Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure (REE) in the critically ill patient. The use of predictive equations to develop nutrition regimens can be problematic in the critical care setting, because the effects that disease, injury, and stress have on REE are often varied and unpredictable. IC testing ensures that the specific conditions of the critically ill patient are taken into account, thereby preventing potential complications from over- and underfeeding. ⋯ Given the importance of predicting REE in the critically ill patient, it is paramount that more healthcare professionals incorporate IC testing into practice. A multidisciplinary approach is helpful in developing a well-established clinical practice. Nutrition support clinicians can promote optimal nutrition management by being well-informed and able to provide evidence-based recommendations for the use of IC.
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Parenteral nutrition (PN) is a life-sustaining therapy for hundreds of thousands of people who have severe impairment of gastrointestinal function. Trace elements are a small but very important part of PN that can be overlooked during busy practice. ⋯ Practical information on parenteral trace element use can be gleaned from case reports, some retrospective studies, and very few randomized controlled trials. A general knowledge of trace element metabolism and excretion, deficiency and toxicity symptoms, products, optimal dosages, and strategies for supplementation, restriction, and monitoring will equip practitioners to provide optimal care for their patients who depend on PN.
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Comparative Study
Infectious complications with nondaily versus daily infusion of intravenous fat emulsions in non-critically ill adults.
Increased risk for infection has been associated with the administration of intravenous fat emulsion (IVFE). Typically, IVFE is infused daily as part of the parenteral nutrition (PN) regimen. However, a national IVFE shortage in 2010 compelled institutions to restrict administration to nondaily. This retrospective study evaluated the rate of infections associated with the nondaily as compared to daily IVFE infusion in hospitalized adult patients. ⋯ Nondaily vs daily IVFE infusion did not have a significant effect on the risk of infection or time to development of infection; however, results are limited due to the small sample size. Large prospective randomized clinical trials are needed to further evaluate the effect of daily as compared to nondaily IVFE infusion on infectious complications.
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There may be a correlation in critically ill children between the accuracy of estimated energy requirement and infection, mortality, and length of stay. Historically, energy needs were estimated using predictive equations with stress factor adjustments. The purpose of this review is to evaluate the evidence for indirect calorimetry, predictive equations, and other clinical indicators (ie, patient outcomes) to estimate energy requirements of the postoperative, critically ill, cardiac infant. ⋯ Actual energy delivery to the postoperative cardiac surgery child in the pediatric intensive care unit (PICU) can be further hindered by many procedural and patient barriers. The provision of appropriate caloric requirements may help clinicians correct the metabolic state and promote recovery and anabolism. Therefore, optimizing nutrition intake of the postoperative, cardiac surgical child requires a paradigm shift toward individualized nutrition prescription, in the context of a PICU-specific feeding algorithm.
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Barbiturate coma may have a significant effect on metabolic rate, but the phenomenon is not extensively studied. The primary purpose of the current study was to compare the metabolic rate of general critical care patients with those requiring barbiturate coma. A secondary purpose was to evaluate the accuracy of the Penn State prediction equation between these 2 groups of patients. ⋯ Resting metabolic rate is moderately reduced in barbiturate coma, but the decrease is out of proportion with changes in body temperature. However, if both body temperature and minute ventilation are considered, then the change is predictable.