Jpen Parenter Enter
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The severity and prevalence of obesity continue to rise throughout the world. A similar rise in the prevalence of obesity is seen in the population of patients admitted to the intensive care unit (ICU). In the ICU setting, nearly every aspect of care is made more difficult by obesity. ⋯ Body mass index (BMI) has been traditionally used to stratify risk in obese populations. Other factors that may be more predictive of poor outcomes in obese populations are further discussed. Further research in these factors has the potential to guide therapy in high-risk critically ill obese populations.
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Jpen Parenter Enter · Sep 2011
Treatment of hypertriglyceridemia in patients receiving parenteral nutrition.
This study aims to evaluate whether withdrawal of a soy oil-based lipid emulsion from the parenteral nutrition (PN) regimen in humans is associated with improved triglyceride and liver enzyme concentrations. ⋯ Short-term withdrawal of the lipid fraction in the PN mixture is associated with a significant reduction of plasma triglyceride concentration. Reintroduction was related to an increase of triglyceride concentration. In addition, liver enzyme abnormalities and leukocyte count reduced, whereas albumin levels increased, suggesting that even short withdrawal of the lipid emulsion diminished hepatocellular damage and systemic inflammation.
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Jpen Parenter Enter · Sep 2011
Nutrition and metabolic complications after bariatric surgery and their treatment.
The increase in the number of bariatric procedures annually suggests that these patients will constitute an increasing portion of obese patients who require hospital and intensive care. Currently, little prospective information is available regarding the course of bariatric surgery patients requiring intensive care. Knowledge of the type of bariatric operation performed and an understanding of its anatomy and physiology are useful to provide optimal care to these patients, particularly when considering potential nutrition complications and their diagnosis and treatment. In this article, the authors describe nutrition problems that may be present and potentially affect the course of a hospitalized and/or critically ill patient who has previously undergone a bariatric operation.
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Jpen Parenter Enter · Sep 2011
Nutrition therapy of the severely obese, critically ill patient: summation of conclusions and recommendations.
This report compiles the conclusions and recommendations for nutrition therapy of the obese, critically ill patient derived by the group of experts participating in this workshop on obesity in critical care nutrition. The recommendations are based on consensus opinions of the group after review of the current literature. ⋯ Although the basic principles of critical care nutrition apply to the obese ICU patient, a high-protein, hypocaloric regimen should be provided to reduce the fat mass, improve insulin sensitivity, and preserve lean body mass. The ideal enteral formula should have a low nonprotein calorie to nitrogen ratio and have a variety of pharmaconutrient agents added to modulate immune responses and reduce inflammation.
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Jpen Parenter Enter · Sep 2011
Review"CAN WE FEED?" A mnemonic to merge nutrition and intensive care assessment of the critically ill patient.
As care of the critically ill patient grows more complex, so does the breadth of knowledge required of the intensivist to deliver quality service. Nutrition is one area of many where the complexity of care has grown and the opportunity for improving patient outcomes has become evident. The use of mnemonics has proven successful in compartmentalizing information that must be considered in complex decision-making processes. ⋯ Energy requirements (E) are determined using conventional weight-based equations, indirect calorimetry, or combinations of both techniques. The more practical aspects of support that follow include formula selection (F), enteral access (E), efficacy (E), and the determination of tolerance (D). With careful consideration of these components through the use of the mnemonic "CAN WE FEED?" the intensivist can successfully implement a nutrition plan, and the clinical nutritionist can appreciate where nutrition therapy appropriately intervenes in the initial resuscitation and management of the critically ill patient.