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Nutritional Approach to Critically Ill Patients

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 September 2017) | Viewed by 42681

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Special Issue Editors

Prof. Dr. Rocco Barazzoni

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Guest Editor

Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
Interests: hormonal and nutritional regulation of energy balance, appetite and insulin action in obesity, undernutrition and aging

Prof. Dr. Enzo Nisoli

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Department of Medical Biotechnology & Translational Medicine, University of Milan, Milan 20129, Italy
Interests: nitric oxide and mitochondrial biogenesis; amino acids and metabolic health; role of cytokines in the pathogenesis of obesity and related disorders
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Pierre Singer

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Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
Interests: nutrition and metabolism in critical illness and disease, sepsis, respiratory disorders and technologies

Special Issue Information

Dear Colleagues,

We welcome the submission of manuscripts, either describing original research, or reviewing scientific literature. Manuscripts should focus on well-defined topics not conclusively defined in the literature, such as (but not limited to):

nutritional approaches to metabolically ill patients in intensive care unit
long-term effects of nutritional decisions on post-ICU syndrome
nutrition and exercise therapy in intensive care unit
molecular and mechanistic insights of nutrients in critically ill patients
food supplements in intensive care unit
intervention studies in humans

Papers covering nutrition and metabolism, or comparison between parenteral and enteral nutrition in surgical critical-care, or controversy about the value of greater nutritional intake in critically ill patients, or glucose homeostasis and nutrition during critical illness, or gut microbiome, nutrition and critical illness, biochemical markers of nutrition support in critically ill patients, or nutrition in pregnant women admitted to the intensive care unit, or design of nutrition trials in critically ill patients are welcome.

Prof. Rocco Barazzoni
Prof. Enzo Nisoli
Prof. Pierre Singer
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

obesity
diabetes
metabolic syndrome
glucose homeostasis
energy balance
intramyocellular lipids
infections
food intake
satiety
exercise
energy efficiency

Published Papers (6 papers)

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Research

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402 KiB

Open AccessArticle

Standard vs. Calorie-Dense Immune Nutrition in Haemodynamically Compromised Cardiac Patients: A Prospective Randomized Controlled Pilot Study

by Sergey Efremov, Vladimir Lomivorotov, Christian Stoppe, Anna Shilova, Vladimir Shmyrev, Michail Deryagin and Alexander Karaskov

Nutrients 2017, 9(11), 1264; https://doi.org/10.3390/nu9111264 - 20 Nov 2017

Cited by 5 | Viewed by 5087

Abstract

Background. The aim of study was to test the hypothesis that early enteral nutrition (EN) with calorie-dense and protein rich enteral formula improves enteral energy and protein delivery in critically ill cardiac patients. Methods. Prospective randomized pilot study of 40 ventilated adult patients undergoing elective cardiac surgery with use of cardiopulmonary bypass receiving inotropic support postoperatively. Patients were to receive either standard isocaloric (1000 Kcal/L and 38 g/L protein) early EN (n = 20) or calorie-dense and protein-rich (1300 Kcal/L and 66.7 g/L protein) early EN (n = 20). Results. The mean time to EN initiation was 27 ± 11 h. Early EN with the calorie-dense formula provided significantly more energy and protein enteral delivery on the 2nd, (p < 0.0001), 5th (p = 0.036), and 7th days (p = 0.024), and was associated with higher levels of prealbumin concentration on the 14th day (0.13 ± 0.01 g/L and 0.21 ± 0.1 g/L; p = 0.04) and significantly increased levels of transferrin on the 3rd, 5th, and 7th day (p < 0.05) after surgery. Conclusion. Present findings support hypothesis that early EN using a calorie-dense and protein rich formula leads to better enteral energy and protein delivery and higher levels of short-lived serum proteins. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

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758 KiB

Open AccessArticle

Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate

by Alice Sabatino, Miriam Theilla, Moran Hellerman, Pierre Singer, Umberto Maggiore, Maria Barbagallo, Giuseppe Regolisti and Enrico Fiaccadori

Nutrients 2017, 9(8), 802; https://doi.org/10.3390/nu9080802 - 26 Jul 2017

Cited by 24 | Viewed by 6884

Abstract

The optimal nutritional support in Acute Kidney Injury (AKI) still remains an open issue. The present study was aimed at evaluating the validity of conventional predictive formulas for the calculation of both energy expenditure and protein needs in critically ill patients with AKI. A prospective, multicenter, observational study was conducted on adult patients hospitalized with AKI in three different intensive care units (ICU). Nutrient needs were estimated by different methods: the Guidelines of the European Society of Parenteral and Enteral Nutrition (ESPEN) for both calories and proteins, the Harris-Benedict equation, the Penn-State and Faisy-Fagon equations for energy. Actual energy and protein needs were repeatedly measured by indirect calorimetry (IC) and protein catabolic rate (PCR) until oral nutrition start, hospital discharge or renal function recovery. Forty-two patients with AKI were enrolled, with 130 IC and 123 PCR measurements obtained over 654 days of artificial nutrition. No predictive formula was precise enough, and Bland-Altman plots wide limits of agreement for all equations highlight the potential to under- or overfeed individual patients. Conventional predictive formulas may frequently lead to incorrect energy and protein need estimation. In critically ill patients with AKI an increased risk for under- or overfeeding is likely when nutrient needs are estimated instead of measured. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

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1251 KiB

Open AccessArticle

Optimal Energy Delivery, Rather than the Implementation of a Feeding Protocol, May Benefit Clinical Outcomes in Critically Ill Patients

by Chen-Yu Wang, Chun-Te Huang, Chao-Hsiu Chen, Mei-Fen Chen, Shiu-Lan Ching and Yi-Chia Huang

Nutrients 2017, 9(5), 527; https://doi.org/10.3390/nu9050527 - 21 May 2017

Cited by 11 | Viewed by 6516

Abstract

Malnutrition is common in intensive care units (ICU), and volume based feeding protocols have been proposed to increase nutrient delivery. However, the volume based approach compared to trophic feeding has not been proven entirely successful in critically ill patients. Our study aimed to compare the clinical outcomes both before and after the implementation of the feeding protocol, and to also evaluate the effects of total energy delivery on outcomes in these patients. We retrospectively collected all patient data, one year before and after the implementation of the volume-based feeding protocol, in the ICU at Taichung Veterans General Hospital. Daily actual energy intake from enteral nutritional support was recorded from the day of ICU admission until either the 7th day of ICU stay, or the day of discharge from the ICU. The energy achievement rate (%) was calculated as: (actual energy intake/estimated energy requirement) × 100%. Two-hundred fourteen patients were enrolled before the implementation of the volume-based feeding protocol (pre-FP group), while 198 patients were enrolled after the implementation of the volume-based feeding protocol (FP group). Although patients in the FP group had significantly higher actual energy intakes and achievement rates when compared with the patients in the pre-FP group, there was no significant difference in mortality rate between the two groups. Comparing survivors and non-survivors from both groups, an energy achievement rate of less than 65% was associated with an increased mortality rate after adjusting for potential confounders (odds ratio, 1.6, 95% confidence interval, 1.01–2.47). The implementation of the feeding protocol could improve energy intake for critically ill patients, however it had no beneficial effects on reducing the ICU mortality rate. Receiving at least 65% of their energy requirements is the main key point for improving clinical outcomes in patients. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

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Review

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7 pages, 225 KiB

Open AccessFeature PaperReview

Protein Requirements in Critically Ill Older Adults

by Rachel R. Deer and Elena Volpi

Nutrients 2018, 10(3), 378; https://doi.org/10.3390/nu10030378 - 20 Mar 2018

Cited by 20 | Viewed by 6977

Abstract

Critically ill elderly patients’ nutritional needs are not well understood and vary with the phase of illness and recovery. Patients’ nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findings and highlight recommendations for protein supplementation in critically ill geriatric patients throughout the stages of recovery. Future research specifically focusing on protein dose, its relationship with caloric needs, and delivery modality must be conducted to provide more specific guidelines for clinical practice. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

763 KiB

Open AccessReview

Early or Late Feeding after ICU Admission?

by Annika Reintam Blaser and Mette M. Berger

Nutrients 2017, 9(12), 1278; https://doi.org/10.3390/nu9121278 - 23 Nov 2017

Cited by 18 | Viewed by 9866

Abstract

The feeding of critically ill patients has recently become a controversial issue, as several studies have provided unexpected and contradictory results. Earlier beliefs regarding energy requirements in critical illness—especially during the initial phase—have been challenged. In the current review, we summarize existing evidence about fasting and the impact of early vs. late feeding on the sick organism’s responses. The most important points are the non-nutritional advantages of using the intestine, and recognition that early endogenous energy production as an important player in the response must be integrated in the nutrient prescription. There is as of yet no bedside tool to monitor dynamics in metabolism and the magnitude of the endogenous energy production. Hence, an early “full-feeding strategy” exposes patients to involuntary overfeeding, due to the absence of an objective measure enabling the adjustment of the nutritional therapy. Suggestions for future research and clinical practice are proposed. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

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340 KiB

Open AccessReview

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

by Duy T. Dao, Lorenzo Anez-Bustillos, Bennet S. Cho, Zhilling Li, Mark Puder and Kathleen M. Gura

Nutrients 2017, 9(11), 1185; https://doi.org/10.3390/nu9111185 - 28 Oct 2017

Cited by 42 | Viewed by 6577

Abstract

Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance. Full article

(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)

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