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https://www.readbyqxmd.com/read/28388370/will-we-ever-agree-on-protein-requirements-in-the-intensive-care-unit
#1
L John Hoffer, Roland N Dickerson, Robert G Martindale, Stephen A McClave, Juan B Ochoa Gautier
The precise value of the normal adult protein requirement has long been debated. For many reasons-one of them being the difficulty of carrying out long-term nutrition experiments in free-living people-uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28385477/espen-guideline-clinical-nutrition-in-surgery
#2
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
March 7, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28365665/nutrition-support-protocols-enhancing-delivery-of-enteral-nutrition
#3
Colleen O'Leary-Kelley, Karen Bawel-Brinkley
In critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients...
April 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28350525/hang-height-of-enteral-nutrition-influences-the-delivery-of-enteral-nutrition
#4
Renee Walker, Lauren Probstfeld, Anne Tucker
PURPOSE: Adequate enteral nutrition (EN) delivery to critically ill patients is difficult to achieve. Given the large number of unpreventable influences affecting adequate caloric intake, further research on preventable influences of adequate EN administration is warranted. The purpose of this study was to evaluate whether hang height of EN formula, formula viscosity, or flow rate influences pump accuracy and formula delivery. METHODS: Formulas of varying viscosities (1...
March 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28244768/underfeeding-versus-full-enteral-feeding-in-critically-ill-patients-with-acute-respiratory-failure-a-systematic-review-with-meta-analysis-of-randomized-controlled-trials
#5
Oellen Stuani Franzosi, Anize Delfino von Frankenberg, Sergio Henrique Loss, Diego Silva Leite Nunes, Silvia Regina Rios Vieira
INTRODUCTION: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy. OBJECTIVE: To compare the effect of two EN strategies (underfeeding versus full-feeding) on ICU and overall mortality (hospital mortality or 60-day mortality) and length of stay (LOS), duration of mechanical ventilation (MV), infectious complications, and gastrointestional tolerability in ICU patients...
February 22, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/28224108/implementation-of-enteral-feeding-protocol-in-an-intensive-care-unit-before-and-after-study
#6
Martin Padar, Gerli Uusvel, Liis Starkopf, Joel Starkopf, Annika Reintam Blaser
AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients. METHODS: An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection Control Service...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28108105/performance-of-predictive-equations-specifically-developed-to-estimate-resting-energy-expenditure-in-ventilated-critically-ill-children
#7
Corinne Jotterand Chaparro, Patrick Taffé, Clémence Moullet, Jocelyne Laure Depeyre, David Longchamp, Marie-Hélène Perez, Jacques Cotting
OBJECTIVE: To determine, based on indirect calorimetry measurements, the biases of predictive equations specifically developed recently for estimating resting energy expenditure (REE) in ventilated critically ill children, or developed for healthy populations but used in critically ill children. STUDY DESIGN: A secondary analysis study was performed using our data on REE measured in a previous prospective study on protein and energy needs in pediatric intensive care unit...
January 18, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28076448/igf-1-induces-ghrh-neuronal-axon-elongation-during-early-postnatal-life-in-mice
#8
Lyvianne Decourtye, Erik Mire, Maud Clemessy, Victor Heurtier, Tatiana Ledent, Iain C Robinson, Patrice Mollard, Jacques Epelbaum, Michael J Meaney, Sonia Garel, Yves Le Bouc, Laurent Kappeler
Nutrition during the perinatal period programs body growth. Growth hormone (GH) secretion from the pituitary regulates body growth and is controlled by Growth Hormone Releasing Hormone (GHRH) neurons located in the arcuate nucleus of the hypothalamus. We observed that dietary restriction during the early postnatal period (i.e. lactation) in mice influences postnatal growth by permanently altering the development of the somatotropic axis in the pituitary gland. This alteration may be due to a lack of GHRH signaling during this critical developmental period...
2017: PloS One
https://www.readbyqxmd.com/read/27997410/influence-of-nutrition-therapy-on-the-intestinal-microbiome
#9
Monika A Krezalek, Andrew Yeh, John C Alverdy, Michael Morowitz
PURPOSE OF REVIEW: This review describes the relationship between nutritional therapies and the intestinal microbiome of critically ill patients. RECENT FINDINGS: The intestinal microbiome of the critically ill displays a near complete loss of health-promoting microbiota with overgrowth of virulent healthcare-associated pathogens. Early enteral nutrition within 24 h of admission to the ICU has been advocated in medical and surgical patients to avoid derangements of the intestinal epithelium and the microbiome associated with starvation...
March 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/27925048/resting-energy-expenditure-in-critically-ill-patients-evaluation-methods-and-clinical-applications
#10
Ana Cláudia Soncini Sanches, Cassiana Regina de Góes, Marina Nogueira Berbel Bufarah, André Luiz Balbi, Daniela Ponce
Patients on intensive care present systemic, metabolic, and hormonal alterations that may adversely affect their nutritional condition and lead to fast and important depletion of lean mass and malnutrition. Several factors and medical conditions can influence the energy expenditure (EE) of critically ill patients, such as age, gender, surgery, serious infections, medications, ventilation modality, and organ dysfunction. Clinical conditions that can present with EE change include acute kidney injury, a complex disorder commonly seen in critically ill patients with manifestations that can range from minimum elevations in serum creatinine to renal failure requiring dialysis...
October 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27903201/nutrition-in-the-intensive-care-unit-you-must-breathe-what-you-eat
#11
John F Cade, Daryl A Jones, Rinaldo Bellomo
The imprecision in prescribing of enteral nutrition in critically ill patients must result in occasions of overfeeding as well as underfeeding. Overfeeding could cause increased CO2 production and thus increased work of breathing and prolonged ventilator dependence. This possibility is supported by the limited relevant literature. We examined this possibility mathematically using the data in The Augmented versus Routine Approach to Giving Energy Trial (TARGET) feasibility study and in its main study protocol...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27832823/resting-energy-expenditure-calorie-and-protein-consumption-in-critically-ill-patients-a-retrospective-cohort-study
#12
Oren Zusman, Miriam Theilla, Jonathan Cohen, Ilya Kagan, Itai Bendavid, Pierre Singer
BACKGROUND: Intense debate exists regarding the optimal energy and protein intake for intensive care unit (ICU) patients. However, most studies use predictive equations, demonstrated to be inaccurate to target energy intake. We sought to examine the outcome of a large cohort of ICU patients in relation to the percent of administered calories divided by resting energy expenditure (% AdCal/REE) obtained by indirect calorimetry (IC) and to protein intake. METHODS: Included patients were hospitalized from 2003 to 2015 at a 16-bed ICU at a university affiliated, tertiary care hospital, and had IC measurement to assess caloric targets...
November 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27807037/two-days-of-calorie-deprivation-induced-by-underfeeding-and-aerobic-exercise-degrades-mood-and-lowers-interstitial-glucose-but-does-not-impair-cognitive-function-in-young-adults
#13
Harris R Lieberman, Asma S Bukhari, John A Caldwell, Marques A Wilson, Caroline R Mahoney, Stefan M Pasiakos, James P McClung, Tracey J Smith
BACKGROUND: In studies assessing the effects of acute undernutrition on cognitive function, volunteers are sedentary and findings are equivocal, even though glucose concentrations fall substantially. However, military personnel and endurance athletes often are underfed when physical demands, and consequently energy expenditure, are substantial. OBJECTIVE: The objective of this study was to determine whether 2 d of near-total calorie deprivation combined with aerobic exercise degraded cognitive performance and mood...
January 2017: Journal of Nutrition
https://www.readbyqxmd.com/read/27805537/-when-enteral-nutrition-is-not-possible-in-intensive-care-patients-whether-to-wait-or-use-parenteral-nutrition
#14
Q L M Habes, P Pickkers
- Overfeeding of critically ill patients is associated with a higher incidence of infections and an increased length of ventilation. However, trophic nutrition or permissive underfeeding appears to have no negative effect on the patient and may even provide a survival benefit.- Initiation of enteral nutrition within 24-48 hours after Intensive Care Unit (ICU) admission may reduce the number of complications and increase the chance of survival.- Total parenteral nutrition is associated with a higher risk of infections than enteral nutrition...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27803805/nutrition-in-critical-illness-a-current-conundrum
#15
REVIEW
L John Hoffer, Bruce R Bistrian
Critically ill people are unable to eat. What's the best way to feed them? Nutrition authorities have long recommended providing generous amounts of protein and calories to critically ill patients, either intravenously or through feeding tubes, in order to counteract the catabolic state associated with this condition. In practice, however, patients in modern intensive care units are substantially underfed. Several large randomized clinical trials were recently carried out to determine the clinical implications of this situation...
2016: F1000Research
https://www.readbyqxmd.com/read/27790606/nutrition-a-primary-therapy-in-pediatric-acute-respiratory-distress-syndrome
#16
REVIEW
Bryan Wilson, Katri Typpo
Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27761730/influence-of-glycemic-control-on-endogenous-circulating-ketone-concentrations-in-adults-following-traumatic-brain-injury
#17
Stephanie M Wolahan, Mayumi L Prins, David L McArthur, Courtney R Real, David A Hovda, Neil A Martin, Paul M Vespa, Thomas C Glenn
BACKGROUND: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS: The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed...
April 2017: Neurocritical Care
https://www.readbyqxmd.com/read/27668228/effectiveness-of-enteral-feeding-protocol-on-clinical-outcomes-in-critically-ill-patients-a-study-protocol-for-before-and-after-design
#18
Zhongheng Zhang, Qian Li, Lingzhi Jiang, Bo Xie, Xiaowei Ji, Jiahong Lu, Ronglin Jiang, Shu Lei, Shihao Mao, Lijun Ying, Di Lu, Xiaoshui Si, Jianxin He, Mingxia Ji, Jianhua Zhu, Guodong Chen, Yadi Shao, Yinghe Xu, Ronghai Lin, Chao Zhang, Weiwen Zhang, Jian Luo, Tianzheng Lou, Xuwei He, Kun Chen, Renhua Sun
INTRODUCTION: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. METHODS AND ANALYSIS: The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers...
August 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27589411/permissive-underfeeding-or-standard-enteral-feeding-in-high-and-low-nutritional-risk-critically-ill-adults-post-hoc-analysis-of-the-permit-trial
#19
Yaseen M Arabi, Abdulaziz S Aldawood, Hasan M Al-Dorzi, Hani M Tamim, Samir H Haddad, Gwynne Jones, Lauralyn McIntyre, Othman Solaiman, Maram H Sakkijha, Musharaf Sadat, Shihab Mundekkadan, Anand Kumar, Sean M Bagshaw, Sangeeta Mehta
RATIONALE: The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear. OBJECTIVES: To examine the effect of permissive underfeeding with full protein intake compared with standard feeding on 90-day mortality in patients with different baseline nutritional risk. METHODS: This is a post hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial...
March 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27373874/impact-of-dose-response-calorie-reduction-or-supplementation-of-a-covertly-manipulated-lunchtime-meal-on-energy-compensation
#20
Siew Ling Tey, Edwin Ming En Chia, Ciarán G Forde
Numerous studies have examined energy compensation following overfeeding regimes whereas much less is known about the impact of acute underfeeding on energy compensation and fewer still have compared energy reduction and addition in the same group of individuals. This study compared the effects of consuming lunches with varying energy content (7.2-fold difference) on subsequent energy intake. A total of 27 healthy males took part in this randomized, crossover study with five treatments: 163kcal (very low energy meal, VLEM), 302kcal (low energy meal, LEM), 605kcal (control), 889kcal (high energy meal, HEM), and 1176kcal (very high energy meal, VHEM) served as a noodle soup...
October 15, 2016: Physiology & Behavior
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