Nutritional management in acute respiratory failure

Pingleton, S. K.

doi:10.1001/jama.257.22.3094

Cited by 10 publications

(5 citation statements)

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“…35 It is possible that the overall preservation of muscle mass attributable to early parenteral nutrition resulted in some degree of preservation of diaphragmatic structure and function, leading to improved respiratory mechanics at time of weaning. 36 We strongly recommend future studies investigate the veracity of this mechanistic hypothesis.…”

Section: Body Compositionmentioning

confidence: 99%

Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition

Doig

Simpson

Sweetman

et al. 2013

JAMA

467

220

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Section: Body Compositionmentioning

confidence: 99%

Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition

Doig

Simpson

Sweetman

et al. 2013

JAMA

467

220

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“…Over the past 5 years, we have studied the effects of recombinant human growth hormone (GH) on protein metabolism in normal volunteers, 7,8 patients with gastrointestinal disease requiring parenteral nutrition,' and in stable postoperative patients. 'o Administration of GH has increased protein synthesis and improved nitrogen balance by [2][3][4] g/day (143-246 mmol/day). This anabolic response occurred even when only one half of the necessary calories were provided.…”

mentioning

confidence: 99%

Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit

Ziegler

Young

Ferrari-Baliviera

et al. 1990

J Parenter Enteral Nutr

151

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The administration of growth factors may potentially accelerate recovery during critical illness by reducing body protein catabolism, enhancing wound healing, and improving skeletal muscle function. The purpose of this phase 1 study was to evaluate the safety and initial efficacy of a recombinant growth factor, human growth hormone (GH), combined with nutritional support in a critical care unit. Following an initial control week, 11 individuals received GH (10 mg/day) daily for 1-6 consecutive weeks. Near constant nutrient intake was provided via parenteral and/or enteral feedings throughout the study period. Vital signs and other clinical parameters, blood values, and nutrient excretion were monitored daily. GH administration was not associated with clinically significant adverse effects. During the first 2 weeks of study, nitrogen excretion decreased from 1356 +/- 157 mmol/day (19.0 +/- 2.2 g/day) during control to 899 +/- 107 mmol/day (12.6 +/- 1.4 g/day) with growth hormone (p less than 0.002) in association with markedly reduced urea generation. Significant reductions in potassium excretion (control 100 +/- 11 mmol/day vs 69 +/- 6 with GH; p less than 0.01) and phosphorus excretion (31 +/- 5 mmol/day vs 18 +/- 3; p less than 0.025) also occurred during GH. The protein-conserving effects of GH were sustained during several weeks of treatment. Growth hormone enhanced the efficiency of administered protein and facilitated nitrogen retention without clinically significant adverse effects in this small patient group. Controlled trials are indicated to determine whether use of this anabolic hormone reduces hospitalization time and improves other clinical outcomes in severely injured patients when combined with appropriate nutritional support.

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“…ICU patients with poor nutritional status commonly experience immune dysfunction, weakened respiratory muscles and lowered ventilation capacity, and reduced GI tolerance [11,12]. As a result, patients are at risk for a wide range of complications: ventilator dependence; GI dysfunction with gastroesophageal reflux, esophagitis, or pulmonary aspiration; and infections that can lead to sepsis, multi-organ failure, and even death [1,12,13].…”

Section: From Supportive Nutrition To Therapeutic Nutritionmentioning

confidence: 99%

“…As a result, patients are at risk for a wide range of complications: ventilator dependence; GI dysfunction with gastroesophageal reflux, esophagitis, or pulmonary aspiration; and infections that can lead to sepsis, multi-organ failure, and even death [1,12,13]. For such patients, supportive nutrition has long been used as adjunctive care; however, such nutrition is often inadequate, including only fundamental macronutrients to sustain patients through periods of metabolic stress.…”

Section: From Supportive Nutrition To Therapeutic Nutritionmentioning

confidence: 99%

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

Hegazi

Wischmeyer

2011

Crit Care

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In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness.

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Nutritional management in acute respiratory failure

Cited by 10 publications

References 0 publications

Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition

Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition

Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

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