Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2004
Review Comparative StudyCan it all be done by enteral nutrition?
During recent years techniques and metabolic considerations have been discussed intensively. One contributing reason is that results have not always been easy to interpret and introduce into clinical practice. Nutrition through the enteral and parenteral route has classically been compared, and this is the topic of this review. ⋯ Recent research has shown that enteral nutrition alone does not cover the total nutritional needs of intensive care unit patients. Enteral nutrition given early in a high dose is associated with a higher risk of complications. Metabolism in intensive care unit patients is different from the perioperative condition, which has been highlighted in recent studies with important clinical implications. The final solution has not been found yet, if it exists at all, and research in this field will continue. As the situation in biology and in real intensive care unit life is neither black nor white, it would be most beneficial for the intensive care unit patient if enteral nutrition and parenteral nutrition joined together in a good balance in order to avoid underload and overload.
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Curr Opin Clin Nutr Metab Care · Mar 2004
ReviewIs parenteral nutrition really that risky in the intensive care unit?
Although enteral nutrition is now the mainstay of nutrition delivery within intensive care, there is a blind faith in its benefits and a disregard of its risks. This has led to the belief that parenteral nutrition is no longer required as it is fraught with risks to the patient. This review attempts to dispel these myths and compares and contrasts the risks of enteral nutrition with those of parenteral nutrition in the critically ill. ⋯ Parenteral nutrition remains a valuable yet challenging weapon in our therapeutic armoury in the presence of gastrointestinal feed intolerance or failure. However, it should be used wisely and not indiscriminately because the majority of intensive care unit patients with a fully functional gastrointestinal tract may be fed safely with enteral nutrition.
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The recent publication of the results of an aggressive approach to the treatment of hyperglycaemia in critically ill patients, and a rekindling of interest in the use of an infusion of glucose insulin and potassium as adjunctive therapy in a diverse group of patients with cardiovascular disease, warrants a review of the multiple effects of insulin and a review of laboratory and clinical studies. ⋯ This review will summarize some of the putative beneficial effects of insulin as a pharmacological agent, and review recent clinical data. Although the relative benefits of normoglycaemia in the critical care setting and the beneficial effects of insulin are difficult to differentiate, a substantial overlap exists. The extent to which these converging therapies (aggressive normoglycaemia and insulin pharmacotherapy) will be applicable to diverse clinical settings has yet to be determined.
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Acute renal failure is commonly present in patients with sepsis, shock, trauma, burn injury, or multi-organ dysfunction syndrome. Acute renal failure is an independent risk factor contributing to increased hospital mortality. The major complications associated with acute renal failure include metabolic derangement and protein catabolism. The purpose of this article is to review the literature between 2001 and December 2003, to determine whether newer studies have provided a better understanding of the optimization of caloric and protein delivery to critically ill patients with acute renal failure receiving continuous renal replacement therapy. ⋯ The results and findings from this review may help clinicians to individualize caloric and protein delivery for patients with acute renal failure. The ultimate goal is to tailor the regimen towards the needs of each individual patient in order to maximize the benefit of nutritional support, in the hope of improving patient survival.