Biology-based nutritional support of critically ill and injured patients

Nutrition in Critically Ill and Injured Patients: Focus on Pathophysiology, Initiation, Choice, Energy Requirements and Complications

“…As catecholamines, cytokines, and insulin levels rise in response to these traumatic insults, energy expenditure and protein turnover increase as well. Ameliorating these changes can be done by increasing metabolic requirements through increased protein breakdown and synthesis and changed substrate turnover which occurs through a range of demands depending on the various clinical situations; however, this is not an easy task (Slone 2004;Dogjani et al 2011;Latifi and Caushaj 1999).…”

“…Their serum concentrations fall immediately after an injury, in proportion to its severity. They are used to monitor the nutritional status of acutely ill patients (Dogjani et al 2011).…”

“…The seemingly logical strategy would be to replace deficiencies of key nutrients (such as amino acids, proteins, vitamins, minerals, and trace elements) in the doses required, within the appropriate time, and in the manner (early oral feeding, enteral, and/or parenteral) most conducive to helping prevent cellular injury and clinical consequences. But given so many complicating factors, many immune-enhancing and immune-modulating formulas have been developed for use in critically ill and injured patients (Dogjani et al 2011). Patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) should be on an enteral formulation characterized by an antiinflammatory lipid profile (i.e., omega-3 fish oil, borage oil) and antioxidants (Gadek et al 1999).…”

Feed the gut, feed early and with the right stuff, but do not forget total parenteral nutrition

“…Specifically, we need to continue to challenge the current understanding of nutritional science, the biology of nutrients and the interaction of these nutrients with trauma, injury and critical illness, and how to further advance timely and disease-directed nutritional support. In the meantime, we need to provide nutritional support to critically ill or injured patients early and we need to do it right [2], and we should tailor nutritional formulas based on the content of the nutrient compositions [3][4][5].…”

“…To this end, there has been a significant paradigm shift in regard to selecting the appropriate nutritional strategy for critically ill and injured patients. In doing so, the nutrition support of patients with a particular disease is no longer regarded as a supportive measure; rather, it is regarded as direct nutritional therapy based on metabolic changes and on the biology of key nutrients induced by the disease process [4].…”