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Nutrition in chronic critical illness.

S K Pingleton1

  • 1Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA. spinglet@kumc.edu

Clinics in Chest Medicine
|April 24, 2001
PubMed
Summary

Optimizing nutrition for critically ill patients with respiratory failure involves managing starvation and hypermetabolism. Appropriate nutritional therapy can improve function and survival in these challenging cases.

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Area of Science:

  • Critical Care Medicine
  • Nutritional Science
  • Pulmonology

Background:

  • Nutritional management is crucial for patients with respiratory failure, serving as a model for chronically critically ill individuals.
  • Metabolic states of starvation and hypermetabolism significantly impact nutritional needs and treatment strategies.
  • Malnutrition in starvation can impair respiratory muscle strength, ventilatory drive, and immune function.

Purpose of the Study:

  • To outline nutritional management strategies for patients with respiratory failure, considering distinct metabolic states.
  • To emphasize the importance of adequate energy and nitrogen balance for preserving lean body mass.
  • To highlight the role of enteral nutrition and essential monitoring in optimizing patient outcomes.

Main Methods:

  • Differentiating nutritional requirements between starvation and hypermetabolic states.
  • Recommending a general substrate mix of 20% protein, 60-70% carbohydrates, and 20-30% fat.
  • Prioritizing enteral nutrition delivery unless the gastrointestinal tract is compromised.

Main Results:

  • Positive nitrogen balance is challenging to achieve in hypermetabolic states, with increased energy needs.
  • Nutritional hypercapnia is a notable complication in chronically critically ill patients.
  • Long-term outcomes for acute patients are often poor, with limited functional recovery post-discharge.

Conclusions:

  • Appropriate nutritional therapy is a key component in managing respiratory failure patients.
  • Tailoring nutritional support to metabolic states can optimize function and survival.
  • Continuous monitoring and management of complications are essential for effective nutritional intervention.

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