ESPEN Guidelines on Enteral Nutrition: Intensive care

Abstract

Enteral nutrition (EN) via tube feeding is, today, the preferred way of feeding the critically ill patient and an important means of counteracting for the catabolic state induced by severe diseases. These guidelines are intended to give evidence-based recommendations for the use of EN in patients who have a complicated course during their ICU stay, focusing particularly on those who develop a severe inflammatory response, i.e. patients who have failure of at least one organ during their ICU stay. These guidelines were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They were discussed and accepted in a consensus conference. EN should be given to all ICU patients who are not expected to be taking a full oral diet within three days. It should have begun during the first 24h using a standard high-protein formula. During the acute and initial phases of critical illness an exogenous energy supply in excess of 20-25 kcal/kg BW/day should be avoided, whereas, during recovery, the aim should be to provide values of 25-30 total kcal/kg BW/day. Supplementary parenteral nutrition remains a reserve tool and should be given only to those patients who do not reach their target nutrient intake on EN alone. There is no general indication for immune-modulating formulae in patients with severe illness or sepsis and an APACHE II Score >15. Glutamine should be supplemented in patients suffering from burns or trauma.

Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults

“…Despite current recommendations regarding nutritional support in patients with hemodynamic failure [4], we agree with the authors that EN is possible in ECMO patients, always under proper medical supervision.…”

Energy expenditure in mechanically ventilated patients: The weight of body weight!

“…Ideal BW (IBW) was calculated for a reference body mass index (BMI) at 22.5 kg/m 2 (IBW 22,5 ), and at 25 kg/m 2 (IBW 25 ) or calculated using the Metropolitan Life Insurance tables (IBW MLI ), the Lorentz equation (IBW LO ) (height (cm) À 100 À ((height (cm) À 150)/2.5 for women and/4 for men)) and the Broca equation (IBW BRO ) (height (cm) À 100). We then used the following equations to calculate EE with the different BWs listed above: ESPEN formula [9], HarriseBenedict, Black et al [10], Faisy et al [7], Frankenfield et al [11], Brandi et al [12], Ireton-Jones et al [13], Penn State et al [14] and Swinamer et al [15] (web Appendix Table 4). …”

Nutritional support with glutamine according to recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN)

“…W grupie otrzymującej dipeptyd Ala --Gln poziom LPS był istotnie niższy (od 3. doby), a czas hospitalizacji istotnie krótszy niż w grupie żywionej standardowo. Przedstawione powyżej badania wskazują na korzystne działanie glutaminy u chorych po rozległych oparzeniach i na ich podstawie ESPEN zaleca jej dojelitowe stosowanie [31].…”

“…Pomiędzy badanymi grupami nie stwierdzono istotnych różnic w czasie pobytu chorych w szpitalu i liczbie zgonów. W kolejnych badaniach [24][25][26][27][28][29][30][31][32] kryterium włącze-nia była punktacja w skali APACHE II powyżej 9-11 (w zależności od badania). W każdym z badań chorzy losowo dzieleni byli na dwie grupy, jedna otrzymywała dojelitowo standardowe żywienie, druga wzbogacone glutaminą (ok. 20 g/dobę przez ok. 10 dni).…”

“…Badane grupy chorych nie różniły się istotnie pod względem liczby zgonów [33,34]. Na podstawie przedstawionych wyników badań ESPEN zaleca stosowanie dojelitowego żywienia z glutaminą u chorych po rozległych urazach [31].…”