Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave, Stephen A.; Taylor, Beth; Martindale, Robert G.; Warren, Melissa; Johnson, Debbie R.; Braunschweig, Carol L.; McCarthy, Mary S.; Davanos, Evangelia; Rice, Todd W.; Cresci, Gail; Gervasio, Jane M.; Sacks, Gordon S.; Roberts, Pamela R.; Compher, Charlene

doi:10.1177/0148607115621863

Cited by 2,645 publications

(1,521 citation statements)

References 459 publications

(585 reference statements)

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“…Moreover, the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines for critically ill patients recommends that patients who have undergone major upper gastrointestinal tract surgery and EN is not feasible, PN should be initiated (only if the duration of therapy is anticipated to be more than 7 days). Unless the patient is at high nutrition risk, PN should not be started in the immediate postoperative period, but should be delayed for 5-7 days [73]. In conclusion, although enteral nutrition seems to be a safe and feasible option postoperatively in terms of immunological parameters and postoperative complications, no firm conclusion can be drawn regarding postoperative nutritional markers that reflect patients' nutritional status.…”

Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 97%

“…According to ESPEN guidelines on nutrition in cancer patients, upper gastrointestinal tract cancer patients undergoing surgical resection should receive oral/enteral immunonutrition in the context of traditional perioperative care [79]. Furthermore, ASPEN guidelines suggest the routine use of an immunemodulating formula (containing both arginine and fish oils) in the surgical intensive care unit for the postoperative patient who requires enteral nutrition therapy [73].…”

Section: Esophageal Abnormalitiesmentioning

confidence: 99%

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Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 97%

Section: Esophageal Abnormalitiesmentioning

confidence: 99%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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“…It is well established in the literature that individuals exposed to situations of disease present an increase in the resting metabolic rate due to the state of metabolic stress 15 . Thus, it is expected that energy supply and the macronutrient percentage distribution of the GHOD meet the nutritional needs of the inpatient for that clinical time.…”

Section: Discussionmentioning

confidence: 99%

Quantitative and Qualitative Nutritional Evaluation of the General Oral Diet Served in a University Hospital

Melo

Crispim

Pereira

et al. 2017

BJMHH

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| Introduction:The high prevalence of hospital protein-energy malnutrition is associated with several factors, including implemented dietary conducts. Objective: Analyze nutritional characteristics of the general hospital oral diet (GHOD). Methods and materials: A prospective and descriptive study, with a qualitative and semi-quantitative approach, concerning the GHOD menu, was developed from May 2012 to August 2013. GHOD menu was established for 28 days and consisted of five meals: breakfast, lunch, mid-afternoon snack, dinner and bedtime snack. Weighing of each food served in the meals (lunch/dinner) from the GHOD menu was performed. Composition tables were used to calculate the total energy value (TEV) and the energy distribution percentage of macronutrients of the foods, as well as to quantify the food portions from different food groups. Results: The average energy distribution to TEV (2409.4±152.6 kcal/day) was adequate for proteins (13.4%), carbohydrates (64.7%), and lipids (21.9%). Variable energy supply was identified at breakfast (15.6-20.6%), lunch (26.2-36.6%), dinner (22.2-31.1%), mid-afternoon and bedtime snacks (8.4-15.5%). The overnight fasting period was up to 13h. In the evaluation of nutritional quality of the GHOD meals in accordance with food groups was identified excessive offer for beans, meat/eggs, oils/fats/oilseeds and sugar/sweets, and deficient offer for fruit/juices, legumes/vegetables and milk/ dairy. Conclusions: It is essential to perform quantitative and qualitative nutritional characterization of the GHOD served to inpatients. Reducing the duration of the overnight fast, as well as adjustments in the supply of food groups and in food fractionation, can contribute to better meeting the nutritional needs and prevention of nutritional deficiencies.

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“…The 2016 ASPEN guidelines for critically ill patients 47 suggest that neither supplemental enteral nor parenteral GLN should be routinely used in critically care, but do not specifically address the use of GLN in an oncology setting. Kuhn et al 12 made no oncology-specific recommendations on GLN supplementation's route, dose, timing or duration.…”

Section: Mucositismentioning

confidence: 99%

“…The ASPEN 2016 guidelines on nutrition support for adult critically-ill patients also recommend against routine IV-GLN supplementation in the critical care setting; but, when PN is used, consideration should be given to supplementing the PN with GLN. 47 It should be noted that cancer patients also do get admitted to ICU, especially surgical and haematological cancer patients; and, therefore, the critical care setting guidelines may sometimes be applicable to this patient group.…”

Section: Guidelinesmentioning

confidence: 99%

Glutamine and its use in selected oncology settings

Tydeman-Edwards

2017

South African Journal of Clinical Nutrition

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This review summarises the latest evidence for the use of glutamine (GLN) in oncology taking cognisance of current systematic reviews and available guidelines. Various studies in adults suggest that GLN supplementation suppresses tumour growth, by restoring the function of natural killer cells; improves protein metabolism; and, possibly enhances the effect of cancer therapy. There is insufficient data on whether GLN supplementation reduces the incidence of infection, although a trend exists towards such a reduction. GLN-supplemented enteral nutrition was superior in improving immune function, whilst oral GLN alone appeared to have no effect on: mortality; infections; time to neutrophil recovery; or, relapse. GLN significantly reduces the duration of diarrhoea, but had no effect on its prevention. Oral GLN may reduce the duration and severity of mucositis, with fewer days on opioid therapy. Oral GLN, but not intravenous GLN (IV-GLN), may decrease mucositis and graft-versus-host disease in adult bone marrow transplant patients. Currently, the evidence for reduction of severe mucositis or infection rate in children is not statistically significant, but GLN does significantly reduce parenteral nutrition use, reflecting a possible improvement in lower gut mucositis. Nevertheless, too few studies exist to either support or refute that GLN supplementation either reduces the duration of, or prevents the progression to, severe mucositis. In children, there is no significant evidence that IV-GLN supplementation reduces infection rates, hospital length of stay (LOS), graft-versus-host disease, or mortality. Children with solid tumours on chemotherapy receiving oral GLN supplementation showed significant improvements in some nutritional and immunological parameters, as well as the severity of stomatitis and need for antibiotic therapy. Caution is recommended when considering provision of IV-GLN to oncology patients who have hepatic or renal insufficiency or failure. Monitoring of hepatic and renal function is recommended. Further studies are needed specifically on the use of glutamine in an oncology setting. Larger, multicentre, randomised placebo-controlled studies are needed in both adult and paediatric oncology populations.

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Cited by 2,645 publications

References 459 publications

Nutritional Management of Esophageal Cancer Patients

Nutritional Management of Esophageal Cancer Patients

Quantitative and Qualitative Nutritional Evaluation of the General Oral Diet Served in a University Hospital

Glutamine and its use in selected oncology settings

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