Management Nutrisi ICU

8/13/2019 Management Nutrisi ICU

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http://www.chestjournal.org/cgi/content/full/115/suppl_2/145S

(Chest.1999;115:145S-14S.!" 1999#$erican %ollege of %hest &h'sicians

Nutrition Management in the ICU*

Samuel Chan, MD; Karen C. McCowen, MB and George L. Blac!urn, MD, "hD

)ro$ the *utrition Support Ser+ice, epart$ent of Surger', eth srael eaconess 0eical%enter/ar+ar 0eical School, oston, 0#.

%orresponence to: 3eorge . lac6urn, 0, &h, *utrition Support Ser+ice, ar+ar 0eical School,

7ne eaconess 8oa-est %a$pus, oston, 0# 2215; e-$ail: g6lac6ucaregroup.har+ar.eu

#!$tract

*utrition support pla's an i$portant role in the $anage$entof nutritional eficiencies in

properl' selecte criticall' illpatients. # full nutritional assess$ent allows the calculation

of appropriate feeing goals. .1&atients $ost liel' to6enefit fro$ nutritional support are those with

6aseline $alnutritionin who$ a protracte perio of star+ation woul otherwise occur. nwell-nourishe persons with short (? 1 wee! anticipateuration of nilper osstatus, it is

+er' ifficult to e$onstrate i$pro+e$entin outco$e with nutrition support.

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http://www.chestjournal.org/cgi/content/full/115/suppl_2/145Shttp://www.chestjournal.org/misc/terms.shtmlhttp://www.chestjournal.org/misc/terms.shtmlmailto:[email protected]:[email protected]://www.chestjournal.org/cgi/content/full/115/suppl_2/145S#B1%23B1http://www.chestjournal.org/cgi/content/full/115/suppl_2/145S#B1%23B1http://www.chestjournal.org/cgi/content/full/115/suppl_2/145Shttp://www.chestjournal.org/misc/terms.shtmlmailto:[email protected]://www.chestjournal.org/cgi/content/full/115/suppl_2/145S#B1%23B1


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#ssess$ent of $alnutrition in criticall' ill patients 6eginswith o6taining an' histor' of

recent, in+oluntar' weight loss(e@ceeing 5A within 1 $onth or 1A o+er B $onths!,

althoughflui o+erloa usuall' pre+ents the accurate eter$ination ofr' weight in the%>.2&h'sical e@a$ination shoul focus onsigns of proteinCcalorie eficienc' (such as

te$poralwasting!, signs of specific $icronutrient eficienc' (such asane$ia, glossitis, or

rash!, h'ration state, an ee$a. r'

weight an height are use to calculate the ieal6o' weight,the percentage of ieal 6o' weight, an the 6o' $ass ine@(0!. eal

weight can 6e calculate as follows:

0en D 1B l6 for 5 feet in height plus B l6 for each aitional inch.

o$en D 1 l6 for 5 feet in height plus 5 l6 for each aitional inch.

f an ini+iualEs fra$e is s$all, the esti$ate ieal6o' weight $a' 6e reuce 6'1A; con+ersel', for a large fra$e,1A $a' 6e ae. 0 is efine as the weight in

ilogra$si+ie 6' the s=uare of the height in $eters. *or$al 0 ranges fro$ 19 to

25. Sur+i+al at a 0 6elow 14 is +er' unusual.

#nthropo$etric ata (sinfol thicness an ar$ $uscle circu$ference!, as well ascreatinine height ine@ (the urinar' creatinine le+el accoring to height!, while useful in

a$6ulator' patients, are significantl'less accurate $easures of $alnutrition in the

criticall' illpatient, particularl' in those who ha+e flui o+erloa or renal 'sfunction.F

#l6u$in is the $ost co$$on la6orator' $easure$ent of +isceral protein status. %ontrar'to popular thining, h'poal6u$ine$iais rarel' present in cases of isolate calorie

$alnutrition.4'poal6u$ine$iais $ore co$$onl' a $arer of the s'ste$ic

infla$$ator' responsean, as such, has prognostic i$portance. t has 6een associate

with increase $or6iit' an $ortalit' a$ong hospitaliGe patients.

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#Gote$ia can 6e aggra+ate 6' a high protein loa, an thus,>* +alues L 1 $g/

$ight 6e an inication to ecreasenitrogen intae, although this is not well +aliate in

theacute illness setting. # $ore usual issue in feeing the patient with acute renal failureis that +olu$e restrictions li$it the =uantit' of feeing. n persons with chronic renal

insufficienc', .g/g/ of protein is sufficient. #nother possi6le inicationfor li$iting

protein consu$ption in . )or such patients,


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enteralfeeing is often effecti+e e+en in the presence of gastric aton' an/or colonic ileus.

)or effecti+e s$all-6owel feeing, si$ultaneousnasogastric eco$pression $a' 6e

re=uire.


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enriche for$ulas for short perios $a' 6e 6eneficial 6ecause the' i$pro+e nitrogen

6alance an lessen encephalopath',6ut their use for longer perios 6eco$es e@pensi+e

an $a' li$itprotein s'nthesis, resulting in an inae=uate nitrogen 6alance.2F

-enal

Specific renal for$ulas are usuall' low in protein or contain +aria6le

proportions of%##.


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4. 0ira, 0, Stewart, &0, MiGGar, Q, et al (19H! ioche$ical a6nor$alities in

anore@ia ner+osa an 6uli$ia.Ann Clin Biochem056"t 17,29-F5ISKI0elineK

5. 8einhart, 3), 0'cofsi, Q, ilens, , et al (19! ncience an $ortalit'of h'poal6u$ine$ic patients in hospitaliGe +eterans.JPEN J Parenter Enteral

Nutr5,F5H-F59I#6stractK

B. 3erso+itG, 0, 0unro, *, >all, Q, et al (19! #l6u$in s'nthesis in 'oung an

elerl' su6jects using a new sta6le isotope $ethoolog': response to le+el ofprotein intae.Metabolism08,1H5-1BISKI0elineK

H. oweio, Q&, *o$pleggi, Q (1991! 8ole of al6u$inin hu$an ph'siolog' an

pathoph'siolog'.JPEN J Parenter Enteral Nutr19,2H-211I#6stractK

. %erra, ), eniteG, 08, lac6urn, 3, et al (199H! #pplie nutrition in %>

patients: a consensus state$ent of the #$erican %ollege of %hest &h'sicians.

Chest111,HB9-HHI)ree )ull


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1H. ower, 8, %erra, ), ershas', , et al (1995! Narl' enteral a$inistration of

a for$ula ($pact! supple$ente with arginine, nucleoties, an fish oil in

intensi+e care unit patients: results of a $ulticenter, prospecti+e, rano$iGe,clinical trial. Crit Care Med02,4FB-449ISKI0elineK

1. 0oore, )#, 0oore, NN, Pus, P#, et al (1994! %linical 6enefits of an i$$une-enhancing iet for earl' postinjur' enteral feeing.J !rauma2,BH-B15ISK

I0elineK

19. 0ancuso, &, helan, Q, e0ichele, SQ, et al (199H! Nffects of eicosapentaenoic

an ga$$a-linolenic aci on lung per$ea6ilit' an al+eolar $acrophage

eicosanoi s'nthesis in enoto@ic rats. Crit Care Med09,52F-5F2I%ross8efKISKI0elineK

2. Seie, , P+etan, M, 3il, P0, et al (199! ranch-chain a$ino acis: their

$eta6olis$ an clinical utilit'. Crit Care Med1:,549-5H1ISKI0elineK

21. Nlia, 0 (1995! #n international perspecti+e on artificial nutritional support in the

co$$unit'."ancet259,1F45-1F49ISKI0elineK

22. Nlia, 0 (1995! %hanging concepts of nutrient re=uire$ents in isease:

i$plications for artificial nutritional support."ancet259,12H9-124I%ross8efK

ISKI0elineK

2F. ell, SQ, istrian, 8, #insle', 0, et al (1991! # che$ical score to e+aluate theprotein =ualit' of co$$ercial parenteral an enteral for$ulas: e$phasis on

for$ulas for patients with li+er failure.J Am #iet Assoc81,5B-59ISK

I0elineK
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Management Nutrisi ICU