Nutrition in the neurocritical care unit

Abstract

The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU) are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

Stan odżywienia pacjentów Neurochirurgicznego Oddziału Intensywnej Opieki Medycznej

“…Calorie count; the predictive equations are generally used by the nutritionists and intensivists in neuro intensive care units in order to predict the basal energy consumption of patients and define target calorie for them [12,16]. The daily calorie intake and risk of malnutrition of patients are defined by the nutritional therapy in these units.…”

“…Moreover, it is highly crucial to control blood sugar of such patients. Through strict sugar control, hypo/hyperglycaemia episodes are avoided in neurologic patients that suffer from traumatic brain injury, subarachnoid haemorrhage and intracranial haemorrhage [12].…”

“…In order to calculate the risk of malnutrition, the factors such as the patients' height (or ulna length as surrogate) and weight, acuteness of illness or serum albumin and history of late serious loss of weight are used by majority of these tools [12] (Table). …”

“…As demonstrated by the new analyses, the mortality and morbidity ratios of the patients who are severely ill are affected by nutritional support [3,4,11,12]. Among the patients who are severely ill and get nutritional support, the rate of use of parenteral nutrition (PN) is 12-71% while the rate of use of enteral nutrition (EN) is 33-92% [13].…”

“…Nonetheless, there are also negative impacts and risks of nutritional support. These complications concern mechanic and metabolic troubles, gastrointestinal complications, infections and tube insertion [12].…”