selective gut decontamination, early enteral nutrition (EN), and most recently immuneenhancing enteral diets) have been shown to reduce these nosocomial infections [4–7]. Of these gut-specific therapies, early EN is most widely employed. However, the most severely ill patients who should benefit most from early EN are frequently intolerant to it and are at increased risk for EN-related complications [8–11]. The purpose of this chapter will be to first provide a brief overview of why critically ill patients (using trauma patients as a model)
{"title":"Gut dysfunction and intolerance to enteral nutrition in critically ill patients.","authors":"Frederick A Moore, Norman W Weisbrodt","doi":"10.1159/000072753","DOIUrl":"https://doi.org/10.1159/000072753","url":null,"abstract":"For patients who survive the first 48 h of intensive care, sepsis-related multiple organ failure (MOF) is the leading cause for prolonged intensive care unit (ICU) stays and deaths. Several lines of clinical evidence convincingly link gut injury and subsequent dysfunction to MOF [1]. First, patients who experience persistent gut hypoperfusion (documented by gastric tonometry) after resuscitation are at high risk for abdominal compartment syndrome (ACS), MOF, and death [2]. Second, epidemiologic studies have consistently shown that the normally sterile proximal gut becomes heavily colonized with a variety of organisms. These same organisms have been identified to be pathogens that cause late nosocomial infections. Thus, the gut has been called the ‘undrained abscess’ of MOF [3]. Third, gut-specific therapies (selective gut decontamination, early enteral nutrition (EN), and most recently immuneenhancing enteral diets) have been shown to reduce these nosocomial infections [4–7]. Of these gut-specific therapies, early EN is most widely employed. However, the most severely ill patients who should benefit most from early EN are frequently intolerant to it and are at increased risk for EN-related complications [8–11]. The purpose of this chapter will be to first provide a brief overview of why critically ill patients (using trauma patients as a model)","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"149-65; discussion 165-70"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22570544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe injury causes alterations in protein metabolism [1], including net muscle protein breakdown, increased transfer of amino acids (AAs) from the peripheral to the splanchnic area, intense use of AAs for gluconeogenesis and consequently a marked increase in nitrogen loss, leading to a negative nitrogen balance [2]. When persistent and/or very severe, this process is responsible for protein wasting and in turn for morbidity and mortality. Nutritional supply must therefore form an integral part of therapeutic strategy in critically ill intensive care unit (ICU) patients. But the qualitative intake of nitrogen has to match the requirements of such patients, which are specific and different from those of healthy subjects [1]. The specificity of their requirements arises from a number of factors, some of which are summarized in table 1. However, because historically the technical aspects were mastered before knowledge of the physiopathological alterations became fully known [3], the specific AA needs of ICU patients unfortunately long went unrecognized, and recommended requirements were merely adapted from those set for healthy subjects. Most products tailored for enteral use supply nitrogen in the form of high nutritional value proteins, and most solutions for parenteral nutrition (PN) provide a mixture of free AAs that reproduce the composition of these high-quality reference proteins (egg and cow milk proteins), namely 45% essential AAs (EAAs) and a ratio of EAAs to total nitrogen of 3.1 mg/g. It is clear that current formulas are unlikely to meet ICU patients’ requirements fully [4]. The key questions that must be addressed are the following: (1) How do we determine the AA requirements of critically ill
{"title":"Lessons from pharmacokinetics in the design of new nutrition formulas for critically ill patients.","authors":"Luc Cynober","doi":"10.1159/000072759","DOIUrl":"https://doi.org/10.1159/000072759","url":null,"abstract":"Severe injury causes alterations in protein metabolism [1], including net muscle protein breakdown, increased transfer of amino acids (AAs) from the peripheral to the splanchnic area, intense use of AAs for gluconeogenesis and consequently a marked increase in nitrogen loss, leading to a negative nitrogen balance [2]. When persistent and/or very severe, this process is responsible for protein wasting and in turn for morbidity and mortality. Nutritional supply must therefore form an integral part of therapeutic strategy in critically ill intensive care unit (ICU) patients. But the qualitative intake of nitrogen has to match the requirements of such patients, which are specific and different from those of healthy subjects [1]. The specificity of their requirements arises from a number of factors, some of which are summarized in table 1. However, because historically the technical aspects were mastered before knowledge of the physiopathological alterations became fully known [3], the specific AA needs of ICU patients unfortunately long went unrecognized, and recommended requirements were merely adapted from those set for healthy subjects. Most products tailored for enteral use supply nitrogen in the form of high nutritional value proteins, and most solutions for parenteral nutrition (PN) provide a mixture of free AAs that reproduce the composition of these high-quality reference proteins (egg and cow milk proteins), namely 45% essential AAs (EAAs) and a ratio of EAAs to total nitrogen of 3.1 mg/g. It is clear that current formulas are unlikely to meet ICU patients’ requirements fully [4]. The key questions that must be addressed are the following: (1) How do we determine the AA requirements of critically ill","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"265-72; discussion 272-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22571610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The importance of nutritional support in surgical patients cannot be overstated, particularly in the realm of intensive care settings. Prevention of mucosal atrophy and stimulation of the gut-associated lymphoid tissue (GALT) by early enteral feeding in postoperative surgical patients has only recently become part of our standard of care. Feeding the gut is clearly a stimulant for the immune system, and plays a key role in lower infection rates measured in patients receiving enteral as opposed to parenteral nutrition. This association between nutrition and infection has been known for centuries. The World Health Organization report in 1968 clearly defined this association and began to set goals in clinical nutrition [1]. The understanding of the gastrointestinal (GI) tract as a major component of the human immune system and a key modulator of the organism’s response to stress and injury has subsequently opened the door to an exciting new field of specialized enteral preparations sometimes referred to as nutraceuticals. The recent expansion of our understanding of stress metabolism and the systemic inflammatory response has influenced critical care nutrition on two levels. First, as stated above, is the importance of the provision of enteral macronutrients, namely a patient’s requirement for protein, carbohydrate, and lipids. Secondly, research in nutraceuticals seems to have focused on various combinations of micronutrients and ‘conditionally’ essential nutrients. Nutraceuticals are felt to function in cellular metabolic pathways where increased demands associated with the stress response benefit from supplementation. These nutrients may be the key to fine-tuning enteral formulas for specific clinical scenarios. For centuries, man has sought the therapeutic benefits of naturally occurring substances as components of the human diet, acknowledging the
{"title":"Nutraceuticals in critical care nutrition.","authors":"Hank Schmidt, Robert Martindale","doi":"10.1159/000072758","DOIUrl":"https://doi.org/10.1159/000072758","url":null,"abstract":"The importance of nutritional support in surgical patients cannot be overstated, particularly in the realm of intensive care settings. Prevention of mucosal atrophy and stimulation of the gut-associated lymphoid tissue (GALT) by early enteral feeding in postoperative surgical patients has only recently become part of our standard of care. Feeding the gut is clearly a stimulant for the immune system, and plays a key role in lower infection rates measured in patients receiving enteral as opposed to parenteral nutrition. This association between nutrition and infection has been known for centuries. The World Health Organization report in 1968 clearly defined this association and began to set goals in clinical nutrition [1]. The understanding of the gastrointestinal (GI) tract as a major component of the human immune system and a key modulator of the organism’s response to stress and injury has subsequently opened the door to an exciting new field of specialized enteral preparations sometimes referred to as nutraceuticals. The recent expansion of our understanding of stress metabolism and the systemic inflammatory response has influenced critical care nutrition on two levels. First, as stated above, is the importance of the provision of enteral macronutrients, namely a patient’s requirement for protein, carbohydrate, and lipids. Secondly, research in nutraceuticals seems to have focused on various combinations of micronutrients and ‘conditionally’ essential nutrients. Nutraceuticals are felt to function in cellular metabolic pathways where increased demands associated with the stress response benefit from supplementation. These nutrients may be the key to fine-tuning enteral formulas for specific clinical scenarios. For centuries, man has sought the therapeutic benefits of naturally occurring substances as components of the human diet, acknowledging the","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"245-56; discussion 256-64"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22571609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is difficult to give a simple answer to this question for a number of reasons. Firstly, because the major determinants of outcome on the ICU are the severity of the disease, coincident cardiorespiratory pathology, sepsis and organ failure. Nutritional support is therefore likely to have only a modest effect on survival although it may have an important role in accelerating recovery. On the other hand, prolonged periods of starvation are deleterious, as is excessive or inappropriate nutrition. Secondly, as pointed out by Griffiths et al. [1] in their studies on glutamine supplementation, it is important to follow the whole course of the patient’s illness before, during and after the intensive care unit (ICU) episode, through convalescence to full recovery (fig. 1), since the patients pre-ICU condition and treatment during ICU stay may influence subsequent events. Our goals must therefore be longas well as short-term. Thirdly, the ICU population is not only heterogeneous within each institution, but also varies from center to center. In a recent paper by Van Den Berghe et al. [2], 63% of the population studied were patients recovering from cardiac surgery. In our own ICU there are none. Berger et al. [3] have a high proportion of burned patients in their practice. Another unit may contain a high proportion of patients recovering from major abdominal surgery or even, in some American series, of gunshot wounds. The patient ventilated for 24–48 h for status asthmaticus suffers not one jot from being starved during their stay. In contrast, the catabolic patient ventilated for 1–2 weeks intuitively needs feeding to minimize a huge loss of lean mass. The average length of stay in many ICUs may be 3–4 days, but this average conceals a wide range.
{"title":"What is the goal of nutrition in the intensive care unit?","authors":"S P Allison","doi":"10.1159/000072751","DOIUrl":"https://doi.org/10.1159/000072751","url":null,"abstract":"It is difficult to give a simple answer to this question for a number of reasons. Firstly, because the major determinants of outcome on the ICU are the severity of the disease, coincident cardiorespiratory pathology, sepsis and organ failure. Nutritional support is therefore likely to have only a modest effect on survival although it may have an important role in accelerating recovery. On the other hand, prolonged periods of starvation are deleterious, as is excessive or inappropriate nutrition. Secondly, as pointed out by Griffiths et al. [1] in their studies on glutamine supplementation, it is important to follow the whole course of the patient’s illness before, during and after the intensive care unit (ICU) episode, through convalescence to full recovery (fig. 1), since the patients pre-ICU condition and treatment during ICU stay may influence subsequent events. Our goals must therefore be longas well as short-term. Thirdly, the ICU population is not only heterogeneous within each institution, but also varies from center to center. In a recent paper by Van Den Berghe et al. [2], 63% of the population studied were patients recovering from cardiac surgery. In our own ICU there are none. Berger et al. [3] have a high proportion of burned patients in their practice. Another unit may contain a high proportion of patients recovering from major abdominal surgery or even, in some American series, of gunshot wounds. The patient ventilated for 24–48 h for status asthmaticus suffers not one jot from being starved during their stay. In contrast, the catabolic patient ventilated for 1–2 weeks intuitively needs feeding to minimize a huge loss of lean mass. The average length of stay in many ICUs may be 3–4 days, but this average conceals a wide range.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"119-27; discussion 127-32"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22570542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advances in mechanical ventilation, the use of pulmonary surfactants, improved pharmacological management of expectant mothers and preterm infants and greater confidence in our overall intensive care techniques have resulted in a marked increase in the number of very immature infants who survive. The same ethical controversies of 20 years ago surrounding whether or not to resuscitate prematures of 26–28 weeks gestation are now focused on 22–24 weeks. Those involved with the care of these survivors are faced with a constellation of problems that include prevention of morbidity and fulfillment of genetic potential. Nutrition is becoming a key factor not only for the growth of these infants during their neonatal intensive care unit (NICU) stay, but also for prevention of morbidity and enhancement of their life-long well being. The major goal of this review is to provide the reader with an overview of a few recent advances in nutrition that can be applied in the daily care of these patients. In addition, a few emerging concepts about conditionally essential amino acids, long-chain polyunsaturated fatty acids (LC-PUFAs) and probiotics are presented that are likely to become important modalities in the future care of these infants.
{"title":"Nutrition of premature and critically ill neonates.","authors":"Josef Neu, Ying Huang","doi":"10.1159/000072754","DOIUrl":"https://doi.org/10.1159/000072754","url":null,"abstract":"Advances in mechanical ventilation, the use of pulmonary surfactants, improved pharmacological management of expectant mothers and preterm infants and greater confidence in our overall intensive care techniques have resulted in a marked increase in the number of very immature infants who survive. The same ethical controversies of 20 years ago surrounding whether or not to resuscitate prematures of 26–28 weeks gestation are now focused on 22–24 weeks. Those involved with the care of these survivors are faced with a constellation of problems that include prevention of morbidity and fulfillment of genetic potential. Nutrition is becoming a key factor not only for the growth of these infants during their neonatal intensive care unit (NICU) stay, but also for prevention of morbidity and enhancement of their life-long well being. The major goal of this review is to provide the reader with an overview of a few recent advances in nutrition that can be applied in the daily care of these patients. In addition, a few emerging concepts about conditionally essential amino acids, long-chain polyunsaturated fatty acids (LC-PUFAs) and probiotics are presented that are likely to become important modalities in the future care of these infants.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"171-81; discussion 181-5"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22570545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The general approach to the nutritional care of the catabolic, malnourished or critically ill patient involves delivery of a balanced diet including energy (in the form of carbohydrates and lipids), an adequate amount of nitrogen, all essential nutrients (amino acids, fatty acids, vitamins, electrolytes) and fluid [1]. Traditionally, the qualitative and quantitative composition of dietetic measures in patients was derived from recommended daily allowances for healthy adults with addition of a so-called ‘safety margin’. In the past 2 decades, this view has been fundamentally modified. Firstly, overwhelming evidence has been brought forward that critical illness is associated with profound alterations in carbohydrate, lipid, and protein metabolism [2, 3]. Consequently, nutrient demands of patients can considerably differ in comparison with healthy adults. Presently, great efforts are being undertaken to define ‘diseaserelated’ recommendations and, in line with this novel concept, to provide ‘tailor-made’ formulas for specific patient groups like children, renal and liver diseases, and critical illness. Secondly, evidence was found that various nutrients including amino acids and fatty acids possess more than the wellknown ‘nutritive’ effects on body function and metabolism [4]. In vitro and in vivo studies showed that nutrients can modify the immune response as well as the integrity of organs and tissues in health and disease in a dose-dependent manner. Moreover, the extent and target of this ‘pharmacological’ effect can be controlled by the timing and the way (oral/enteral, intravenous) of substrate administration. Indeed, this approach opens the possibility to modulate the metabolic response to stress.
{"title":"Nutrition support in critical illness: amino acids.","authors":"Peter Stehle","doi":"10.1159/000072748","DOIUrl":"https://doi.org/10.1159/000072748","url":null,"abstract":"The general approach to the nutritional care of the catabolic, malnourished or critically ill patient involves delivery of a balanced diet including energy (in the form of carbohydrates and lipids), an adequate amount of nitrogen, all essential nutrients (amino acids, fatty acids, vitamins, electrolytes) and fluid [1]. Traditionally, the qualitative and quantitative composition of dietetic measures in patients was derived from recommended daily allowances for healthy adults with addition of a so-called ‘safety margin’. In the past 2 decades, this view has been fundamentally modified. Firstly, overwhelming evidence has been brought forward that critical illness is associated with profound alterations in carbohydrate, lipid, and protein metabolism [2, 3]. Consequently, nutrient demands of patients can considerably differ in comparison with healthy adults. Presently, great efforts are being undertaken to define ‘diseaserelated’ recommendations and, in line with this novel concept, to provide ‘tailor-made’ formulas for specific patient groups like children, renal and liver diseases, and critical illness. Secondly, evidence was found that various nutrients including amino acids and fatty acids possess more than the wellknown ‘nutritive’ effects on body function and metabolism [4]. In vitro and in vivo studies showed that nutrients can modify the immune response as well as the integrity of organs and tissues in health and disease in a dose-dependent manner. Moreover, the extent and target of this ‘pharmacological’ effect can be controlled by the timing and the way (oral/enteral, intravenous) of substrate administration. Indeed, this approach opens the possibility to modulate the metabolic response to stress.","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"57-66; discussion 67-73"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22570539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trace elements and vitamins are essential components of nutrition (unless specified, vitamins and trace elements will hereafter be designated globally as micronutrients). Trace elements are metals and metalloids present in the body at fairly constant concentrations. Trace elements act as a structure of enzymes or as cofactors, and frequently they exert electron transfer functions. Their absence causes reproducible structural or biochemical deficits, and they are associated with specific biochemical alterations. These alterations can be prevented or corrected by the intake of the deficient element alone. Vitamins are organic substances required in minute amounts, and they are not synthesized by the body (or not in sufficient quantities). Vitamins are cofactors in the different metabolic steps of enzymes, carbohydrate, protein, and lipid metabolism. Micronutrients are involved in the prevention of nutritional deficiencies, immune humoral and cellular defense, regulation of gene expression during the acute phase response, antioxidant defense, and prevention of chronic diseases. Most micronutrients have been discovered due to acute nutritional deficiencies causing specific diseases, such as ascorbic acid and scurvies, zinc and delayed wound healing and dwarfism, selenium and skeletal myopathy, and iron and anemia. Micronutrient deficiency in the general population is infrequent, but inadequate intake is widespread as shown by a series of epidemiological studies carried out over the last 2 decades [1–3]. Due to changes in nutrient
{"title":"Key vitamins and trace elements in the critically ill.","authors":"M. Berger, R. Chioléro","doi":"10.1159/000072750","DOIUrl":"https://doi.org/10.1159/000072750","url":null,"abstract":"Trace elements and vitamins are essential components of nutrition (unless specified, vitamins and trace elements will hereafter be designated globally as micronutrients). Trace elements are metals and metalloids present in the body at fairly constant concentrations. Trace elements act as a structure of enzymes or as cofactors, and frequently they exert electron transfer functions. Their absence causes reproducible structural or biochemical deficits, and they are associated with specific biochemical alterations. These alterations can be prevented or corrected by the intake of the deficient element alone. Vitamins are organic substances required in minute amounts, and they are not synthesized by the body (or not in sufficient quantities). Vitamins are cofactors in the different metabolic steps of enzymes, carbohydrate, protein, and lipid metabolism. Micronutrients are involved in the prevention of nutritional deficiencies, immune humoral and cellular defense, regulation of gene expression during the acute phase response, antioxidant defense, and prevention of chronic diseases. Most micronutrients have been discovered due to acute nutritional deficiencies causing specific diseases, such as ascorbic acid and scurvies, zinc and delayed wound healing and dwarfism, selenium and skeletal myopathy, and iron and anemia. Micronutrient deficiency in the general population is infrequent, but inadequate intake is widespread as shown by a series of epidemiological studies carried out over the last 2 decades [1–3]. Due to changes in nutrient","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"44 1","pages":"99-111; discussion 111-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78527335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most prominent metabolic alterations which characterize the systemic inflammatory response syndrome and sepsis include hypermetabolism, hyperglycemia with insulin resistance, accelerated lipolysis and net protein catabolism [1–3]. The combined effect of these metabolic alterations associated with bed rest and lack of nutritional intake can lead to a progressive depletion of lean body mass. Even if nutritional support in critically ill patients cannot fully prevent or reverse the metabolic alterations and, consequently, the disruption in body composition and the erosion of the body cell mass, it can nevertheless slow the rate of net protein catabolism by providing an exogenous load of energy and nitrogen [2, 4]. Recent publications demonstrate increased non-resting energy expenditure (i.e. activity) after the first week of critical illness [5]. Total energy expenditure in septic patients was in fact 25 5 kcal/kg/day during the first week of critical illness and increased to 47 6 kcal/kg/day during the second week. However, it remains to be determined if administering more than 25–30 kcal/kg/day is beneficial to these patients, and if providing more than 1 g amino acid/kg/day (a quantity sufficient to minimize loss of body protein during the initial 2 weeks of critical illness) carries further benefit [6]. We reviewed the official statements of some national and international scientific societies regarding the nutritional support of intensive care unit (ICU) patients: the Italian Society for Parenteral and Enteral Nutrition (SINPE) 1995 [7]; the French Speaking Society for Enteral and Parenteral Nutrition (SFNEP) 1996 [8] that only considered septic patients; the American College of Chest Physicians (ACCP) 1997 [9]; the French Speaking Society of Enteral and Parenteral Nutrition (FSNEP) 1998 [10]; the European Society of Intensive Care Medicine (ESICM) 1998 [11] that also published a position
{"title":"Nutritional support in ICU patients: position of scientific societies.","authors":"Federico Bozzetti, Biagio Allaria","doi":"10.1159/000072760","DOIUrl":"https://doi.org/10.1159/000072760","url":null,"abstract":"The most prominent metabolic alterations which characterize the systemic inflammatory response syndrome and sepsis include hypermetabolism, hyperglycemia with insulin resistance, accelerated lipolysis and net protein catabolism [1–3]. The combined effect of these metabolic alterations associated with bed rest and lack of nutritional intake can lead to a progressive depletion of lean body mass. Even if nutritional support in critically ill patients cannot fully prevent or reverse the metabolic alterations and, consequently, the disruption in body composition and the erosion of the body cell mass, it can nevertheless slow the rate of net protein catabolism by providing an exogenous load of energy and nitrogen [2, 4]. Recent publications demonstrate increased non-resting energy expenditure (i.e. activity) after the first week of critical illness [5]. Total energy expenditure in septic patients was in fact 25 5 kcal/kg/day during the first week of critical illness and increased to 47 6 kcal/kg/day during the second week. However, it remains to be determined if administering more than 25–30 kcal/kg/day is beneficial to these patients, and if providing more than 1 g amino acid/kg/day (a quantity sufficient to minimize loss of body protein during the initial 2 weeks of critical illness) carries further benefit [6]. We reviewed the official statements of some national and international scientific societies regarding the nutritional support of intensive care unit (ICU) patients: the Italian Society for Parenteral and Enteral Nutrition (SINPE) 1995 [7]; the French Speaking Society for Enteral and Parenteral Nutrition (SFNEP) 1996 [8] that only considered septic patients; the American College of Chest Physicians (ACCP) 1997 [9]; the French Speaking Society of Enteral and Parenteral Nutrition (FSNEP) 1998 [10]; the European Society of Intensive Care Medicine (ESICM) 1998 [11] that also published a position","PeriodicalId":18989,"journal":{"name":"Nestle Nutrition workshop series. Clinical & performance programme","volume":"8 ","pages":"279-92; discussion 293-8"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000072760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22571611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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