Nutrition Literature Summaries
summaries of key studies from the intensive care nutrition literature
Month January 2019
Nutritional Assessment in the Critically Ill
Nutritional Assessment in Critical Illness: poor nutritional state is a common feature of critically ill patients, either pre-existing or as a result of the illness
Overfeeding
In the 1980s, the concept of parenteral hyperalimentation or hypercaloric feeding was dominant. This was stopped due to the sequelae, which limit attempts to rapidly correct malnutrition. Some early studies suggesting harm from early feeding were actually showing the effects of overfeeding
Periprocedural Fasting
Periprocedural fasting is widely performed with little evidence base. NBM = nil by mouth; NPO = nil per oral
Prokinetics
Prokinetics are agents that increase gastrointestinal motility. Gastroparesis common -> increased gastric residual volumes -> GORD, aspiration risk and inability to meet nutrition targets. Theoretically, an increase in gastric motility helps in establishing target enteral feeds early in critically ill patients, which improves outcome
Refeeding Syndrome
Refeeding Syndrome = a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support.
Starvation Response
Starvation response: adaptive hypometabolic state; unlike most other species, human brains can also use ketones as fuel, so muscle (i.e. protein) can be relatively spared in favour of fat as the primary energy fuel during prolonged starvation
Substrate Metabolism – Rest versus Stress
Rest = basal metabolic rate + minimal exercise. Major stress = 50% burn. The body's goal is to preserve plasma glucose levels for brain metabolism.
John Birkett
John Birkett (1815-1904) was an English general surgeon.
Bispectral Index (BIS) Monitoring
Bispectral Index (BIS) Monitoring: BIS monitor was developed by Aspect Medical Systems; BIS = bispectral index; other 'depth of anaesthesia' monitors exist (e.g. Entropy)
Hyperbaric oxygen for carbon monoxide poisoning
Reviewed and revised 27 December 2013 OVERVIEW MECHANISM OF CARBON MONOXIDE TOXICITY Effects of CO toxicity include those of acute hypoxia as well as delayed neurological sequelae, that are more prominent with chronic exposure RATIONALE FOR HYPERBARIC OXYGEN THERAPY CO…
Isoniazid toxicity
Isoniazid toxicity, like other hydrazines, primarily cause life-threatening seizures and lactic acidosis through depletion of vitamin B6. The antidote is pyridoxine