Metabolic Support Of The Critically Ill Patient

Nutritional support of critically ill patients is a major treatment modality which will enhance recovery and shorten convalescence. New knowledge has emphasized that much of the organ dysfunction associated with sepsis and altered blood flow is related to oxidative injury. Specific nutrients are highly effective in counteracting these effects and their early administration may attenuate cellular damage and multi-organ failure. Patient outcome may also be enhanced by the route of feeding, administration of newer nutrient combinations, utilization of evolving methods of monitoring and the use of growth factors. This new knowledge has evolved to a new area of metabolic support which is addressed for the first time by a group of international experts. The topics presented and general conclusions are of major importance to the practitioners in this field, for they show, for the first time, a departure from the more traditional approaches of nutritional support in patients with life-threatening diseases.

HOW DO I USE THIS BOOK? This book is organized to answer specific questions about the metabolic and nutritional problems of critically ill patients. Thc questions are listed under five chapter headings in the Contents. Each question is self-contained with its own charts, tables, and references, although, in some instances, you may be referred to another section of the book for additional information. A detailed subject outline appears on the first page of each chapter, and there is an index for cross-reference to specific subjects. A metabolic support plan and accompanying metabolic and nutritional worksheet are locatcd in the Appendix. This plan pro vides the best estimates available for predicting the metabolic requirements of patients, and outlines approaches to feeding the hospitalized patient which will satisfy these nutritional needs. Clin ical cases are presented in this section to help you get started using the support plan. This volume is a handbook organized for frequent use - place the appropriate tables and nomograms on the bulletin board of the intensive care unit or in your office for convenient reference. Use the metabolic and nutritional support plan and establish the habit of assessing the metabolic requirements of your patients. Refer to the references cited to explore in further detail specific questions or areas of interest. By applying our knowledge of the metabolic and nutritional alterations which occur following disease, we can improve our care of the critically ill.

The purpose of this book is to bring together the latest findings on metabolic disorders that are strongly implicated in various critically ill patients. Since the beginning of the 20th century, maintaining the "milieu intérieur" has been a major challenge for intensivists. In addition to considerable technological developments in intensive care units, important advances in our understanding of metabolic disorders observed in critically ill patients have been made during the 10 last years. Today, the intensivit can’t ignore these disorders when selecting the most appropriate treatment for an illness. Cellular metabolic abnormalities are responsible for systems and organ failures, so the modern approach of organ dysfunctions now includes prevention or treatment of such disorders. This book is a comprehensive tool, allowing the physician to understand, diagnose and treat these metabolic disorders. Water, electrolyte, acid-base, glycemic and endocrinologic problems, as well as metabolic abnormalities observed in renal, cerebral and hepatic failure are presented in different chapters. The last part of the book is devoted to modern nutritional concepts, the consequences of energy modifications, mitochondrial dysfunction, hypothermia, oxidative stress and ischemia reperfusion, which open the way for new therapies.​

Nutrition Support for the Critically Ill Patient: A Guide to Practice provides state-of-the-art practices and key principles of nutrition support through evidence-based medicine. Following a review of the metabolic alterations that occur during critical illness, this book discusses the nutrient requirements of critically ill patients as well

The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes.

​This text provides a review of the current knowledge in both the mechanics of nourishing the critically ill and the metabolic and immunological roles nutrients play. In-depth chapters discuss disease-related malnutrition as distinct from under-or-over nourishment and the impact of nourishment in either form of malnutrition. The appropriate timing and indications for nutrition support are provided as well as advanced techniques for improving practice. A broad range of issues related to interdisciplinary practice are addressed. Useful for a wide variety of practitioners, including ICU doctors, hospitalists, and nutrition support physicians, Nutrition Support of the Critically Ill provides practical bedside advice and simplified recommendations for practice.

Completely revised and updated, Nutrition Support for the Critically Ill Patient: A Guide to Practice, Second Edition presents an unbiased, evidence-based examination of critical nutrition across the life cycle. Taking a multidisciplinary approach, each chapter has been carefully designed to provide a comprehensive review of the literature and a detailed exploration of the practical application of this information. With chapters written by experts, you get the most pertinent and current knowledge available, bolstered by tables, figures, and case studies that make the information accessible. New Coverage in the Second Edition: Gut microbiota support Short bowel syndrome Chronic critically ill phenomenon Professional nutrition practice guidelines and protocols Ethical considerations Quality and performance improvement Many challenges remain when providing optimal nutrition to all patients under all conditions at all times. Divided into eight sections, the book covers metabolic issues, nutrients for critically ill patients, delivery of nutrition therapy, nutrition therapy throughout the life cycle, special interest groups, specific organ system failure, general systemic failures, and professional issues in the field. It keeps you informed and aware of the continuous accrual of knowledge needed to craft and provide optimal nutrition therapy for the critically ill patient.

Reaching beyond traditional nutrition support The care of ICU patients has seen many improvements over the years, both with regard to technical aspects and supportive measures. The first part of this book analyzes nutritional support at various levels, ranging from the cell level to the whole-body aspect; drawing on recent prospective randomized studies, the authors propose a new approach for oral, enteral and/or parenteral nutrition. The second part underlines the interference between nutrition and outcome to reach recovery, giving to this field an increased importance for better short and long term management: The best glucose control, individualized nutritional support and the avoidance of harmful interferences is extensively discussed. The final part deals with patients suffering from multi-organ failure and the need for a better understanding of the interactions between disease and nutrition. Identification of the metabolic condition of the patient, existence or not of evidence-based medicine, expert opinion, treatment opportunities and the case manager recognizing threats are all integrated to reach the appropriate decision. This last part will help the reader to untangle the complexity of the ICU patient of the 21st century and to propose a personalized nutritional support process.