The challenge of integrating a diagnosis of malnutrition in the practical application of nutrition care in the intensive care unit.

Evidence of poor nutrition status in a patient present on admission to the intensive care unit is associated with worse clinical outcomes than that for a well-nourished patient who becomes critically ill. Diagnosing malnutrition in this setting is fraught with difficulty, though, because elements of nutrition history are hard to obtain, the interpretation of anthropometric parameters is influenced by the disease process and interventions of critical care and the subjectivity of traditional assessment tools lacks precision. Determining the severity of disease drives the initial management and sets priorities in the derivation of the nutrition plan, focusing on strategies that promote survival.

Exploring the impact of arginine-supplemented immunonutrition on length of stay in the intensive care unit: A retrospective cross-sectional analysis.

Background: Arginine-supplemented enteral immunonutrition has been designed to optimize outcomes in critical care patients. Existing formulas may be isocaloric and isoproteic, yet differ in L-arginine content, energy distribution, and in source and amount of many other specialized ingredients. The individual contributions of each may be difficult to pinpoint; however, all cumulate in the body's response to illness and injury.

The importance of providing dietary fiber in medical and surgical critical care.

The early provision of soluble/insoluble fiber to the patient who is critically ill has been controversial in the past. Especially in the setting of hemodynamic instability, dysmotility, or impaired gastrointestinal transit, fear of inspissation of formula with precipitation of nonocclusive mesenteric ischemia (NOMI)/nonocclusive bowel necrosis (NOBN) limited its utilization by medical and surgical intensivists. The incidence of NOMI/NOBN has been estimated at 0.

Healthcare Resource Utilization and Cost Comparisons of High-Protein Enteral Nutrition Formulas Used in Critically Ill Patients.

High-protein enteral nutrition is advised for patients who are critically ill. Options include immunonutrition formulas of various compositions and standard high-protein formulas (StdHP). Additional research is needed on the health economic value of immunonutrition in a broad cohort of severely ill hospitalized patients.

The 2016 ESPEN Arvid Wretlind lecture: The gut in stress.

The gut has a major influence on the course of the human stress response in critical illness for several reasons; the quantity of its immune tissue, the extent of interface with the external environment, the expanse of the microbiome, and its access to the systemic circulation. In critical illness, it is not uncommon to lose mucosal barrier function, which exposes the host to the downside effects of luminal contents and epithelial cell regulation. In that setting, the microbiome is converted to a pathobiome, upregulation of metabolic and immune responses occurs, and homeostatic defense systems are compromised.

Targeted Physician Education Positively Affects Delivery of Nutrition Therapy and Patient Outcomes: Results of a Prospective Clinical Trial.

Background: Malnutrition is a continuing epidemic among hospitalized patients. We hypothesize that targeted physician education should help reduce caloric deficits and improve patient outcomes.

Materials And Methods: We performed a prospective trial of patients (n = 121) assigned to 1 of 2 trauma groups.

"CAN WE FEED?" A mnemonic to merge nutrition and intensive care assessment of the critically ill patient.

As care of the critically ill patient grows more complex, so does the breadth of knowledge required of the intensivist to deliver quality service. Nutrition is one area of many where the complexity of care has grown and the opportunity for improving patient outcomes has become evident. The use of mnemonics has proven successful in compartmentalizing information that must be considered in complex decision-making processes.

Physician-delivered malnutrition: why do patients receive nothing by mouth or a clear liquid diet in a university hospital setting?

Background: Traditional practices of placing patients nil per os (NPO) or on clear liquid diet (CLD) deter delivery of optimal nutrition care and are not always supported by sound physiologic principles.

Objective: This perspective survey evaluated the incidence of this practice, the reasons for such orders, and the response to intervention by the Multidisciplinary Nutrition Team (MNT).

Methods: All patients admitted to University of Louisville Hospital were monitored by MNT dietitians and were candidates for the study if they were placed NPO upon CLD for ≥ 3 days.

Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients.

Background And Aims: Elevated residual volumes (RV), considered a marker for the risk of aspiration, are used to regulate the delivery of enteral tube feeding. We designed this prospective study to validate such use.

Methods: Critically ill patients undergoing mechanical ventilation in the medical, coronary, or surgical intensive care units in a university-based tertiary care hospital, placed on intragastric enteral tube feeding through nasogastric or percutaneous endoscopic gastrostomy tubes, were included in this study.

Clinical use of the respiratory quotient obtained from indirect calorimetry.

Background: The respiratory quotient (RQ) obtained from indirect calorimetry (IC), defined by the ratio carbon dioxide production (VCO2)/oxygen consumption (VO2), is affected by extremes of substrate use by the body. Underfeeding, which promotes use of endogenous fat stores, should cause decreases in the RQ, whereas overfeeding, which results in lipogenesis, should cause increases in the RQ. Marked increases in VCO2 (with subsequent increases in RQ) in response to overfeeding may cause respiratory compromise in patients with limited pulmonary reserve.

Achievement of steady state optimizes results when performing indirect calorimetry.

Background: The use of steady state as the endpoint for performance of indirect calorimetry (IC) is controversial. We designed this prospective study to evaluate the necessity and significance of achieving steady state.

Methods: Patients with respiratory failure placed on mechanical ventilation in a short- or long-term acute care unit at any 1 of 3 university-based urban hospitals were eligible for the study.