Evidence-based Nutritional Support in the Intensive Care Unit

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

“…17,25 In critically ill patients, severe protein calorie malnutrition is common because of impaired intake and the hypercatabolichypermetabolic response to injury or severe illness. 26,27 The hypermetabolic response results in increased caloric needs and a disproportionate increase in protein requirements. 17 Calories are pulled from glycogen stores first in an effort to meet end-organ energy needs.…”

“…27,32,33 Suboptimal nutrition can alter immune function, collagen synthesis, and tensile strength, all of which are essential elements in the wound-healing cascade. 17 Patients who experience involuntary weight loss and protein calorie malnutrition are also at risk for delayed and impaired wound healing.…”

Loss of Protein, Immunoglobulins, and Electrolytes in Exudates From Negative Pressure Wound Therapy

“…The difference between median wound surface area (543 cm 2 open abdomens vs 290 cm 2 soft tissue wounds) was not statistically significant (P = .15). The difference between median exudate volume in relation to wound surface area was not statistically significant (P = .43): 0.91 mL/cm 2 /d in soft tissue wounds vs 1.23 mL/cm 2 There were no significant differences between open abdomen and soft tissue wounds in the concentrations of total protein, albumin, or urea nitrogen in wound exudate ( Table 3). Because of the greater volume of exudate from open abdomens, the loss of these analytes was significantly increased, by >3-fold (Table 3).…”

Penurunan Kadar Laktat pada Pemberian Norepinefrin dengan Plasebo dan Norepinefrin dengan Adjuvan Vasopresin pada Pasien Syok Septik

“…Berdasar atas penelitian terhadap 2.323 pasien syok septik yang dibanding dengan penggunaan norepinefrin dengan vasopresin, ternyata angka mortalitas pasien yang menggunakan norepinefrin tidak jauh berbeda dibanding dengan yang diberikan vasopresin. 10,11 Penelitian lain menunjukkan bahwa vasopresin tidak lebih buruk dibanding dengan norepinefrin. Penggunaan vasopresin akan lebih cepat meningkatkan MAP daripada menggunakan norepinefrin tunggal dan nilai laktat pada kelompok vasopresin mengalami perbaikan yang lebih baik dibanding dengan norepinefrin pada jam ke-6 resusitasi.…”