Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.
ABSTRACT Critically ill patients with complicated evolution are frequently hypermetabolic, catabolic, and at risk of underfeeding. The study aimed at assessing the relationship between energy balance and outcome in critically ill patients.
Prospective observational study conducted in consecutive patients staying > or = 5 days in the surgical ICU of a University hospital. Demographic data, time to feeding, route, energy delivery, and outcome were recorded. Energy balance was calculated as energy delivery minus target. Data in means+/-SD, linear regressions between energy balance and outcome variables.
Forty eight patients aged 57+/-16 years were investigated; complete data are available in 669 days. Mechanical ventilation lasted 11+/-8 days, ICU stay 15+/-9 was days, and 30-days mortality was 38%. Time to feeding was 3.1+/-2.2 days. Enteral nutrition was the most frequent route with 433 days. Mean daily energy delivery was 1090+/-930 kcal. Combining enteral and parenteral nutrition achieved highest energy delivery. Cumulated energy balance was between -12,600+/-10,520 kcal, and correlated with complications (P < 0.001), already after 1 week.
Negative energy balances were correlated with increasing number of complications, particularly infections. Energy debt appears as a promising tool for nutritional follow-up, which should be further tested. Delaying initiation of nutritional support exposes the patients to energy deficits that cannot be compensated later on.
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ABSTRACT: Critically ill patients are susceptible to protein catabolism. Enteral feeding may ameliorate protein loss, but its effect is not well characterized in terms of protein kinetics. We established a method of quantifying the effect of enteral protein feeding on whole-body protein turnover and studied critically ill patients receiving early enteral nutrition. In a proof-of-concept study, we established, in healthy subjects (n = 6), a method of measuring the effect of continuous enteral protein feeding on whole-body protein turnover by using (13)C-phenylalanine ((13)C-Phe) intrinsically labeled casein by a nasogastric feeding tube and an intravenous (2)H5-Phe tracer. The protocol was applied to study critically ill patients (n = 10) during the initial hypocaloric-hyponitrogenous dose of enteral nutrition. Patients were catabolic with a negative protein balance. The median splanchnic extraction fraction of hourly dietary Phe intake was 92% (range: 86-99%); that is, the availability of dietary Phe in arterial plasma was low. In patients with a stable parenteral amino acid supply (n = 7), the median net protein balance improved during enteral feeding from -8.6 to -5.8 μmol · kg body weight(-1) · h(-1) (P = 0.018). Whole-body protein turnover and the contribution of dietary protein can be quantified in critically ill patients by using intravenous and enteral stable-isotope Phe tracers. The whole-body protein balance improved during early hypocaloric-hyponitrogenous enteral protein feeding in these patients. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12614000333617. © 2015 American Society for Nutrition.American Journal of Clinical Nutrition 03/2015; 101(3). DOI:10.3945/ajcn.114.091934 · 6.92 Impact Factor
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ABSTRACT: This is a guideline for the management of sepsis, developed by the Sepsis Registry Committee of The Japanese Society of Intensive Care Medicine (JSICM) launched in March 2007. This guideline was developed on the basis of evidence-based medicine and focuses on unique treatments in Japan that have not been included in the Surviving Sepsis Campaign guidelines (SSCG), as well as treatments that are viewed differently in Japan and in Western countries. Although the methods in this guideline conform to the 2008 SSCG, the Japanese literature and the results of the Sepsis Registry Survey, which was performed twice by the Sepsis Registry Committee in intensive care units (ICUs) registered with JSICM, are also referred. This is the first and original guideline for sepsis in Japan and is expected to be properly used in daily clinical practice. This article is translated from Japanese, originally published as "The Japanese Guidelines for the Management of Sepsis" in the Journal of the Japanese Society of Intensive Care Medicine (J Jpn Soc Intensive Care Med), 2013; 20:124-73. The original work is at http://dx.doi.org/10.3918/jsicm.20.124.
World Journal of Gastroenterology 01/2007; 13(29):3909. DOI:10.3748/wjg.v13.i29.3909 · 2.43 Impact Factor