Parenteral nutritional support in surgical patients: expert consensus statements regarding intravenous lipid emulsions containing omega-3 fatty acids.

Objectives: The International Lipids in Parenteral Nutrition (PN) Summit was convened to offer practical guidance and expert consensus opinion regarding the use of intravenous lipid emulsions (ILEs) in various clinical settings. Herein, we briefly review aspects from this summit that are of particular importance for surgical/hospitalized patients.

Methods: Summit participants identified and discussed new evidence, data, and analyses, that potentially influence the benefits and risks of ILEs in PN or their use in clinical practice.

The History of Critical Care Nutrition: Seventy-Five Years of Evolution.

In its infancy during the formation of the specialty of critical care medicine, the need for safe and effective nutritional therapy was recognized as a key component of the care for severely ill patients admitted to an intensive care unit. The origin of modern critical care nutrition can be traced back to the invention of total parenteral nutrition, which enabled the delivery of long-term nutritional support to critically ill adults who had insufficient absorption or access to the gastrointestinal tract. This report discusses the rationale for these innovations and summarizes the events leading up to our current state of patient management in critical care nutrition.

Short-chain fatty acids in clinical practice: where are we?

Purpose Of Review: Once considered to have only local influences on the gut mucosa, short-chain fatty acids (SCFAs) now appear to have a much wider anti-inflammatory, immune-modulating, systemic effect. This article reviews recent evidence to suggest a much wider clinical application of this valued dietary substrate.

Recent Findings: SCFAs act systemically through stimulation of G protein receptors (GPRs) and inhibition of histone deacetylases (HDACs).

What is the role of parenteral nutrition in the management of the patient with severe acute pancreatitis?

Severe acute pancreatitis often presents as a complex critical illness associated with a high rate of infectious morbidity, multiple organ failure, and in-hospital mortality. Breakdown of gut barrier defenses, dysbiosis of intestinal microbiota, and exaggerated immune responses dictate that early enteral nutrition (EN) is preferred over parenteral nutrition (PN) as the primary route of nutrition therapy. EN, however, is not feasible in all cases because of intolerance, risk of complications, or a direct contraindication to enteral feeding.

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.