Nutritional Support in the ICU

BMJ, Год журнала: 2025, Номер unknown, С. e077979 - e077979

Опубликована: Янв. 2, 2025

Abstract Critical illness is a complex condition that can have devastating impact on health and quality of life. Nutritional support crucial component critical care aims to maintain or restore nutritional status muscle function. A one-size-fits-all approach the components has not proven beneficial. Recent randomized controlled trials challenge conventional strategy safety potential benefits below-usual calorie protein intakes at early, acute phase illness. Further research needed define optimal throughout intensive unit stay. Individualized strategies relying risk assessment tools biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, trials. Importantly, although crucial, it might be sufficient enhance recovery critically ill patients. Thus, achieving greatest efficacy may require individualized combined with prolonged physical rehabilitation within multimodal, holistic program patient's journey.

Язык: Английский

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Überwachung von Ernährungstherapie und Kalorienzufuhr

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Год журнала: 2025, Номер 60(03), С. 142 - 154

Опубликована: Март 1, 2025

The Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive Care Emergency Medicine (DIVI) recently published two position papers specifying some aspects guideline on clinical nutrition critically ill patients by Society Nutritional in 2018. This article provides a condensed overview practice; key these are presented focussing monitoring energy expenditure macronutrient administration.

Язык: Английский

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Targeted nutritional strategies in postoperative care

Anesthesia and Pain Medicine, Год журнала: 2025, Номер unknown

Опубликована: Янв. 15, 2025

Immunonutrition, which uses specific nutrients to modulate the immune response, has emerged as a vital adjunct perioperative care. Surgery-induced stress triggers responses that can lead complications, such infections and delayed wound healing. Traditional nutritional support often overlooks immunological needs of surgical patients. Immunonutrition addresses this oversight by providing key nutrients, arginine, omega-3 fatty acids, glutamine, nucleotides, antioxidants (vitamins C E) enhance function tissue repair. This review examined efficacy safety immunonutrition in settings, guided recommendations American Society for Parenteral Enteral Nutrition European Clinical Metabolism. Both organizations recommend high-risk or malnourished patients undergoing major surgery its use reducing complications improving recovery. The aim improve cell function, reduce inflammation, studies meta-analyses have demonstrated lowers infection rate, shortens length hospital stay, accelerates Challenges hindering clinical application include cost, logistics, lack standardized personalized protocols. Future should focus on biomarker-driven approaches, pharmacogenomics, innovative nutrient formulations. Addressing these issues will help integrate into practice, ultimately outcomes patient

Язык: Английский

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Effects of essential amino acid (EAA) and glutamine supplementation on skeletal muscle wasting in acute, subacute, and postacute conditions

Clinical Nutrition ESPEN, Год журнала: 2024, Номер 62, С. 224 - 233

Опубликована: Май 29, 2024

Under optimal physiological conditions, muscle mass maintenance is ensured by dietary protein, which balances the amino acid loss during post-absorption period and preserves body's protein homeostasis. Conversely, in critical clinical conditions (acute, subacute or postacute), particularly those related to hypomobility immobility, combined with malnutrition, local/systemic inflammation, of strength can be quantitatively significant. A decline more than 1% 3% has been registered subjects aged 20-37 yr after just five days bed rest, similarly observed one year age-related individuals over age 50. Loss have a dramatic effect on subjects' functional capacities, their systemic metabolic control reserve function, all are fundamental for other organs' tissues' cell processes. References available indicate that average 1%-2% reduction per day patients intensive care unit (ICU) could represent an independent predictor hospital mortality physical disability years following hospitalization. After few weeks administration, supplementation EAAs glutamine shown significant effects maintaining size strength, typically negatively affected some acute/subacute postacute (muscle recovery surgery, oncology patients, ICU treatments), especially elderly pre-existing degenerative diseases. In this review, we focused theoretical bases most relevant studies EAA as single compound, aim clarifying whether use blend (EAAs-glutamine) potentially synergistic prevent disease-related wasting its impact duration quality patients' course.

Язык: Английский

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Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults

Intensive Care Medicine, Год журнала: 2024, Номер 50(10), С. 1593 - 1602

Опубликована: Июль 17, 2024

Язык: Английский

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Nutritional and metabolic modulation of inflammation in critically ill patients: a narrative review of rationale, evidence and grey areas

Annals of Intensive Care, Год журнала: 2024, Номер 14(1)

Опубликована: Авг. 1, 2024

Abstract Background Inflammation is the hallmark of critical illness and triggers neuro-endocrine stress response an oxidative stress. Acute inflammation initially essential for patient’s survival. However, ongoing or exaggerated inflammation, due to persistent organ dysfunction, immune dysfunction poor resolution, associated subsequent hypermetabolism hypercatabolism that severely impact short long-term functional status, autonomy, as well health-related costs. Modulation thus tempting, with goal improve short- outcomes critically ill patients. Findings can be modulated by nutritional strategies (including timing enteral nutrition initiation, provision some specific macronutrients micronutrients, use probiotics) metabolic treatments. The most interesting seem n-3 polyunsaturated fatty acids, vitamin D, antioxidant micronutrients propranolol, given their safety, accessibility clinical use, benefits in studies context care. optimal doses, route administration are still unknown them. Furthermore, recovery phase not studied defined. Conclusion rationale modulation obvious, based on pathophysiology increasingly described effects pharmacological strategies. Regretfully, there isn’t always substantial proof from research regarding positive impacts directly brought about modulation. Some arguments come performed severe burn patients, but such results should transposed non-burn patients caution. Further needed explore how after a illness.

Язык: Английский

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Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

Journal of Intensive Care, Год журнала: 2024, Номер 12(1)

Опубликована: Янв. 23, 2024

Abstract Background Our previous study in 2011 concluded that permissive underfeeding may improve outcomes patients receiving parenteral nutrition therapy. This conclusion was tentative, given the small sample size. We conducted present systematic review and trial sequential meta-analysis to update status of who were admitted intensive care unit (ICU). Methods Seven databases searched: PubMed, Embase, Web Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, Cochrane Library. Randomized controlled trials (RCTs) included. The Revised risk-of-bias tool (ROB 2) used assess risk bias enrolled trials. RevMan software for data synthesis. Trial analyses (TSA) overall ICU mortalities performed. Results Twenty-three RCTs involving 11,444 critically ill There no significant differences mortality, hospital length stays, incidence infection. Compared with control group, significantly reduced mortality (risk ratio [RR] = 0.90; 95% confidence interval [CI], [0.81, 0.99]; P 0.02; I 2 0%), gastrointestinal adverse events decreased (RR 0.79; CI, [0.69, 0.90]; 0.0003; 56%). Furthermore, mechanical ventilation duration (mean difference (MD) − 1.85 days; [− 3.44, 0.27]; 0%). Conclusions Permissive reduce help shorten duration, but is not improved. Owing size patient heterogeneity, conclusions still need be verified by well-designed, large-scale RCTs. Registration protocol our registered recorded PROSPERO (registration no. CRD42023451308). Registered 14 August 2023

Язык: Английский

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Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients: A claims database study using a propensity score analysis

Clinical Nutrition, Год журнала: 2024, Номер 43(8), С. 1872 - 1879

Опубликована: Июнь 28, 2024

Язык: Английский

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Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients

Nutrients, Год журнала: 2025, Номер 17(3), С. 380 - 380

Опубликована: Янв. 21, 2025

Nutritional support in critically ill patients has been acknowledged as a pillar of ICU care, playing pivotal role preserving muscle mass, supporting immune function, and promoting recovery during after critical illness. Providing effective nutritional requires adapting it to the patient’s diagnosis, unique characteristics, metabolic state minimize risks overfeeding or underfeeding while mitigating loss. This level care comprehensive assessment establishment nutrition-focused protocol. Regular, consistent detailed evaluation can influence both therapeutic decisions clinical interventions, thus ensuring that specific needs are met from acute phase through their entire process. Bioelectrical impedance analysis (BIA) is increasingly recognized valuable tool for enhancing patients. By delivering precise, real-time insights into key aspects body composition, BIA thought provide clinicians with more understanding complex physiological changes occur narrative review highlights potential offering these precise assessments, facilitating development accurate personalized strategies If reliably assess dynamic shifts hydration tissue integrity, holds promise further advancing individualized optimizing outcomes this vulnerable population.

Язык: Английский

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Unlocking the Predictive Power of Nutritional Scores in Septic Patients

Nutrients, Год журнала: 2025, Номер 17(3), С. 545 - 545

Опубликована: Янв. 31, 2025

Background: Sepsis is a critical condition characterized by severe immune dysregulation, ranking among the leading causes of morbidity and mortality in intensive care internal medicine units. Nutritional status plays pivotal role modulating these responses, as when inadequate it can compromise defenses, body's ability to handle stress inflammation, clinical course. Malnutrition frequently observed septic patients strongly associated with worse outcomes, including increased mortality, prolonged hospital stays, greater complication rates. In this context, nutritional scoring systems have emerged valuable tools evaluate patients' predict trajectories. Objectives: Given absence direct comparison their performance an setting, study aimed assess effectiveness various scores predictive for outcomes patients, emphasizing application within field medicine. Methods Results: A retrospective analysis was conducted on 143 diagnosed sepsis or shock who were admitted unit. Key variables included laboratory parameters, comorbidities, at time diagnosis. The modified Glasgow Prognostic Score (mGPS), Index (PNI), Controlling Status (CONUT) score, Nutrition Risk Critically Ill (mNUTRIC) blood urea nitrogen-to-albumin ratio (BAR) evaluated forecasting sepsis. Among them, mNUTRIC score strongest independent predictor in-hospital good reasonable threshold risk stratification. Conclusions: highlights score's practicality reliability assessing inflammatory risks particularly non-ICU settings. These findings suggest its potential utility guiding interventions improving importance integrating assessment into management.

Язык: Английский

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