Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Bariatric surgery, an effective treatment for morbid obesity, may result in complications that require nutrition support. Common goals for nutrition support in post-bariatric surgery patients include nutrition repletion, avoiding overfeeding, preserving lean body mass, and promoting wound healing. It is often questioned if continued weight loss can be part of the nutrition goals and if weight loss is safe for patients who become critically ill following bariatric surgery. ⋯ Two small studies in complicated post-bariatric surgery patients requiring nutrition support have shown that the strategy of hypocaloric, high-protein feedings can result in positive outcomes, including positive nitrogen balance, wound healing, weight loss, and successful transition to oral diets. Additional research, including large, randomized studies, is still needed to validate these findings. However, based on a review of available clinical practice guidelines, predictive equations, indirect calorimetry, case studies, and systematic reviews, hypocaloric, high-protein nutrition support appears to at least be equal to eucaloric feedings and may be a useful tool for clinicians to achieve continued weight loss in complicated bariatric surgery patients requiring nutrition support.
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Nutrition therapy protocols seek to correlate current scientific knowledge with clinical practice by converting evidence-based efficacy data into clinical effectiveness. Implementing nutrition therapy protocols should be justified by their impact on clinical outcomes. Thus, our objective was to analyze studies that verified the effect of implementing protocols for enteral nutrition (EN) in critically ill patients who are mechanically ventilated. We investigated initiation of nutrition therapy, time until nutrition requirements are met, optimization of protein and energy intake, duration of mechanical ventilation, length of hospital and intensive care unit stay, mortality, and adherence to protocols. ⋯ Our analysis of previously published studies indicates that implementing a nutrition therapy protocol can lead to optimization of various aspects of nutrition practice. Further studies that take into consideration local facilitating (as well as hindering) factors may reveal the impact of strategic EN protocols on clinical outcomes.
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Obesity has been associated with poor clinical outcomes in critically ill children. The optimal approach to nutrition therapy in this vulnerable cohort is unclear. ⋯ These cases were notable for (1) challenges to anthropometric assessments, (2) inaccurate estimates of energy requirements, (3) suboptimal enteral nutrition delivery, (4) need for supplemental parenteral nutrition, and (5) suboptimal protein intake. Research is needed to determine the best approach to nutrition therapy in this cohort.
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Sepsis is a common disease seen in critically ill patients. Many patients with sepsis are unable to provide nutrition for themselves, and therefore initiating artificial nutrition has become part of routine care for these patients. ⋯ The best recommendations have to be extrapolated from studies in heterogeneous populations of critically ill patients or in those with syndromes such as acute lung injury or acute respiratory distress syndrome (ARDS) where sepsis is a common predisposing etiology. In this review, we summarize pertinent studies that inform clinical practice on providing artificial nutrition to critically ill patients with severe sepsis and make recommendations as to how these studies influence clinical care of these patients.
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Observational Study
Nutrition adequacy in enhanced recovery after surgery: a single academic center experience.
A prospective observational study was initiated to determine the prevalence of nutrition risk before surgery and assess nutrition adequacy of food choices after elective colorectal surgery. ⋯ A third of patients scheduled for elective colorectal surgery were at nutrition risk. An acceptable intake of dietary protein was not achieved during the first 3 days of hospitalization. Preoperative nutrition education, as part of Enhanced Recovery Programs, may be useful to optimize nutrition status before surgery to mitigate clinical consequences associated with undernutrition and empower patients to make adequate food choices for recovery. NCT 01727570.