Respiratory care clinics of North America
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Although the nutrition support literature is limited and therefore does not provide robust evidence to promote grade A or strong recommendations, there is a "signal" from all of these studies taken a a whole that critically ill patients may benefit from nutritional manipulation. The acutely ventilated patient that is likely to still be intubated by day three is a classic example of the critically ill patient who has the potential to achieve positive outcomes with nutritional support. Initiating nutrition support early improves the chances of benefit. ⋯ Further study may demonstrate the possibility for nutritional manipulation to be one of the most important treatments physicians can offer to critically ill ventilated patients. Nutrition may have as much survival benefit as activated protein C, a drug costing over $7000 per course of therapy. No longer can it be said that nutrition makes no difference.
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Respir Care Clin N Am · Dec 2006
ReviewNutrition support for the long-term ventilator-dependent patient.
This article discusses issues related to nutrition support for the critically ill (CCI), especially those who are dependent on ventilators for long periods. A large and growing population of patients survives acute critical illness only to become CCI with profound debilitation, weeks to months of hospitalization, and often permanent dependence on mechanical ventilation and other life-sustaining modalities. ⋯ Topics addressed in this article include neuroendocrine profiles in CCI patients, allostatic overload, causes of prolonged mechanical ventilation, and the metabolism of chronic ventilator dependence. The article also describes issues related to assessing the nutrition, determining nutrition requirements, and deciding the route of nutrient delivery for CCI patients.
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Respir Care Clin N Am · Dec 2006
ReviewFeeding the critically ill obese patient: the role of hypocaloric nutrition support.
Obesity and its many metabolic and physiologic comorbidities are becoming more common. Thus, a strategy to approach the nutritional needs of obese critically ill patients is warranted. The adverse effect of obesity on the respiratory system is well established. ⋯ A strategy of hypocaloric nutrition support avoids the many detrimental effects of overfeeding and has been considered for all critically ill patients. In the obese patient, the strategy addresses the additional problem of the excessive fat store and has the additional benefit of fat reduction while sparing lean body mass. In the patient with normal renal and hepatic function, hypocaloric nutrition support simplifies care and may improve outcome.
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Respir Care Clin N Am · Dec 2006
ReviewA nutritional strategy to improve oxygenation and decrease morbidity in patients who have acute respiratory distress syndrome.
Enteral nutrition is increasingly becoming the standard of care for critically ill patients with the goal of providing nutritional support that prevents nutritional deficiencies and reduces morbidity. Furthermore, the development of nutritional strategies that dampen inflammation is an encouraging advance in the management of patients who have acute respiratory distress syndrome. This article discusses evidence from randomized, controlled studies that the use of a specialized nutritional formula containing eicosapentaenoic acid plus gamma-linolenic acid and elevated antioxidants offer physiologic and anti-inflammatory benefits over standard formulas.
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Indirect calorimetry provides an important adjunctive monitor for the provision of nutrition support in the critically ill patient. Accuracy in determining caloric requirements may serve to optimize benefit from nutrition therapy and improve patient outcome. A number of strategies in nutrition management in the intensive care setting (eg, dosing of enteral nutrition, monitoring cumulative caloric balance, and deliberate but "permissive" underfeeding) necessitate the determination of a fairly specific goal for caloric provision. Inaccuracy leading to inappropriate under- or overfeeding may generate additional morbidity and adverse clinical consequences for patients already at high risk from hypermetabolic stress response to injury.