Special commentary : a call for intensive metabolic support.

Details

Serval ID
serval:BIB_FB3C13011168
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Special commentary : a call for intensive metabolic support.
Journal
Current Opinion in Clinical Nutrition and Metabolic Care
Author(s)
Mechanick J.I., Chiolero R.
ISSN
1363-1950
Publication state
Published
Issued date
2008
Volume
11
Number
5
Pages
666-670
Language
english
Abstract
PURPOSE OF REVIEW: This special commentary addresses recent clinical reviews regarding appropriate nutrition and metabolic support in the critical care setting. RECENT FINDINGS: There are divergent approaches between North America and Europe for the use of early nutrition support and combined enteral nutrition and parenteral nutrition support possibly due to the commercial availability of specific parenteral nutrients. The advent of intensive insulin therapy has changed the landscape of metabolic support in the intensive care unit, and previous notions about infective risk of parenteral nutrition will need to be re-addressed. Patients with brain failure may benefit from an intensive insulin therapy with a blood glucose target that is higher than that used in patients without brain failure. Patients with heart failure may benefit from the addition of nutritional pharmacology that targets proximate oxidative pathophysiological pathways. Intradialytic parenteral nutrition may be viewed as another form of supplemental parenteral nutrition when enteral nutrition is insufficient in patients on hemodialysis in the intensive care unit. SUMMARY: It is proposed that intensive metabolic support be routinely implemented in the intensive care unit based on the following steps: intensive insulin therapy with an appropriate blood glucose target, nutrition risk assessment, early and if needed combined enteral nutrition and parenteral nutrition to target 20-25 kcal/kg/day and 1.2-1.5 g protein/kg/day, and nutritional and metabolic monitoring.
Keywords
Blood Glucose, Critical Care, Dialysis, Glucose Metabolism Disorders/therapy, Humans, Insulin/adverse effects, Insulin/therapeutic use, Intensive Care Units, Nutritional Support/methods, Sepsis/therapy
Pubmed
Web of science
Create date
15/10/2009 8:37
Last modification date
20/08/2019 17:26
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