Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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The purpose of this study was to determine the effect of an enteral tube feeding protocol on caloric and protein delivery to intensive care unit (ICU) patients. ⋯ Enteral tube feeding protocol is effective in improving feeding delivery in ICU patients independent of prokinetic agent use. Protocol for enteral tube feeding should be considered in the management of ICU patients, given the positive impact of this nonpharmacologic, non-interventional tool.
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This review will attempt to summarize recent clinical data on glutamine's use. It will present the concept of glutamine as a "drug" or "nutraceutical," given in addition to standard nutrition support. Key references will be discussed, and clinical recommendations with regard to patients who may benefit and dosing are also provided. ⋯ High-dose or parenteral (> 0.25 to 0.30 g/kg/day IV or >or=30 g/day enterally) glutamine appears to demonstrate the greatest potential for benefit in hospitalized patients. No evidence of harm has been observed in studies conducted to date; thus, further clinical trials using glutamine as a pharmacologic supplement to standard nutrition are warranted.
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A retrospective analysis of 55 mechanically ventilated critically ill patients was conducted to determine adequacy of nutritional support (total parenteral nutrition or enteral nutrition) according to requirements established by indirect calorimetry. Patients who received 90% to 110% of the established energy requirements as measured by indirect calorimetry were defined as adequately fed. ⋯ We determined that critically ill patients with a body mass index <20 kg/m2 were the most likely group to be assessed inappropriately by available regression equations. If indirect calorimetry measurement is unavailable, we suggest using an empiric formula of 37 kcal/kg for critically ill patients with a body mass index <20 kg/m2.
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Over the last decade there has been considerable interest in the use of specific nutrients to alter the metabolic response to injury and infection, to improve immune function, and to prevent or reverse the severe catabolism and wasting of the lean body mass that accompanies critical illness. In this review, representative animal studies and, when available, human studies examining the potential benefits of these individual nutrients are summarized. The overview of basic investigations is by no means all-inclusive, and the emphasis of this manuscript is a review of the currently available clinical trials examining the potential benefits of combinations of these individual immunity-enhancing nutrients in human patients.
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In summary, thermal injury elicits numerous pathophysiological aberrations that affect nutritional status. The current recommendation for macronutrient provision postburn supports a high-calorie, protein and carbohydrate regimen and a reduction of the fat provision because of its apparent immunosuppressive properties. ⋯ Because of its direct effect on morbidity and mortality, the introduction of early, continuous enteral feedings is recommended as standard therapy after burn injury. Finally, monitors for enteral placement and tolerance should be incorporated into routine care as well as the multidisciplinary Quality Management Program.