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Nutritional interventions in critical illness.

Jeremy Powell-Tuck1

  • 1Department of Human Nutrition, The Royal London Hospital, Whitechapel, London E1 1BB, UK. j.powell_tuck@qmul.ac.uk

The Proceedings of the Nutrition Society
|March 9, 2007
PubMed
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Critical illness metabolism involves starvation and stress, impacting nutrient utilization. Nutritional support aims to save lives and speed recovery, with enteral feeding preferred and hyperglycemia control beneficial.

Area of Science:

  • Critical care medicine
  • Human metabolism
  • Nutritional science

Background:

  • Critical illness triggers a catabolic state combining starvation and stress responses.
  • Metabolic alterations include hormonal changes (cortisol, glucagon, growth hormone), oxidative stress, and altered glucose metabolism (hyperglycemia, insulin resistance).
  • Cellular responses involve the production of reactive species, inflammatory mediators, and antioxidant depletion.

Purpose of the Study:

  • To outline the metabolic characteristics of critical illness.
  • To discuss the goals and optimal strategies for nutritional support in critically ill patients.
  • To review current understanding and debates regarding specific nutritional interventions.

Main Methods:

  • Review of existing literature on critical illness metabolism and nutrition.

Related Experiment Videos

  • Analysis of hormonal, cellular, and substrate changes during critical illness.
  • Discussion of evidence regarding enteral vs. parenteral nutrition, glycemic control, and specific nutrient supplementation.

    • Main Results:

    • Critical illness is characterized by hormonal dysregulation, increased catabolism, hyperglycemia, and insulin resistance.
    • Enteral nutrition is generally preferred, but parenteral routes remain important.
    • Glycemic control and avoidance of overfeeding are crucial; growth hormone administration is detrimental.
    • Energy balance may not be essential early on, especially in overweight/obese patients.
    • Protein turnover is high, often leading to negative nitrogen balance; optimal intake is debated.
    • Amino acid supplementation (e.g., glutamine) and antioxidant therapy show potential benefits.

    Conclusions:

    • Nutritional support is vital for survival and recovery in critical illness.
    • Tailored nutritional strategies, including route, timing, and specific nutrients, are essential.
    • Further research is needed on refeding syndrome in critical illness and optimal nitrogen and antioxidant strategies.