Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Critically ill patients have important modifications in their energetic requirements, in which the clinical situation, treatment applied and the time course take part. Thus, the most appropriate method to calculate the caloric intake is indirect calorimetry. When this test is not available, calculations such as Harris-Benedict's may be used, although not using the so high correction factors as previously recommended in order to avoid hypercaloric intakes. ⋯ The recommended protein intake is 1.0-1.5 g/kg/day, according to the clinical situation characteristics. Special care must be taken with micronutrients intake, an issue that is many times undervalued. In this sense, there are data to consider some micronutrients such as Zn, CU, Mn, Cr, Se, Mo and some vitamins (A, B, C, and E) of great importance for patients in a critical condition, although specific requirements for each one of them have not been established.
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Polytraumatism usually presents in previously healthy patients with a good nutritional status. However, metabolic changes derived from the traumatic injury put these patients in a nutritional risk situation. Specialized nutritional support should be started if it is foreseeable that nutritional requirements will not be met p.o. within the 5-10 days period from admission. ⋯ However, the presence of head trauma leads to gastrointestinal motility impairments that hinder tolerance to enteral nutrition. Patients with abdominal trauma also present difficulties for the onset and tolerance of enteral diet. The insertion of transpyloric tubes or jejunostomy catheters allows early use of enteral nutrition in these patients.