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Nutrition and the chronically critically ill patient
Jeffrey I Mechanick1, Elise M Brett
1Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, USA. jmechanick@aol.com
Current Opinion in Clinical Nutrition and Metabolic Care
|December 9, 2004
Summary
Aggressive nutritional support is key for chronic critical illness (CCI) patients. Early assessment and tailored enteral nutrition can help these patients recover from respiratory compromise and debilitation.
Area of Science:
- Critical Care Medicine
- Nutritional Science
- Pulmonology
Background:
- Chronic critical illness (CCI) patients, stabilized but life-support dependent, have unique clinical attributes.
- This population is often undertreated due to perceived futility of aggressive therapies.
- A comprehensive metabolic and nutritional approach can improve CCI patient outcomes.
Purpose of the Study:
- To present the nutritional approach for chronic critical illness (CCI) patients.
- To highlight the role of nutrition in a comprehensive metabolic program for CCI.
- To improve survival and quality of life for CCI patients.
Main Methods:
- Review of recent theoretical and data-driven advances in CCI.
- Focus on nutritional assessment and support strategies.
- Emphasis on early intervention in the respiratory care unit (RCU).
Main Results:
- Recurrent immune-neuroendocrine axis activation may cause allostatic overload in CCI.
- Experimental studies show abrogation of perpetuating mechanisms with hypothalamic releasing factors and insulin therapy.
- Recent evidence supports aggressive nutrition support for CCI patients.
Conclusions:
- Nutritional assessment and support should begin upon RCU admission.
- Enteral nutrition (EN) with semi-elemental formulas is preferred, supplemented by parenteral nutrition if needed.
- Avoiding overfeeding, maintaining glycemic control, managing diarrhea, and addressing underlying causes are crucial for recovery.