Monitoring nutrition in the ICU

Berger, Mette M.; Blaser, Annika Reintam; Calder, Philip C.; Casaer, Michaël P; Hiesmayr, Michael; Mayer, Konstantin; Montejo, Juan Carlos; Pichard, Claude; Preiser, Jean‐Charles; Zanten, Arthur R. H. van; Bischoff, Stephan C.; Singer, Pierre

doi:10.1016/j.clnu.2018.07.009

Cited by 139 publications

(156 citation statements)

References 101 publications

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“…When feeding begins, patients must be closely monitored for appropriate response to the chosen regimen such that feeds can be tailored to meet the individual patient's needs. The goals of nutrition monitoring in the postburn period include ensuring that patient energy and protein needs are met, detecting possible complications of nutrition, assessing patient response to nutrition support, and identifying specific correctable electrolyte and/or micronutrient deficiencies …”

Section: Introductionmentioning

confidence: 99%

“…It is important to monitor patients for abdominal pain and distention, vomiting, and bowel function. There are conflicting data about the practicality of measuring gastric residual volumes (GRVs) when EN is initiated via a gastrostomy tube, but this is common practice at many facilities, and a high GRV can be an indicator of intestinal dysfunction …”

Section: Introductionmentioning

confidence: 99%

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Feeding During Resuscitation After Burn Injury

2019

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Burn injury results in a sustained hypermetabolic state with resulting increased caloric and protein requirements to support the stress and immune responses; augmented protein, fat, and carbohydrate catabolism; oxidative stress; and exudative losses. Along with surgical debridement, nutrition and resuscitation are the foundations of patient management after severe burn injury. Recent literature has demonstrated a clear benefit to early enteral nutrition initiation during the resuscitation period. This review aims to examine recent literature discussing both physiologic impact of burn injury and approaches to feeding during resuscitation after burn injury; including methods of determining nutrition requirements, routes, timing, and monitoring response and the associated benefits and consequences thereof.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feeding During Resuscitation After Burn Injury

2019

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“…Hypertriglyceridemia in the ICU may be caused by sepsis, administration of propofol, lipid emulsions, or overfeeding. Thus, it is important to monitor triglycerides, with the ESPEN guideline group setting an upper limit of 500 mg/dL (5.6 mmol/L) for critically ill patients . To some this limit might seem somewhat high.…”

Section: Critically Ill Adult Patients: Practical Aspectsmentioning

confidence: 99%

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

Mayer

Kłęk²,

Garcı́a-de-Lorenzo

et al. 2020

J Parenter Enteral Nutr

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In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium‐chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω‐3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and inflammation‐resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro‐resolution mediators (SPMs). Moreover, parenteral nutrition including ω‐3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.

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“…With the majority of EN solutions, micronutrient DRI requirements are only met when 1–1.5 L of product (±1500 kcal) is administered …”

Section: Q3: Other Than During Parenteral Nutrition Do Patients Needmentioning

confidence: 99%

“…The decision to monitor micronutrient status biochemically may be considered in clinical situations that represent follow up after micronutrient replacement therapies are provided, routine surveillance of patients receiving long‐term HPN patients, in cases of organ failure (liver or kidney), danger of toxicity necessitates monitoring . Renal function should be considered when vitamins and TEs are supplemented, in case of prolonged (>2 weeks) CRRT, a monthly monitoring of hydrosoluble micronutrients may be considered …”

Section: Q11: How and When Should Micronutrient Status Be Assessed/momentioning

confidence: 99%

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper

Blaauw

Osland

Sriram

et al. 2019

J Parenter Enteral Nutr

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Background Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines’ recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. Methods Based on the available evidenced‐based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. Results The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. Conclusion Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision—including voluntary omission, partial provision, and supply issues—must be overcome to allow safe and responsible nutrition practice.

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Monitoring nutrition in the ICU

Abstract: Understanding and defining risks and developing local SOPs are critical to reduce specific risks.

Cited by 139 publications

References 101 publications

Feeding During Resuscitation After Burn Injury

Feeding During Resuscitation After Burn Injury

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper

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