Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewNutrition and clinical outcome in intensive care patients.
In the setting of ICU, the characteristics of patients have changed during the last decade. Patients are older, frequently overweight or obese, present with more chronic diseases and undernutrition. These conditions are characterized by reduced muscle mass and vulnerable homeostasis. This review sustains the hypothesis that an early and optimal nutritional support, combining enteral and parenteral nutrition, could improve the clinical outcome of ICU patients. ⋯ It is hypothesized that supplemental parenteral nutrition, together with insufficient enteral nutrition, could optimize the nutritional therapy by preventing the onset of early energy deficiency, and thus, could allow to reduce the side-effects of undernutrition and promote better chances of recovery after the ICU stay.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewComparisons of different insulin infusion protocols: a review of recent literature.
To provide an update on the currently available insulin infusion protocols for treatment of hyperglycemia in critically ill patients and to discuss the major differences and similarities among them. ⋯ Insulin infusion is the most effective method for controlling hyperglycemia in critically ill patients. Clinicians should utilize a validated insulin infusion protocol that is well tolerated, and is most appropriate and practical for their institution based on the resources that are available.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewWhich factors influence glycemic control in the intensive care unit?
Intensive insulin therapy titrated to restore and maintain blood glucose between 80 and 110 mg/dl (4.4-6.1 mmol/l) was found to improve survival of critically ill patients in one pioneering proof-of-concept study performed in a surgical intensive care unit. The external validity of these findings was investigated. ⋯ Before a better understanding and delineation of the conditions associated with and improved outcome by tight glycemic control, the choice of an intermediate glycemic target appears as a safe and effective solution.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewConsidering energy deficit in the intensive care unit.
A discrepancy has emerged between experts' recommendations on how to feed ICU patients according to their requirements using parenteral nutrition, if enteral nutrition is not reaching the target. This review describes the differences in the recent guidelines issued by the American Society of Parenteral and Enteral Nutrition (ASPEN) and the European Society of Clinical Nutrition and Metabolism (ESPEN) regarding these aspects. ⋯ The energy deficit accumulated by underfed ICU patients during the first days of stay may play an important role in ICU and hospital outcomes for long-staying ICU patients. To reach calorie requirements by artificial nutritional support without harming the patient is still a subject of debate. Future studies, some already on their way will clarify this discussion.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewCritique of normoglycemia in intensive care evaluation: survival using glucose algorithm regulation (NICE-SUGAR)--a review of recent literature.
The publication of the long awaited results of the Normoglycaemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial generated intense controversy in the area of glycemic control in the critically ill. NICE-SUGAR reported results in direct contrast to the original Leuven study and challenged the legitimacy of a mortality benefit of tight glycemic control in the intensive care unit (ICU). This review of the recent literature critically examines the salient differences between NICE-SUGAR and the original Leuven study. ⋯ Accurate replication of the original Leuven methodology may be the limiting factor for achieving the benefits gained by intensive insulin therapy (IIT). Determination of ICU capability (physicians, nurses, standardization of equipment, etc.) is crucial to implementing tight glycemic targets. If IIT is not achievable due to adverse outcomes such as hypoglycemia, more lax and reachable glucose control should be sought.