Journal of the American College of Nutrition
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With both enteral and parenteral feedings, the amount of nutrients required depends on the degree of nutritional depletion, level of hypermetabolism, and the phase of the patient's response to illness or injury. Protein requirements are significantly increased in the critically ill. In skeletal trauma, energy needs are increased approximately 25%, in sepsis, 50%, and in severe burns, 75-100%. ⋯ In the hypoalbunemic patient with concomitant stress, nitrogen retention will be limited until the stress, i.e. acute injury or infection, is relieved. Nitrogen (g):calorie (kcal) intake will average 1:80. During therapy, nutritional assessment parameters must be measured periodically to evaluate the effectiveness of the nutritional regime.
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Respiratory function in mechanically ventilated patients (VP) is adversely affected by starvation and hypermetabolic stress. These patients are more successfully managed and extubated if proper nutritional support is provided. The features of metabolism and respiratory function in VP require moderation in glucose, fat, and protein administration. In delivering energy to VP, attention must be given to nearby tracheostomy sites complicating the parenteral route and airway-cuff problems that may inhibit effective enteral feeding.
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A consensus definition of malnutrition does not exist. We define "clinically relevant malnutrition" as the state of altered nutritional status that adversely affects clinical outcome. Over four years we have attempted to delineate a clinically applicable and validated nutritional assessment approach. ⋯ In numerous prospective studies of different patient groups, a large percentage of which were critically ill, the PNI has been shown to be a reliable nutritional assessment tool for diagnosing clinically relevant malnutrition. Furthermore, we have shown that seriously malnourished patients classified by the PNI will clinically benefit from preoperative nutritional support. The relevance of baseline and serial nutritional assessment to the nutritional care of the critically ill patient is discussed.